Percutaneous transhepatic cholangioscopy-guided lithotripsy and retrieval of vascular coils eroded into the biliary tree

Endovascular coil erosion into the biliary system after hepatic artery embolization is a rare complication which may result in inflammation, strictures, choledocholithiasis, biliary colic, and cholangitis. Removal of coils may result in cessation of these symptoms, but is challenging in patients who cannot undergo removal via standard endoscopic approaches. This case report describes the retrieval of coils placed across a hepatic artery pseudoaneurysm, which over several years eroded into the biliary tree, resulting in calculi formation and post-prandial pain. Using combined fluoroscopy and cholangioscopy via percutaneous transhepatic accesses, the calculi were fragmented and the coils were retrieved, resulting in cessation of symptoms.