INTRODUCTION:Portal vein tumour thrombus (PVTT) is a common complication of hepatocellular carcinoma (HCC) and has a poor prognosis. Selective internal radiation therapy (SIRT) with Yttrium-90 (Y90) microspheres is a minimally invasive treatment option that has shown promise in treating PVTT. Studies have suggested a survival advantage of SIRT in this population, but data in the Australasian population are lacking. The aim of this study was to evaluate the safety and efficacy of SIRT in a series of patients at an Australian hospital with advanced HCC and PVTT. METHOD:All patients underwent pre-treatment imaging with MRI or CT, and immediate post-treatment imaging with Y90 PET CT and MRIs at 3-, 6-, 9- and 12-months. The primary endpoints were time to progression (TTP) and overall survival (OS) post-SIRT. The secondary endpoint was safety. RESULTS:Of the 698 patients who underwent SIRT at our institution between 2007 and 2023, 64 patients had HCC and PVTT. 59/64 (92%) were male, with a median age of 61 years (range 37-86 years). The majority of patients had Child-Pugh a cirrhosis (87%), and the majority were ECOG 0 (91%). The majority had main PVTT at the time of SIRT. All patients underwent SIRT with Y90-coated resin microspheres (SIR-Spheres, Sirtex Medical, Australia). Personalised dosimetry planning was performed by the treating interventional radiologist. SIRT was well tolerated by most patients, with major complications reported in a minority of cases (19/64 patients had an episode of biochemical decompensation within 90 days following treatment). The median TTP was 4.8 months (range 1-48 months). The median OS was 11.5 months (range 1-80 months), with those with a favourable MAAPE score having a median OS of 21.2 months (12.6-29.7 months). CONCLUSIONS:Our cohort suggests that SIRT is a safe and effective treatment option for a difficult-to-treat patient population. Our data suggest a longer OS for those with preserved liver function, good functional status and low AFP levels at 21.2 months. Poor pre-treatment liver function and functional status are predictors of decompensation, and decompensation is a predictor of poor survival. These data provide an Australasian perspective and support the expanding role of SIRT in HCC treatment guidelines. Further prospective studies with larger sample sizes and longer follow-up are warranted to confirm these findings.

INTRODUCTION:Sutton-Kadir Syndrome (SKS) describes true inferior pancreaticoduodenal artery (IPDA) aneurysms in the setting of coeliac artery (CA) stenosis or occlusion. Although rare, SKS aneurysms can rupture and cause morbidity. Due to its rarity and lack of controlled treatment data, correct treatment for the CA lesion is currently unknown. Our aim was to assess if endovascular embolisation alone was safe and effective in treatment of SKS aneurysms, in emergent and elective settings. Secondary objectives were to describe presentation and imaging findings.METHODS:A retrospective cohort study of patients treated at Sir Charles Gairdner Hospital between January 2014 and December 2021 was done. Data on presentation, diagnostics, aneurysm characteristics, CA lesion aetiology, treatment and outcomes were extracted from chart review.RESULTS:Twenty-four aneurysms in 14 patients were identified. Rupture was seen in 7/15 patients. Most aneurysms (22/24) were in the IPDA or one of its anterior or posterior branches. Median arcuate ligament (MAL) compression was identified in all. There was no difference in median (IQR) maximal transverse diameter between ruptured and non-ruptured aneurysms (6 mm (9), 12 mm (6), P = 0.18). Of ruptures, 6/7 had successful endovascular embolisation and 1/7 open surgical ligation. Of non-ruptures, 6/7 had successful endovascular embolisation, 1/7 open MAL division then endovascular CA stenting and aneurysm embolisation. No recurrences or new aneurysms were detected with computed tomography or magnetic resonance angiography over a median (IQR) follow-up period of 30 (10) months in 12 patients.CONCLUSION:Endovascular embolisation of SKS aneurysms without treatment of MAL compression is safe and effective in both the emergent and elective settings.

