Large-bore Aspiration for Percutaneous Drainage of a Complex Liver Abscess

Abstract Liver abscesses require tailored management based on etiology, comorbidities, and complexity. While conventional treatment involves antibiotics and image-guided percutaneous drainage, refractory cases may need more advanced interventions. This report describes using a 20 Fr large-bore aspiration device (LBAD), typically used for pulmonary embolism, to manage a complex liver abscess in a 43-year-old male. After failing multiple drain exchanges and long-term antibiotics, the LBAD catheter was used under fluoroscopic guidance to aspirate 250–300 mL of necrotic debris, followed by the placement of a 20 Fr drain. The patient showed marked improvement, with normalization of inflammatory markers by week 7 and near-complete resolution of the abscess, enabling a successful multivisceral transplant. This case highlights the potential for repurposing thrombectomy devices for refractory liver abscesses and highlights the need for further studies on their efficacy, safety, and cost-effectiveness in hepatobiliary care.