Fig. 2.

Cholangiographic images of a patient with irresectable PHC (Bismuth IV, histologically proven; A) treated for 5 years with systemic chemotherapy (gemcitabine & cisplatin) and repeated intraductal RFA (B) every 3 months followed by plastic stenting. The malignant hilar stricture was kept stable and open for 4 years (C). In the 5th year, we noticed a progression of the stricture (D), and 4 weeks after the last RFA procedure, arterial intrabiliary bleeding from a pseudoaneurysm of the right hepatic artery occurred (E). Although this was controlled through embolization and biliary stents (F), a further RFA was not possible anymore, and the patient finally died in April 2018 due to liver failure.