A 73-year-old female was transferred to our institution after presenting to a peripheral hospital with hypovolaemic shock. She was a vehicle passenger when she had a transient loss of consciousness following a single vomit. There was no history of preceding trauma. Her medical history included hypertension and hypercholesterolaemia. She was not on any anti-platelet or anticoagulant medications. She had received the first dose of the AstraZeneca COVID-19 Vaccine 17 days prior. She reported general malaise on day 7 post-vaccination and first noticed abdominal pain on day 14. At initial presentation, she was hypotensive (systolic blood pressure 70 mmHg) and tachycardic (heart rate of 100 beats per minute). Initial biochemistry demonstrated anaemia (haemoglobin 84 g/L) and thrombocytopenia (platelets 31 × 109/L). A coagulation profile demonstrated disseminated intravascular coagulation with fibrinogen 1.2 g/L, prothrombin time 14.4 s, activated partial thromboplastin time (aPTT) 25 s and d-dimer 137 mcg/mL. She had an acute kidney injury with creatinine of 160 μmol/L. She was stable on arrival to the high-dependency unit and underwent a triphasic computed tomography demonstrating enlarging peri-splenic haemoperitoneum with extensive mesenteric thrombus involving the portal vein, superior mesenteric vein and splenic vein. In addition, thrombosis of the right ovarian vein and a right-sided pulmonary embolism was seen. The spleen was non-enhancing on the portal venous phase and no contrast blush was seen (Figs 1, 2). Due to the extensive thrombosis and history of recent vaccination, vaccine-induced immune thrombocytopenia (VITT) was suspected and a haematology opinion sought. The diagnosis was confirmed by heparin/PF4 antibody enzyme-linked immunosorbent assay (ELISA) which was strongly positive with an optical density of 2.254. Her functional procoagulant platelet VITT assay was consistent with a VITT pattern (Fig. 3). She was commenced on intravenous (IV) immunoglobulin (2 g/kg split over 2 days) and IV methylprednisolone 500 mg dosing daily. Ongoing low-volume intra-abdominal bleeding was suspected due to ongoing requirement for low-dose inotropes and slow blood transfusions despite adequate resuscitation. A splenectomy was considered, but given her requirement for ongoing steroid therapy and full anticoagulation a conservative approach was trialled. She underwent interventional radiology-guided splenic artery embolization with coils, Histoacryl and lipiodol applied to the upper and lower pole arteries achieving near-complete devascularization of the spleen. Post-procedure, she was commenced on bivalirudin (short-acting direct thrombin inhibitor) to treat the extensive thrombosis and the remainder of her 8-day hospital admission was unremarkable. She completed 3 days of IV methylprednisolone with oral prednisolone step down. Her haemoglobin improved to 108 g/L, her thrombocytopenia resolved by day 4 of admission and her coagulation profile normalized by day 5. She was discharged on rivaroxaban 15 mg twice a day as a 3-week loading course followed by 20 mg once-daily therapy. Antibiotic prophylaxis with amoxicillin 250 mg once a day and splenectomy vaccinations were prescribed in line with local post-spleen embolization guidelines.1 Her full written informed consent was obtained for the case report prior to her discharge. VITT is an immune thrombosis syndrome associated with the ChAdOx1 CoV-19 vaccine (AstraZeneca, University of Oxford and Serum Institute of India). The syndrome presents within 42 days of vaccination with both arterial and venous thrombosis in unusual sites.2 VITT is caused by anti-platelet factor 4 antibodies (anti-PF4, also called CXCL4) in a similar manner to the pathophysiology of heparin-induced thrombocytopenia.3 In addition to a strongly positive anti-PF4 on either ELISA or functional testing, other features that support a diagnosis of VITT include severe thrombocytopenia, d-dimer greater than five times the upper limit of normal and a low fibrinogen. This is the first case in the literature of splenic rupture secondary to VITT. Atraumatic splenic rupture is a rare occurrence and may occur as a result of malignant haematological disorders, infections or inflammatory disorders.4, 5 Splenic rupture secondary to splanchnic vein thrombosis is thought to occur when enlargement of the spleen and increased pressure on the splenic capsule results in ischaemia and eventual necrotic dehiscence.6, 7 This case was a management dilemma, where the simultaneous need for systemic anticoagulation had to be balanced with ongoing intra-abdominal haemorrhage. We demonstrate that the problem can be safely approached with splenic embolization and short-acting anticoagulation in a highly monitored setting. Vaccination programmes are a critical pathway out of virus-related social and economic restrictions with an overwhelmingly positive impact on reducing COVID-19-related illness. Complications are very rare; however, we encourage the medical community to maintain a high index of suspicion for potential VITT complications when patients present with unusual thrombosis profiles. Daniel Magee: Conceptualization; data curation; project administration; writing – original draft; writing – review and editing. Talia Shepherd: Conceptualization; data curation; project administration; writing – original draft; writing – review and editing. Zoe Krisnadi: Writing – original draft; writing – review and editing. Ho-Cing Victor Yau: Writing – original draft. Shaun Samuelson: Methodology; validation; writing – review and editing. Dejan Radeski: Methodology; supervision; validation; writing – original draft; writing – review and editing.

