Direct percutaneous embolization of intestinal lymphatic trunk for chylous ascites management following liver transplant.

Chylous ascites can be caused by infection, trauma, malignancy, or maybe a complication after major abdominal surgery including liver transplantation. We present a case of a patient who developed chylous ascites following his liver transplantation. He was subsequently treated with direct embolization of lymphatic trunk efferent branches with a mixture of N-butyl cyanoacrylate and lipiodol after the identification of a localized leak on a fluoroscopic lymphangiogram.

Parallel transjugular intrahepatic portosystemic shunt with Viatorr stents for primary TIPS insufficiency: Case series and review of literature.

Background: Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr) is largely lacking despite Viatorr being the current gold standard for modern TIPS placement.

Image-Guided Nephrostomy Interventions: How to Recognize, Avoid, or Get Out of Trouble.

Image-guided percutaneous nephrostomy is a relatively safe and successful procedure for access to the renal collecting system for multiple purposes including relief of urinary obstruction, urinary diversion, access for endourologic procedures, and diagnostic testing. Although placing a percutaneous nephrostomy catheter is most times straightforward, providing immediate benefit for the patient and satisfaction for the practitioner, there can be situations that make the procedure more difficult or risky. A thorough review of the patient's imaging and medical record will help to set a path for success.

Percutaneous Gastrostomy: How to Recognize, Avoid, or Get Out of Trouble.

Placement of gastrostomy tubes can be done with different techniques. The radiologic-guided tube placement relies on image guidance for safe placement of the tube. A thorough knowledge of the immediate and delayed hazards is essential.

Image-Guided Biliary Interventions: How to Recognize, Avoid, or Get Out of Trouble.

Percutaneous biliary interventions have a well-established role in the management of hepatobiliary diseases. Good outcomes include recognizing and avoiding complications. This section will cover the "standard" technique of percutaneous biliary drainage, pearls to decrease the risk of problems, and approaches to treat those complications in patients undergoing percutaneous transhepatic cholangiography and percutaneous transhepatic biliary drainage.

Interventional Oncology: Keeping Out of Trouble in Ablation Techniques.

Interventional radiologists provide an essential role in the therapy and management of cancer patients. Computed-tomography (CT) guided percutaneous procedures have enabled interventionalists to treat multiple solid organ malignancies with minimal risk, however, certain lesions may present challenges to physicians due to a difficult approach, or their close proximity to other vital structures. The following presents a brief summary of tips and tricks the interventionalist may use to provide their patients with safe and effective therapy.

Restoration of Completely Transected Common Bile Duct Continuity Using Single Operator Cholangioscopy.

Common bile duct (CBD) injury, ranging from a partial tear to a complete transection, is a major surgical complication of cholecystectomy with significant morbidity and mortality. Proper management of these complex injuries depends on the type and extent of injury and time of recognition. Identifying and repairing injuries during cholecystectomy can prevent development of complications, but this only occurs in about one-third of cases.

Gastrointestinal bleeding from supraduodenal artery with aberrant origin.

Angiography and endovascular embolization play an important role in controlling acute arterial upper gastrointestinal hemorrhage, particularly when endoscopic intervention fails to do so. In our case, the patient presented with recurrent life-threatening bleed in spite of multiple prior endoscopic interventions and gastroduodenal artery embolization. Our teaching points focus on the role of angiography in acute upper gastrointestinal bleed and when to conduct empiric embolization, while reviewing the supraduodenal artery as an atypical but important potential culprit for refractory upper gastrointestinal bleed.

Cancer stem cell marker expression alone and in combination with microvascular invasion predicts poor prognosis in patients undergoing transplantation for hepatocellular carcinoma.

Background: The cancer stem cell hypothesis provides an explanation for hepatocellular carcinoma (HCC) heterogeneity. We investigated the expression of CD44 and CD133 alone and in combination with microvascular invasion (MVI) as predictors of prognosis in patients undergoing liver transplantation for HCC.

Methods: Explanted livers from 95 patients transplanted for HCC were analyzed.

Superior mesenteric artery-duodenal fistula secondary to a gunshot wound.

Arterioenteric fistulas are a rare cause of massive gastrointestinal hemorrhage. We present a patient who developed a fistula between a middle colic artery pseudoaneurysm, a proximal branch of the superior mesenteric artery (SMA), and the third part of the duodenum 2 weeks after a self-inflicted gunshot wound to the abdomen. The patient's presentation, evaluation, treatment, and prognosis are discussed.

Congenital bronchial artery to pulmonary artery fistula presenting as hemoptysis.

A 51-year-old male presented with 2 weeks of hemoptysis. Pulmonary angiography was performed and identified a bronchial artery to pulmonary artery fistula of the right upper lobe. Despite angioembolization, the hemoptysis recurred 1 year later.

Endovascular recanalization of symptomatic portomesenteric venous obstruction after pancreaticoduodenectomy and radiation.

Intraoperative radiation therapy (RT) may improve outcomes after pancreaticoduodenectomy for periampullary cancer; however, there is a 20% risk of late portomesenteric venous obstruction. This retrospective study evaluated the percutaneous treatment of portomesenteric venous obstruction that occurred a mean of 10 months after pancreaticoduodenectomy and intraoperative RT. Five patients with medically refractory ascites and portomesenteric obstruction on computed tomographic angiography had successful recanalization with elimination of the pressure gradient and no procedural complications.

Transcatheter embolization for delayed hemorrhage caused by blunt splenic trauma.

Although the exact benefit of adjunctive splenic artery embolization (SAE) in the nonoperative management (NOM) of patients with blunt splenic trauma has been debated, the role of transcatheter embolization in delayed splenic hemorrhage is rarely addressed. The purpose of this study was to evaluate the effectiveness of SAE in the management of patients who presented at least 3 days after initial splenic trauma with delayed hemorrhage. During a 24-month period 4 patients (all male; ages 19-49 years) presented with acute onset of pain 5-70 days after blunt trauma to the left upper quadrant.