During the past decade, laparoscopic distal pancreatectomy (LDP) has gained increasing acceptance in the surgical community as a viable treatment option for distal pancreatic lesions. However, the possible complication of post-LDP pancreatic leakage remains a challenge, because it may lead to a series of events resulting in intraperitoneal abscess formation, sepsis, pseudoaneurysm formation, and occasional fatal hemorrhage. Dealing with these complications is extremely difficult and not much experience has been reported to date. We report a case involving the aforementioned post-LDP complications successfully managed by interventional radiological techniques while avoiding reoperation. We conclude that these management options are attractive, safe and minimally invasive alternatives to standard protocols.
Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor, and overall, it is one of the most frequent cancers. The association of HCC with chronic liver disease, and cirrhosis in particular, is well known, making treatment complex and challenging. The treatment of HCC must take into account the presence and stage of chronic liver disease, with the aim of preserving hepatic function that is often already impaired, the stage of HCC and the clinical condition of the patient. The different treatment options include surgical resection, transplantation, local ablation, chemoembolization, radioembolization and molecular targeted therapies; these treatments can be combined in various ways to achieve different goals. Ideally, liver transplantation is best treatment for early stage HCC on cirrhosis because it removes both the tumor and the chronic disease that produced it; however, the application of this powerful tool is limited by the scarcity of donors. Downstaging and bridging are different strategies for the management of HCC patients who will undergo liver transplantation. Several professionals, including gastroenterologists, radiologists and surgeons, are involved in the choice of the most appropriate treatment for a single case, and a multidisciplinary approach is necessary to optimize the outcome. The purpose of this review is to provide a comprehensive description of the current treatment options for patients with HCC by analyzing the advantages, disadvantages and rationale for their use.
Aims: This study analysed quality of life (QoL), anxiety and depression, headache and stress tolerance in patients with resistant hypertension before and after renal denervation (RDN).
Purpose: The British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry was produced to provide an audit of current United Kingdom (UK) practice regarding placement and retrieval of IVC filters to address concerns regarding their safety.
OBJECTIVE. The purpose of this article is to compare the complication rate for ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy to the rate in patients with normal coagulation.
Intraperitoneal carcinomatosis (PC) may occur with several tumor entities. The prognosis of patients suffering from PC is usually poor. Present treatment depends on the cancer entity and includes systemic chemotherapy, radiation therapy, hormonal therapy and surgical resection. Only few patients may also benefit from hyperthermic intraperitoneal chemotherapy with a complete tumor remission. These therapies are often accompanied by severe systemic side-effects. One approach to reduce side effects is to target chemotherapeutic agents to the tumor with carrier devices. Promising experimental results have been achieved using drug-eluting beads (DEBs). A series of in vitro and in vitro experiments has been conducted to determine the suitability of their extravascular use. These encapsulation devices were able to harbor CYP2B1 producing cells and to shield them from the hosts immune system when injected intratumorally. In this way ifosfamide - which is transformed into its active metabolites by CYP2B1 - could be successfully targeted into pancreatic tumor growths. Furthermore DEBs can be used to target chemotherapeutics into the abdominal cavity for treatment of PC. If CYP2B1 producing cells are proven to be save for usage in man and if local toxic effects of chemotherapeutics can be controlled, DEBs will become promising tools in compartment-based anticancer treatment.
Purpose: To compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs).
OBJECTIVE. The objective of our study was to evaluate radiation dose and quantitative image quality parameters at high-pitch CT angiography (CTA) of the aorta compared with conventional CTA.
