S. Moawad

Outcomes of fluoroscopic and ultrasound-guided placement versus laparoscopic placement of peritoneal dialysis catheters

Abstract Background Several peritoneal dialysis catheter (PDC) placement techniques have been described. The objective of this study was to compare the fluoroscopy and ultrasound guidance technique with the laparoscopic technique. Methods We retrospectively reviewed the medical records of 260 patients who had their first PDC placed between January 2005 and June 2016. We compared the outcomes of the fluoroscopic and ultrasound-guided catheter placement technique (radiologic group, n = 50) with the laparoscopic catheter placement technique (laparoscopic group, n = 190). The primary endpoint was complication-free catheter survival at 365 days. Secondary endpoints were complication-free catheter survival at 90 days, overall catheter survival at 90 and 365 days, median days to first complication and median days to catheter removal. Results In the radiologic group, the complication-free catheter survival at 90 and 365 days was 64% and 48%, respectively, while in the laparoscopic group it was 71% (P = 0.374) and 53% (P = 0.494), respectively. Catheter malfunction was significantly higher in the laparoscopic group (30%) compared with the radiologic group (16%, P = 0.048). The overall catheter survival at 90 and 365 days was 76% and 52%, respectively, in the radiologic group, while in the laparoscopic group it was 88% (P = 0.0514) an 48% (P = 0.652), respectively. There was no significant difference in the median days to first complication and the median days to catheter removal between the two groups (P = 0.71). Conclusion The technique of fluoroscopic and ultrasound-guided PDC placement is a clinically effective and safe alternative to laparoscopic catheter placement with similar survival and complication rates.

Approaches for safe transarterial chemoembolization of multifocal hepatocellular carcinoma with retrograde flow in a retroportal artery

We report a case of an 81-year-old woman with multifocal hepatocellular carcinoma who underwent transarterial chemoembolization. The patient had significant superior mesenteric artery (SMA) ostial stenosis, which led to retrograde flow in the retroportal artery to the SMA. The authors adopted several approaches to avoid potential nontarget embolization that might result from the change in the hemodynamics in the hepatoenteric arteries by initially stenting the SMA ostial stenosis as well as the use of the Surefire infusion system and balloon occlusion for delivery of chemoembolization material to tumors in the hepatic lobes. To our knowledge, the collective use of these approaches to avoid potential risks related to SMA ostial stenosis and retrograde flow in a retroportal artery has not been previously described in the literature.

Embolization of congenital intercostobronchial trunk-pulmonary artery fistula using Amplatzer vascular plugs

We present the case of a 54-year-old male patient diagnosed with a right upper lobe lung cancer and was referred for resection. Positron emission tomography-computed tomography scan showed a prominent vascular structure in the right lung, suspicious for vascular malformation. A computed tomography angiography was done, demonstrating an intercostobronchial trunk-pulmonary artery fistula. There was also non-tapering dilated wandering pulmonary artery coursing through the right lower lung without any abnormal connection with pulmonary veins and were supplying normal lung parenchyma. Amplatzer vascular plugs were used for the treatment of the intercostobronchial trunk-pulmonary artery fistula. Our case highlights these very rare vascular anomalies, and their management.

Percutaneous embolization of cystic duct stump leak following failed endoscopic management

A case of a 79-year-old man, status post laparoscopic cholecystectomy with a drainage catheter placed at the gallbladder fossa is presented. The case was complicated postoperatively by abdominal pain and bilious discharge from the drainage catheter. Endoscopic retrograde cholangio-pancreatography demonstrated leakage through the cystic duct stump into the gallbladder fossa. Placement of a covered metal stent endoscopically failed to seal the leak. We performed percutaneous embolization of the cystic duct stump using a combination of coils and gelatin sponge through the drainage catheter in the gallbladder fossa. To our knowledge, this technique has not been previously described in the literature.

Percutaneous Treatment of Iatrogenic and Traumatic Injury of the Biliary System

Purpose of ReviewTraumatic or iatrogenic bile duct injury (BDI) includes bile leaks, benign stenoses, and fistulae. These complications result in significant morbidity and mortality. This review will provide insight into the presentation, diagnosis, classification, and percutaneous management of BDI.Recent FindingsPrompt diagnosis through non-invasive imaging and minimally invasive procedures is paramount to improved patient outcomes. Numerous classifications of BDI exist, although none are universally accepted. Percutaneous approaches to the management of BDI offer a minimally invasive alternative to traditional surgery. Bile leaks are primarily treated with drainage and decompression; however, adjunctive techniques such as embolization are also presented. Fistulae are routinely treated with embolization even though limited literature exists to provide a consensus treatment algorithm. Benign stenosis is primarily treated with balloon dilation with long-term biliary intubation while placement of bile duct stents is often reserved for patients with recurrent stricture.SummaryIatrogenic or traumatic BDI typically requires a multidisciplinary team approach, although prompt diagnosis and advances in therapeutic approaches have improved patient outcomes.

Persistent Pulmonary Arteriovenous Malformations: Percutaneous Embolotherapy

Pulmonary arteriovenous malformations (PAVM) are an uncommon entity that interventional radiologists may face in their clinical practice. Many of these lesions are treated successfully using endovascular techniques with satisfactory long-term results. However, some PAVMs respond poorly to initial interventional techniques. This article reviews the signs and symptoms of persistent PAVMs, illustrates different imaging modalities used to diagnose these lesions, and outlines mechanisms by which these lesions may persist. The article highlights techniques and embolic agents used for percutaneous transcatheter embolotherapy of persistent PAVMs and discuss the outcomes of these interventions.