Incidence of cholangitis and sepsis associated with percutaneous transhepatic biliary drain cholangiography and exchange: a comparison between liver transplant and native liver patients.

Objective: The purpose of our study was to determine the rate of sepsis and cholangitis associated with percutaneous biliary drain cholangiography and subsequent drain exchanges and to compare the incidence of these complications between patients with liver transplants and those with native livers.

Materials And Methods: A retrospective review of 154 consecutive patients (100 with liver transplants and 54 with native livers) who underwent a total of 910 percutaneous biliary drain cholangiography examinations and exchanges (January 2005 to July 2008) was performed. Cholangitis was defined as fever (> 38.

Replacement of inadvertently discontinued tunneled jugular high-flow central catheters with tract recannulation: technical results and outcome.

Purpose: To determine the technical and clinical outcomes of recannulating the tracts of inadvertently discontinued high-flow tunneled internal jugular central venous catheters.

Materials And Methods: Retrospective review was performed of 49 patients who underwent 57 replacements of inadvertently discontinued catheters by recannulation from January 1997 through January 2005. The study group was divided into successful and failed recannulation groups.

Pulmonary arterial coil embolization for the management of persistent type I hepatopulmonary syndrome after liver transplantation.

Hepatopulmonary syndrome (HPS) is a common complication of chronic liver disease. The definitive therapy is liver transplantation. Medical management, transjugular intrahepatic portosystemic shunt creation, and pulmonary arterial coil embolization have been described as temporizing measures until liver transplantation is performed.

Endovascular repair of a traumatic aortic transection in a pediatric patient.

Traumatic aortic rupture due to blunt trauma in the pediatric population is rare. The management of this unusual injury has largely been extrapolated from the adult literature and is evolving. Open surgical repair is the accepted treatment; however, endograft repair is a promising alternative, which can serve as a definitive or bridging technique in select patients who are high-risk surgical candidates.

Catheter thrombolysis of thrombosed hepatic arteries in liver transplant recipients: predictors of success and role of thrombolysis.

Hepatic artery thrombosis is an uncommon complication of liver transplantation. However, it is a major indication for re-transplantation. The use of transcatheter thrombolysis and subsequent surgical revascularization as a graft salvage procedure is discussed.

Elective transjugular intrahepatic portosystemic shunt creation for portal decompression in the immediate pretransplantation period in adult living related liver transplant recipient candidates: preliminary results.

Purpose: To evaluate (i) the efficacy of purposeful creation of transjugular intrahepatic portosystemic shunts (TIPS) before transplantation to optimize potential living related liver transplantation (LRLTx) and (ii) the efficacy of TIPS creation in this setting in reducing perioperative resource utilization.

Materials And Methods: Retrospective review was performed of the records of patients who underwent adult LRLTx with or without preoperative TIPS creation from October 2003 through April 2005. Patients were evaluated for preoperative parameters (Child-Pugh class, Model for End-stage Liver Disease score, Acute Physiology and Chronic Health Evaluation [APACHE] II score, and coagulation parameters), intraoperative parameters (blood transfusion requirements and operative time), and postoperative parameters (intensive care unit stay, hospital stay, and 30-day repeat operation and mortality rates).

Transhepatic dilation of anastomotic biliary strictures in liver transplant recipients with use of a combined cutting and conventional balloon protocol: technical safety and efficacy.

Purpose: To determine the safety and technical efficacy of a transhepatic dilation protocol involving the use of a combined cutting and conventional balloon protocol in the management of anastomotic biliary strictures in adult liver transplant recipients.

Materials And Methods: Retrospective review of adult transplant recipients undergoing transhepatic cutting balloon dilation for anastomotic biliary strictures was performed over a period of 8 months. Cutting balloon dilation was followed by conventional balloon dilation with use of a balloon with a diameter at least as large as that of the initial cutting balloon.

Pseudoaneurysms and the role of minimally invasive techniques in their management.

Pseudoaneurysms are common vascular abnormalities that represent a disruption in arterial wall continuity. Some complications associated with pseudoaneurysms develop unpredictably and carry high morbidity and mortality rates. The advent of new radiologic techniques with a greater sensitivity for asymptomatic disease has allowed more frequent diagnosis of pseudoaneurysms.

Transhepatic balloon dilation of anastomotic biliary strictures in liver transplant recipients: the significance of a patent hepatic artery.

Purpose: To determine the significance of hepatic artery steno-occlusive disease on the patency of anastomotic biliary strictures in liver transplant recipients after transhepatic balloon dilation.

Materials And Methods: A retrospective review of records of all patients undergoing transhepatic balloon dilation for anastomotic biliary strictures after orthotopic liver transplantation was performed over an 8-year period. Patency of the anastomosis was based on subsequent cholangiography.