Successful Treatment of a Rare Complication in a Heart Transplant Recipient: Spontaneous Axillary Artery Bleeding.

Spontaneous atraumatic axillary artery bleeding is an unusual clinical entity. Axillary artery bleeding is associated with a high mortality rate. Vascular fragility is defined as a decrease in blood vessel resistance, and increased vascular fragility is one of the reasons for arterial bleeding.

Ultrasound-guided brachiocephalic vein catheterization in infants weighing less than five kilograms.

Purpose: To describe our experience with the use of ultrasound-guided supraclavicular brachiocephalic vein approach for central vein catheterization in infants weighing less than 5 kg.

Methods: A retrospective review was performed for infants who underwent ultrasound-guided central vein catheterization from January 2012 to November 2014. Infants weighing less than 5 kg with supraclavicular brachiocephalic vein access were included in the study.

Anatomic variations of the celiac trunk and hepatic arterial system with digital subtraction angiography.

Background/aims: Anatomical variation of the abdominal arteries is important. Historic and modern anatomists, radiologists, as well as surgeons have reported and accumulated anatomical variations with a morphological and clinical interest. During graft procurement and reconstruction, accidental injury of the hepatic artery is more likely in the presence of hepatic arterial variation, which can be a common clinical entity.

Evaluation of safety and efficacy of liver biopsy following liver transplant.

Objectives: Liver biopsy is a diagnostic tool for liver pathology after liver transplant. However, biopsy can cause life-threating complications. There is limited knowledge about efficacy and complications of liver biopsy after liver transplant.

The role of choice-lock catheter and trocar technique in percutaneous ablation of symptomatic renal cysts.

Background: The most common benign lesions of the kidney are simple cysts. They are acquired lesions and mostly affect the elderly population.

Objectives: To describe the usage of choice-lock catheter and trocar technique in percutaneous renal cyst treatment and determining long-term outcomes.

Endovascular stent placement of juxtaanastomotic stenosis in native arteriovenous fistula after unsuccessful balloon angioplasty.

Background: In hemodialysis patients, the most common problem in arteriovenous fistulas, as the best functional vascular access, is the juxtaanastomotic located lesions. Percutaneous transluminal angioplasty is accepted as the treatment method for juxtanastomotic lesions.

Objectives: To assess juxtaanastomotic stent placement after insufficient balloon angioplasty in the treatment of autogenous radiocephalic or brachiocephalic fistula dysfunction.

Devascularization of head and neck paragangliomas by direct percutaneous embolization.

Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx.

Emergency renal ablation for life-threatening hemorrhage from multiple capsular branches during renal artery stenting.

A 55-year-old woman underwent bilateral renal artery stent placement with good angiographic result. After the procedure, the patient complained of left flank pain secondary to subcapsular hematoma. Retrospective evaluation of images taken during stent implantation favored the diagnosis of guidewire perforation.

Long-term results of angioplasty and stent placement for treatment of central venous obstruction in 126 hemodialysis patients: a 10-year single-center experience.

Objective: The objective of our study was to report and compare long-term results of percutaneous transluminal angioplasty and stenting of central venous obstruction in hemodialysis patients.

Materials And Methods: Hemodialysis patients who underwent successful endovascular treatment of central venous obstruction were retrospectively evaluated. Stenotic lesions greater than 50% or inducing extremity swelling were subject to treatment.

Application of the AMPLATZER vascular plug in endovascular occlusion of dialysis accesses.

The purpose of this study was to share our initial experience with the AMPLATZER Vascular Plug (AVP) in occluding dialysis accesses. Between January 2007 and October 2008, five patients with autogenous and one patient with prosthetic accesses were referred for endovascular occlusion owing to central venous obstruction (n = 4) and dialysis-associated steal syndrome (n = 2) leading to disabling complications. We used a single AVP in two patients, double AVPs in two patients, and double AVPs and n-butyl 2-cyanoacrylate in one patient with an autogenous access.

Interventional radiology in liver transplant.

An increased number of transplant centers now actively perform deceased-donor as well as living-related liver transplants. Although postoperative vascular and nonvascular complications after liver transplant have been well documented, early diagnosis and intervention are important to increase graft and recipient survival. With improvements in interventional radiologic techniques and a multidisciplinary approach to liver transplant, management of complications by percutaneous and endovascular techniques is possible with less morbidity and mortality.

Coil embolization of a congenital intrahepatic arterioportal fistula: increasing experience in management.

Congenital intrahepatic arterioportal fistula (IAPF) is a rare condition and there is limited experience of transcatheter embolization. We report here the transcatheter coil embolization of an incidentally found, asymptomatic congenital IAPF in a 16-month-old patient. After demonstrating that the IAPF was fed by two branches of a dilated left hepatic artery and drained into an aneurysm of the left portal vein, the feeding arteries were superselectively catheterized and occluded by microcoils in a single session.

Percutaneous sonographic guidance for TIPS in Budd-Chiari syndrome: direct simultaneous puncture of the portal vein and inferior vena cava.