Introduction The Flixene™ vascular graft (Maquet-Atrium Medical, Hudson, NH) has emerged as a new generation synthetic graft, which allows for early needling for haemodialysis. Most studies have shown satisfactory early results. The aim of this study is to report on long-term outcomes of the Flixene graft over eight years in a cohort of patients. Methods From February 2011 to September 2019, 61 patients had 64 arteriovenous graft fistulas (AVGs) by using the Flixene grafts. The median patient age was 67 years; the male to female ratio was 30:31. Diabetes was the reason for the majority of kidney failures (57%). The configuration of the grafts used was mostly upper arm straight AVG. The primary patency rate, secondary patency rate, and surgical complications were assessed. Results In a median follow-up of three years (interquartile range (IQR): 2 - 6), 36 of the AVGs required a fistulogram. Venous side stenosis was the most common cause of high venous pressure or AVG occlusion in 97%. The one-year primary patency rate was 30%. The secondary patency rate was 94.8%, 83.7%, and 77.7% at one, three, and five years, respectively. The longest functional AVG was observed for up to seven years. Conclusions This study has shown satisfactory long-term results of the Flixene graft used for hemodialysis. The Flixene graft could be needled within 72 hours without increased complications, which allows the creation of an AVG under an emergency setting to avoid the placement of a central venous catheter (CVC). This strategy should be advocated in future clinical practice.

Background: The use of directional atherectomy (DA) with or without drug -coated balloon (DCB) may be considered for the management of common femoral artery (CFA) occlusive dis- ease because of its minimally invasive nature with early mobilization, reduced incision complica- tions, and infection rates. However, it has recognized complications, which may be related to the learning curve. We present our initial experience using DA and suggest changes that may, based on our practice, improve outcomes. Methods: Retrospective analysis with a prospective data collection from 2 centers to analyze outcomes in all consecutive patients treated during 1 year (n = 25). Patients who underwent CFA DA with/without DCB for CFA 70% stenosis. Primary end points include technical success, primary patency of the CFA, morbidity, and mortality. Secondary end points include change in Rutherford -Becker class, length of stay, and target lesion revascu- larization rate. Results: Between July 2017 and December 2018, 25 patients underwent CFA DA. Two had an occluded CFA, and 23 had >70% CFA stenosis as determined by ultrasound scan (USS) and/or computed tomography angiogram (CTA) preoperatively. There were no deaths within 30 days. Procedure -related complications included 2 cases of CFA pseudoaneurysm (one of them repaired by open surgery) and 1 CFA perforation (repaired with covered stent). No distal embo- lization or limb loss occurred. Mean length of stay was 1.9 days. Primary and secondary patency at 3 and 6 months was 100%. At 12 months, it was 96%. Conclusions: Early results suggest that CFA DA with/without DCB is safe and effective. Previous CTA, focused USS, and/or intravascular USS may be useful to minimize the risk of pseudoaneurysm or perforation by excessive thinning of the media. Experience is required to prevent localized dilatation over time.

