Management of single double-J stent failure in malignant ureteral obstruction: tandem ureteral stenting with less frequent stent exchange.

Purpose: To evaluate the safety and efficacy of the placement and exchange of tandem ureteral stents (TUS) under fluoroscopic guidance in the management of indwelling single double-J stent (DJS) failure in patients with malignant ureteral obstruction. We also aimed to investigate whether the generally accepted exchange period of DJSs could be extended using TUS.

Methods: This retrospective study involved 11 patients (10 female) with an age range of 27-64 years, median of 49 years, who underwent TUS (ipsilateral two 8F DJSs) placement due to indwelling single DJS failure occurring in less than 3 months.

Radioembolization Followed by Transarterial Chemoembolization in Hepatocellular Carcinoma.

Background And Objective: In recent years, combination therapies for hepatocellular carcinoma (HCC) have been increasingly used with superior treatment responses compared to monotherapies. However, the safety and efficacy of the transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) combinations for HCC patients have not been investigated in the literature. In this study, our aim was to evaluate the safety and outcomes of TACE after TARE in HCC patients.

Evaluation of staging systems to predict prognosis in hepatocellular carcinoma patients treated with radioembolization.

Purpose: To compare the prognostic accuracy of nine staging systems, some of which are well-known and some of which have only been more recently described, for patients with unresectable HCC treated with radioembolization (RE).

Materials And Methods: Individual scores or classes for the following staging systems were recorded or calculated for patients (n = 89) with unresectable HCC who underwent RE at a single tertiary care center from January 2008 to October 2016: Eastern Cooperative Oncology Group, Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, Okuda, Cancer of the Liver Italian Program (CLIP), Model for End Stage Liver Disease, Child-Pugh (CP) Categorical and Numeric, and Albumin-Bilirubin. For each staging system, a cox proportional hazards regression model was fit to the data and log-rank test statistics, concordance indices, Akaike Information Criteria (AIC) and other diagnostic statistics were calculated.

A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization.

Objective: There is no standardized and objective method for determining the optimal treatment endpoint (sub-stasis) during transarterial embolization. The objective of this study was to demonstrate the feasibility of using a quantitative digital subtraction angiography (qDSA) technique to characterize intra-procedural changes in hepatic arterial blood flow velocity in response to transarterial embolization in an in vivo porcine model.

Materials And Methods: Eight domestic swine underwent bland transarterial embolizations to partial- and sub-stasis angiographic endpoints with intraprocedural DSA acquisitions.

Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone.

Purpose: To compare transarterial chemoembolization (TACE) monotherapy to combination TACE and microwave ablation (MWA) for local control of 3- to 5-cm hepatocellular carcinoma (HCC).

Methods: Patients with HCC between 3 and 5 cm treated with TACE monotherapy or combination TACE + MWA at a single institution between 2007 and 2016 were retrospectively reviewed. Twenty-four HCCs (median diameter 3.

Complex Inferior Vena Cava Filter Retrieval Complicated by Migration of Filter Fragment into the Aorta and Subsequent Distal Embolization.

In 2005, a 48-year-old man with a spinal cord injury had an inferior vena cava filter placed for recurrent deep vein thrombosis and pulmonary embolism. He was referred for filter retrieval after a computed tomography scan demonstrated caval stenosis and 2 fractured filter arms, 1 in a pulmonary artery and 1 penetrating into the retroperitoneum and impinging on the aorta. During retrieval, 1 arm was inadvertently advanced into the aorta, and embolization of the arm occurred to the left profunda femoris artery.

Comparison of the effect of low- and iso-osmolar contrast agents on heart rate during chest CT angiography: results of a prospective randomized multicenter study.

Purpose: To prospectively compare the effect of intravenous injection of low-osmolar iopamidol with that of intravenous injection of iso-osmolar iodixanol on heart rate (HR) during nongated chest computed tomographic (CT) angiography.

Materials And Methods: This multicenter study was approved by local institutional review boards, and patients provided written informed consent. Patient enrollment and examination at centers in the United States complied with HIPAA regulations.

Percutaneous management of tumoral biliary obstruction in children.

Background: There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures.

Objective: To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children.

Materials And Methods: Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.

Palliation of malignant biliary and duodenal obstruction with combined metallic stenting.

Purpose: The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance.

Materials And Methods: A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years).

Radiofrequency ablation of unresectable hepatic tumors.

Purpose: To evaluate the efficacy and safety of radiofrequency ablation (RFA) in the treatment of primary and metastatic liver malignancies.

Materials And Methods: Twenty-nine consecutive patients who have primary (n=9) and metastatic (n=20) liver malignancies were treated with RFA. The total number of lesions were 62 at the initiation of treatment and 28 new lesions were diagnosed at the follow-up period.

Preoperative multidetector computed tomography diagnosis of a seminoma originating from an undescended testis by "testicular vascular pedicle" sign.