Objective: Budd-Chiari syndrome (BCS) is a clinical condition characterized by hepatic venous outflow obstruction. A transjugular intrahepatic portosystemic shunt (TIPS) is an effective means of decompressing the portal system in patients unresponsive to traditional medical therapy. TIPS may be difficult in patients with BCS owing to the presence of hepatic venous occlusive disease.

Treatment of an unusual complication of endovenous laser therapy: multiple small arteriovenous fistulas causing complete recanalization.

A 67-year-old woman was admitted to our institution with pain, night cramping, and visible varicose veins on her left leg. Doppler ultrasonography revealed continuous reflux in the great saphenous vein when the patient did the Valsalva maneuver. Endovenous laser therapy was applied to the great saphenous vein.

CT-guided cutting needle lung biopsy using modified coaxial technique: factors effecting risk of complications.

Purpose: We present our 7-year experience with coaxial computed tomography (CT)-guided cutting needle lung biopsy and evaluate the factors affecting risk of complications.

Material And Method: Between June 2000 and March 2007, we performed 225 CT-guided coaxial lung biopsies in 213 consecutive patients (161 men, 52 women). Lesion size, lesion depth, lesion location, needle-pleural angle, presence of pleural effusion, patient's position, and complications secondary to biopsy procedure (pneumothorax and bleeding) were noted.

Endovascular treatment of active bleeding after liver transplant.

Objectives: To evaluate the incidence of active bleeding complications following transplant and the efficacy of interventional radiologic management.

Materials And Methods: Between June 2000 and February 2007, 14 liver transplant patients with active bleeding were treated via endovascular techniques (coils, glue, or graft-covered stents). Active bleeding was spontaneous in 6 patients through the inferior epigastric artery (n=1), the inferior phrenic artery (n=1), the superior mesenteric artery (n=2), the internal mammary artery (n=1), and the hepatic artery (n=1).

Percutaneous management of anastomotic bile leaks following liver transplantation.

Purpose: To review our experience with percutaneous internal-external biliary drainage in treating biliary anastomotic leaks following orthotopic liver transplantation.

Materials And Methods: Between September 1997 and June 2006, 157 liver transplantations were performed in our hospital. Percutaneous transhepatic biliary drainage was performed in 10 patients (9 males, 1 female; mean age, 32.

Percutaneous therapy of ureteral obstructions and leak after renal transplantation: long-term results.

The purpose of this study was to evaluate the long-term outcome of percutaneous therapy of ureteral complications after renal transplantation. Between January 2000 and June 2006 we percutaneously treated 26 renal transplant patients with ureteral obstruction (n=19) and leak (n=7). Obstructions were classified as early (<2 months after transplantation) or late (>2 months).

Management of infracentimetric thyroid nodules with respect to ultrasonographic features.

An assumed indolent course of thyroid microcarcinomas and concerns about the cost-effectiveness of treatment raise management issues. As various studies have reported controversial results, management remains unclear. The purpose of this study was to examine the use of ultrasonography (US) in detecting malignancies in a series of 589 infracentimetric nodules.

Use of the rendezvous technique in the treatment of biliary anastomotic disruption in a liver transplant recipient.

In liver transplant recipients, the treatment of a biliary leak resulting from anastomotic disruption usually requires surgical intervention. However, reoperation results in significant morbidity in such patients, whose clinical status may preclude a second surgery. Restoring the integrity of a disrupted biliary anastomosis can be difficult, and in some patients with that complication, neither the percutaneous technique nor the endoscopic approach effectively stents the biliary anastomosis.

Transjugular intrahepatic portosystemic shunt creation in Budd-Chiari syndrome: percutaneous ultrasound-guided direct simultaneous puncture of the portal vein and vena cava.

Budd-Chiari syndrome (BCS) is an uncommon disorder that can be life-threatening, depending on the degree of hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) provides decompression of the congested liver but the hepatic vein obstruction makes the procedure more difficult. We describe a modified method that involved a single percutaneous puncture of the portal vein and inferior vena cava simultaneously for TIPS creation in a patient with BCS.

Budd-Chiari syndrome in a child due to a membranous web of the inferior vena cava resolved by systemic and local recombinant tissue plasminogen activator treatment.

Budd-Chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction. Although there are no guidelines for treatment of patients with Budd-Chiari syndrome, thrombolytic therapy may be useful in patients with acute Budd-Chiari syndrome. In this report, a boy with Budd-Chiari syndrome due to membranous obstruction of the inferior vena cava treated with systemic and local administration of recombinant tissue plasminogen activator is described.

Memokath metallic stent in the treatment of transplant kidney ureter stenosis or occlusion.

Purpose: To determine the efficacy of the Memokath 051 stent (Engineers and Doctors, Hornbaek, Denmark) in the treatment of recurrent ureteral stenosis or occlusion in transplant kidneys.

Methods: From October 1985 through January 2004, 1,131 renal transplantations were performed at our center. Four patients who developed recurrent renal transplant ureter obstruction had nephrostomy catheters placed.