Background and Aim Yttrium-90 resin microsphere radioembolization (RE) is not recommended for routine use in intermediate or advanced hepatocellular carcinoma (HCC) by recent guidelines. This study aims to establish pre-treatment variables which predict survival in HCC patients treated with RE to identify those who will benefit most from it, and to inform patient selection for future trials. Methods Single center, retrospective study of consecutive patients with HCC treated with RE from 2007 to 2018. Patients included if undergoing their first RE treatment for intermediate or advanced HCC; a Child-Pugh score of B7 or less; and a performance status of 1 or less. Multivariable Cox regression identified variables that were significantly associated with survival. A predictive score was developed based upon coefficients from the fitted Cox regression model, and cubic spline regression was used to identify prognostic groups. Results One hundred thirteen patients with intermediate (53.1%) and advanced HCC (45.1%) followed for a median of 13.2 months were included. Variables associated with superior survival used to derive the MAAPE score were lower Model for End-Stage Liver Disease score (<= 7), lower Alpha-fetoprotein (<= 150 IU/L), higher serum Albumin (> 37 g/L), absence of Portal vein tumor thrombus, and better performance status (Eastern Cooperative Oncology Group = 0). Three survival prognostic groups were identified: good (median overall survival 25.0 months), average (15.3 months), and poor (6.3 months) (overall log-rank test, P < 0.001). Conclusion The MAAPE score accurately identifies HCC patients in whom RE is safe and effective. This will allow for optimal patient selection for future trials of RE versus systemic therapy.

BACKGROUND AND AIMS:18F-fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) is an emerging functional imaging technique in the diagnosis and management of hepatocellular carcinoma (HCC). The aim of this study was to assess the ability of a pre- and post-treatment 18F-FCH PET/CT to predict prognosis and treatment response in early-stage HCC. METHODS:Patients with early- or intermediate-stage HCC planned for locoregional therapy were prospectively enrolled. Baseline demographic and tumor information was collected and baseline and post-treatment 18F-FCH PET/CT performed. Maximum standardized uptake values (SUVmax) were determined for each HCC lesion, and the difference between baseline and post-treatment SUVmax values were compared with progression-free survival outcomes. RESULTS:A total of 29 patients with 39 confirmed HCC lesions were enrolled from a single clinical center. Patients were mostly men (89.7%) with hepatitis C or alcohol-related cirrhosis (65.5%) and early-stage disease (89.7%). Per-patient and per-lesion sensitivity of 18F-FCH PET/CT was 72.4% and 59.0%, respectively. A baseline SUVmax < 13 was associated with a superior median progression-free survival compared with an SUVmax of > 13 (17.7 vs. 5.1 months; p = 0.006). A > 45% decrease in SUVmax between baseline and post-treatment 18F-FCH PET/CT ("responders") was associated with a superior mean progression-free survival than a percentage decrease of < 45% ("non-responders," 36.1 vs. 11.6 months; p = 0.034). CONCLUSIONS:Baseline and post-treatment 18F-FCH PET/CT predicts outcomes in early-stage HCC undergoing locoregional therapy. This technique may identify patients with an objective response post-locoregional therapy who would benefit from further therapy.

Introduction: The use of Directional Atherectomy (DA) with or without anti-restenotic therapy (ART) may be considered for the management of common femoral artery (CFA) occlusive disease because of its minimally invasive nature with early mobilisation, reduced incision complications and infection rates [1-5]. However, it has recognised complications, which may be related to the learning curve. We present our initial experience using DA and suggest changes that may, based on our practice, improve outcomes. Methods: A consecutive series of patients who underwent CFA DA +/- ART for chronic limb ischemia with > 70 % CFA stenosis in two tertiary hospitals between June 2017 and December 2018 are described here. All of them had Ultrasound (USS) and /or Computerised Tomography Angiogram (CTA) before the procedure. Data were collected prospectively and retrospectively evaluated. The primary endpoints were technical success (< 50% residual stenosis in the CFA measured by USS after the procedure), primary patency of the CFA measured by USS at 1, 3, 6 and 12 months and also morbidity and mortality. Secondary endpoints were change in Rutherford-Becker class, target lesion revascularisation rate and length of stay post-procedure. Patients were selected for DA by the treating surgeon based on IFU and significant comorbidities. CFA DA was performed in isolation or in conjunction with other endovascular treatment of the iliac/ipsilateral femoral or tibial vessels Results: Between July 2017 and December 2018, 25 patients underwent CFA DA. Two had an occluded CFA and 23 had >70% CFA stenosis as determined by USS [6, 7] and CTA preop. There were no deaths within 30 days. Procedure-related complications included 2 cases of CFA pseudoaneurysm (one of them repaired by open surgery) (Figure 1 and Figure 2) and 1 CFA perforation (repaired with covered stent). No distal embolisation or limb loss occurred. The mean length of stay was: 1.96 days. The primary and secondary patency at 3 and 6 months was 100%. At 12 months it was 96%. Conclusion: Early results suggest that CFA DA ± ART is safe & effective and may be advantageous over open endarterectomy in some patients. However preoperative imaging or intravascular USS (IVUS) may be required to ensure that the device passes are in areas of highest plaque burden to avoid early complications and localised dilatation over time.Figure 2A: Pre DA. B: Post CFA DA + EIA Viabahn. C: Duplex USS 6 month later. D: 6 months later.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose

Purpose: To examine the efficacy, safety, and procedural costs of percutaneous aspiration thrombectomy (PAT) as a first-line treatment for noniatrogenic acute lower limb ischemia (ALI) compared with conventional catheter-directed thrombolysis (CDT). Materials and Methods: All patients who underwent endovascular intervention for ALI from January 2015 to August 2017 were included. Fifteen patients were treated with the use of primary PAT and 27 patients were treated with the use of primary CDT. The primary end point was complete thrombus clearance with improvement in Thrombolysis in Myocardial Infarction (TIMI) score. Adjunctive treatment for thrombus removal was considered to indicate technical failure. Treatment of underlying chronic disease was not considered to indicate technical failure. Procedural costs for each patient were calculated by itemizing all disposable equipment, facility overheads, and staff costs. Results: Of the 15 primary PAT patients, technical success was achieved in 8 (53%); the remaining 7 (47%) required adjunctive CDT. Of the 27 primary CDT patients, technical success was achieved in 25 (89%); the remaining 2 (11%) required adjunctive PAT. There were 4 complications in the primary PAT group: 2 were procedure related and of a minor grade. There were 8 complications in the primary CDT group: All were procedure-related, including 2 major groin/retroperitoneal hemorrhage and 1 death from intracranial hemorrhage. Limb salvage was attained in all patients. There were no significant differences in average procedural costs per patient between the 2 groups. Conclusions: First-line use of PAT for endovascular treatment of ALI can reduce the need for CDT, with no significant cost difference.

This report presents 3 procedures with visceral “chimney stenting” in conjunction with an endovascular aneurysm sealing (EVAS) device, known as chEVAS, for treatment of type 1a endoleak. It includes the first published chEVAS in a patient with previous fenestrated endovascular aneurysm repair (FEVAR). Cases include an 80-year-old man 8 years after FEVAR for a juxtarenal abdominal aortic aneurysm (AAA); an 85-year-old woman 9 months after endovascular aneurysm repair (EVAR) for a ruptured infrarenal AAA; and an 84-year-old woman 3 months after EVAR for a symptomatic infrarenal AAA. Technical success was achieved in all cases, with 1 postoperative death. The remaining 2 patients had no residual type 1a endoleak at 10 and 14 months respectively.