We report a 65-year-old man with a palpable right lower quadrant mass who underwent multidetector computed tomography (MDCT) examination. Preoperative diagnosis of seminoma was possible by demonstration of "testicular vascular pedicle" sign by MDCT. We describe CT findings of the "testicular vascular pedicle" sign in this report.

Removal of a trapped endoscopic catheter from the gallbladder via percutaneous transhepatic cholecystostomy: technical innovation.

Background: Percutaneous cholecystostomy is used for a variety of clinical problems.

Methods: Percutaneous cholecystostomy was utilized in a novel setting to resolve a problematic endoscopic situation.

Observations: Percutaneous cholecystostomy permitted successful removal of a broken and trapped endoscopic biliary catheter, in addition to helping treat cholecystitis.

Bilateral multiple pulmonary arteriovenous malformations: endovascular treatment with the Amplatzer Vascular Plug.

Pulmonary arteriovenous malformation (AVM) is a rare vascular malformation of the lung that carries a considerable risk of serious complications such as cerebral embolism, brain abscess, and pulmonary hemorrhage. Embolization with coils or detachable balloons is currently the preferred treatment. Paradoxical embolization of coils and balloons may occur, especially in patients with large feeding arteries.

Diaphragmatic mesothelial cysts in children: radiologic findings and percutaneous ethanol sclerotherapy.

Objective: We describe CT, MR, and sonography findings of diaphragmatic mesothelial cysts and the results of percutaneous treatment with ethanol. All cysts were bilobulate and showed extrahepatic location between the right liver lobe and diaphragm.

Conclusion: Radiologic findings are helpful in diagnosing diaphragmatic mesothelial cysts, which should be managed conservatively.

Percutaneous hepaticogastrostomy in a patient with complete common duct obstruction after right hepatectomy.

Complete bile duct obstruction that cannot be traversed by a guide wire can be challenging for the interventional radiologist. Although hepaticogastrostomy, which can be an alternative for such cases, has been performed under fluoroscopic and endoscopic guidance previously, this technique can be simplified by using only fluoroscopy. This technique was used in a patient who had complete common bile duct obstruction after hepatic resection.

Percutaneous management of parapneumonic effusions.

Parapneumonic effusions continue to be a significant source of morbidity and mortality. Treatment at earlier stages before fibrous peel and loculations occur has a much better prognosis. Using image guidance, addition of intracavitary fibrinolytic instillation, close follow-up with drainage of residual or new collections are some of the other factors that improve prognosis.

Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up.

Background: Simple renal cysts are rare in children and managed conservatively unless symptomatic.

Objective: To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children.

Materials And Methods: Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study.

CT of small bowel obstruction secondary to a cocaine-filled condom.

Drug smuggling is prevalent in our society. It is now frequently seen in the emergency room as an acute life-threatening emergency. The following case describes one such patient with an emphasis on the CT findings in these cases.

Clinical outcomes with airway stents for proximal versus distal malignant tracheobronchial obstructions.

Purpose: This study evaluates the outcome of tracheobronchial stent placement in symptomatic patients with malignant disease.

Materials And Methods: From 1993 to 2002, 30 patients had stents placed for malignant strictures. Five of 30 patients underwent stent placement distal to the mainstem bronchi, 13 received stents in both the proximal and distal airways, and 12 received stents in only the proximal airways.

Percutaneous retrieval of chronic intravascular foreign bodies.

To evaluate the feasibility of intravascular retrieval of chronic foreign bodies, we retrospectively reviewed an 8 year experience (1993-2001) of percutaneous retrieval of chronically retained intravascular foreign bodies (n = 6). In 6 of 6 cases (4 catheter fragments, 2 guidewires), 5-90 days elapsed before retrieval via the femoral or internal jugular vein. Under fluoroscopy, we determined the foreign body's course, position and size.

Hepatic perfusion as a predictor of mortality after transjugular intrahepatic portosystemic shunt creation in patients with refractory ascites.

Purpose: To determine whether hepatic perfusion patterns predict mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with severe ascites.

Materials And Methods: This retrospective study included 22 patients who had enhanced cine magnetic resonance (MR) imaging performed immediately before TIPS creation in the angled coronal plane including the left kidney, liver, and main portal vein. Regions of interest were centered over the liver and kidney, and perfusion curves were generated and reviewed before the standard TIPS procedure was performed.

Guglielmi detachable coil erosion into the common bile duct after embolization of iatrogenic hepatic artery pseudoaneurysm.

Intermittent hemobilia with a hepatic artery pseudoaneurysm can be seen after open or laparoscopic cholecystectomy. Transcatheter treatment of this complication is widely accepted. Although some authors suggest packing the pseudoaneurysm with coils as the treatment of choice, occluding the parent artery is the standard treatment.