Introduction: Liver biopsy and the histologic assessment of liver parenchyma remains a key diagnostic tool in the diagnosis and care of patients with liver disease. Although noninvasive tools, such as imaging and blood tests, are available and may be able to replace histologic analysis in some cases, such as liver fibrosis, liver biopsy remains the reference standard for most diseases (1). Core biopsy is accepted as being of increased diagnostic value when compared with fine-needle aspiration cytology. For liver biopsy to be effective, a sample adequate for histologic assessment and also representative of the disease process is required, together with good patient acceptance and a low incidence of potential complications. In view of these requirements, there has been a shift in recent years from the traditional blind palpation technique of biopsy to use of image guidance or assistance to direct the biopsy. In most patients, the liver is readily amenable to ultrasonographic (US) assessment, and this modality has become the biopsy technique of choice in most patients (2–4). Computed tomography (CT) and, in some centers, magnetic resonance (MR) imaging can be used to guide percutaneous biopsy (5,6). The process of liver biopsy has been studied extensively, both prospectively and retrospectively (2,3), and guidelines for biopsy practice have been introduced in both the United Kingdom (7) and the United States (8). When looking at current national biopsy practice, however, one sees that multicenter data involving image guidance or assistance and core biopsy are relatively limited in the literature. This United Kingdom–wide audit is divided into two sections covered in two separate articles. This article aims to assess procedural aspects, diagnostic adequacy, and accuracy of liver biopsy across the United Kingdom. The second article looks at complications and procedure-related mortality associated with liver biopsy (9).
Purpose: To evaluate the correlation between packing density and the incidence of coil compaction or recanalization of visceral artery aneurysms (VAAs) after coil packing.
PURPOSE: Plasma-mediated radiofrequency ablation (coblation) creates a cavity for directed polymethylmethacrylate deposition through molecular dissociation, providing a safe and efficacious cementoplasty for patients with high-risk, painful vertebral body metastatic disease. The purpose of this study was to retrospectively review and report details regarding the feasibility, safety, and efficacy of coblation and cementoplasty for treating painful advanced vertebral body metastatic disease.
OBJECTIVE. A high-risk location—defined as the tumor margin being less than 5 mm from large vessels or vital structures—represents a well-known limitation and contraindication for radiofrequency ablation of hepatocellular carcinoma (HCC) nodules. The aim of this study was to verify whether HCC nodule location negatively affected the outcome of percutaneous laser ablation in terms of its primary effectiveness, safety, and ability to prevent local tumor progression.
Introduction: Colorectal cancer is the fourth most common malignancy worldwide. The majority of colorectal cancer–related deaths are attributed to metastatic disease (1,2). To date, the most successful treatment for hepatic metastases has been surgical resection, with 5-year survival rates of 24%–58% (3,4), compared with lower rates for chemotherapy alone (5,6) and with less than 5% survival for patients with untreated hepatic metastases (7,8). More recently, actuarial 10-year survival rates of 16%–25% with surgical resection of metastases have been reported (9–12). Unfortunately, only 8%–27% of patients are surgical candidates at the time of presentation, though surgical eligibility has increased with adjuvant techniques such as portal vein embolization and two-staged hepatectomy (13–15). Radiofrequency (RF) tumor ablation uses needlelike applicators (positioned percutaneously or laparoscopically with image guidance) to induce focal high-temperature cytotoxic heating in target tumors and has been incorporated into the treatment paradigm for a range of tumors, including primary hepatocellular carcinoma (16) and unresectable liver metastases from colorectal cancer (17–20). Advantages of ablative therapies over traditional surgical resection include potential application in a wider patient population—including those who are not surgical candidates—and an anticipated reduction in morbidity and mortality (16). However, compared with surgical series, there have been fewer studies and limited long-term follow-up reported for patients with hepatic colorectal metastases treated with RF ablation. Thus, to our knowledge, its optimal role in current treatment paradigms remains undefined (20,21). The purpose of our study was retrospectively review a relatively large series of patients treated with RF ablation for unresectable hepatic metastases from colorectal carcinoma with long-term follow-up for up to 10 years after treatment.
Aims: Renal artery denervation (RADN) is an emerging technique for the treatment of resistant hypertension (RH). However, the use of the available systems has been associated with vascular injury, resulting in vasospasm and vessel wall thrombosis. The OneShot™ System (Covidien, San Jose, CA, USA) is an irrigated radiofrequency balloon designed to reduce vessel heating and injury during RADN.
Purpose: To examine the efficacy of venous sac embolization (VSE) in comparison with transcatheter feeding artery embolization (FAE) for treatment of pulmonary arteriovenous malformations (PAVMs).
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