AIMS:Ultrasound surveillance for hepatocellular carcinoma (HCC) is recommended in cirrhotic patients to allow early diagnosis. This study investigated risk factors for nonsurveillance and advanced HCC at diagnosis and their effect on survival.MATERIALS AND METHODS:Two hundred seventy HCC patients were included. Clinical data were collected from hospital databases.RESULTS:One hundred twenty-eight (47.1%) patients had 6-monthly ultrasound surveillance before HCC diagnosis. Ninety-two (34.1%) patients had advanced HCC (multifocal or total diameter ≥6 cm) at diagnosis. The nonsurveillance rate was significantly higher in nonalcoholic fatty liver disease (NAFLD) (79%) compared with other causes of chronic liver disease (31.6% to 58.1%, P<0.001). Nonrecognition of NAFLD was significantly higher (68.4%) compared with other causes of chronic liver disease (0% to 23.2%, P<0.001). In NAFLD HCC patients, 23.7% were noncirrhotic and smoking was significantly associated HCC in this noncirrhotic group (P=0.041). No-surveillance for HCC was significantly associated with advanced HCC at diagnosis with an odds ratio (OR) of 8.1. Compared with nondrinkers, heavy alcohol consumption was significantly associated with advanced HCC (OR=7.6). In the surveillance group, diagnosis using computed tomography rather than magnetic resonance imaging was significantly associated with advanced HCC (OR=3.36). Patients without HCC surveillance had a significantly shorter median survival compared with those who had HCC surveillance (27.4 vs. 52.0 mo, P=0.0006).CONCLUSIONS:The lack of HCC surveillance is associated with advanced HCC at diagnosis and decreased survival. NAFLD patients with HCC have a significantly lower rate of diagnosis of chronic liver disease and HCC surveillance compared with the other causes of chronic liver disease.

The Hong Kong Liver Cancer (HKLC) system proposes to triage hepatocellular carcinoma (HCC) patients to more aggressive treatment and may be associated with superior survival compared with the Barcelona Clinic Liver Cancer (BCLC) system. We aimed to identify the influence of adherence to HKLC or BCLC treatment recommendations on survival and time to progression.

Internal Medicine JournalVolume 47, Issue 4 p. 470-471 Letter to the Editor Plug-assisted retrograde transvenous obliteration of splenorenal shunts for refractory hepatic encephalopathy Tiffany Khoo, Tiffany Khoo orcid.org/0000-0003-2654-843X Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorGary Jeffrey, Gary Jeffrey Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorGeorge Garas, George Garas Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorGerald MacQuillan, Gerald MacQuillan Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorLeon Adams, Leon Adams Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorShaun Samuelson, Shaun Samuelson Department of Interventional Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this author Tiffany Khoo, Tiffany Khoo orcid.org/0000-0003-2654-843X Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorGary Jeffrey, Gary Jeffrey Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorGeorge Garas, George Garas Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorGerald MacQuillan, Gerald MacQuillan Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorLeon Adams, Leon Adams Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorShaun Samuelson, Shaun Samuelson Department of Interventional Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, AustraliaSearch for more papers by this author First published: 11 April 2017 https://doi.org/10.1111/imj.13395Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume47, Issue4April 2017Pages 470-471 RelatedInformation

Background/Aims: A review of the effectiveness and outcomes in liver abscess drainage performed by different operators using percutaneous aspiration (PA) and catheter drainage (PCD), respectively, from 2008-2013 at Sir Charles Gairdner Hospital, a tertiary hospital in Australia.Methods: Forty-two patients (29 males and 13 females; aged between 28-93 years; median age of 67 years) with liver abscesses underwent either ultrasound or CT-guided PA (n=22) and PCD (n=20) in conjunction with appropriate antimicrobial therapy. A median of 18 Gauge needle and 10 French catheters were utilised.Results: Nineteen (86.4 per cent) PA cases and 12 (60 per cent) PCD cases were successfully drained on a single attempt (p=0.08). More male patients (69 per cent) than females (31 per cent) were observed. Portal sepsis (42.9 per cent) was the most common cause identified. Fever (47.6 per cent) was the most frequent clinical presentation on admission. Thirty-two patients (76.2 per cent) had solitary abscesses with a right lobe (59.5 per cent) predilection. CRP was significantly raised. The PCD group observed a significantly larger abscess size (p=0.01). Klebsiella pneumoniae was the most common organism isolated in both pus (33.3 per cent) and blood cultures (11.9 per cent). Five procedure-related complications were noted, all in the PCD group. Thirty-day mortality was 2.4 per cent. No difference was observed in clinical and treatment outcomes in both groups.Conclusion: The null hypothesis that both PA and PCD are equally effective in the drainage of liver abscess cannot be rejected. Apart from PA being simpler and safer to perform, the higher incidence of indwelling catheter-associated complications suggests that a trial of PA should always be attempted first.