Peritoneal Dialysis (PD) catheter insertion is traditionally performed using open surgical or laparoscopic techniques. The minimally invasive percutaneous PD catheter insertion techniques guided by fluoroscopy and ultrasound proved to provide comparable results in terms of catheter survival and dysfunction rates and lower incidence of catheter related peritonitis and leak. Percutaneous insertion by interventional radiologists offers more flexible scheduling and efficiency compared to surgical approaches that require operating room booking and general anesthesia. Here we report a step-by-step guide for percutaneous image-guided PD catheter insertion based on our institutional experience and previous best practice recommendations in the literature.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

We report a case of a 72-year-old male with a cascade of complications being diagnosed as an acute cholecystitis. The cascade includes iatrogenic pulling of coils, which were placed for treatment of right hepatic artery pseudoaneurysm, into the common bile duct (CBD) in an attempt for removal of the misplaced/migrated CBD plastic stent inserted by endoscopic retrograde cholangiopancreatography (ERCP). The case demonstrates a series of mishaps leading to a rare complication of iatrogenic migration of transarterial coil in the gastrointestinal tract. This could be the first case of coil migration as a complication of ERCP due to suboptimal stenting/removal techniques.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Stereotactic body radiation therapy (SBRT) using CyberKnife system is a relatively new radiation therapy that has demonstrated feasibility, safety, and efficacy with a high local control of various extracranial unresectable primary cancer and oligometastasis. It involves accurate delivery of very high dose of radiation to the target or tumor volume with high precision and conformity, while minimizing the radiation exposure of nontargeted tissue. Radiopaque fiducial markers (FMs) implantation in and around the tumors is required to track the selected tumor during CyberKnife SBRT, especially in those organs moving with respiration. They act as internal radiographic landmarks that maintain a fixed relationship within the tumor and with each other. Although their implantation can be technically demanding, it can be performed using various techniques with varying success; however, percutaneous implantation under image guidance by interventional radiologists is the most common method. Close collaboration between interventional radiologists and radiation oncologists with understanding of the technical aspects of CyberKnife SBRT and FMs implantation has important implications for optimal delivery of therapy and direct impact on the interventional radiology practice in selected patients proposed for CyberKnife SBRT.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Purpose: To evaluate the morbidity and efficacy of percutaneous radiofrequency ablation (RFA) performed before surgical resection for multiple residual lung metastases of germ cell tumors with negative tumor markers. Materials and Methods: This Review Board-approved retrospective study was carried out on five consecutive patients (mean age: 31 years, range: 22–41) treated successively with percutaneous RFA and surgery for multiple lung metastases of germ cell tumors. Mean number of lung metastases before treatment was 9.4. Staged procedures were performed on an average of 7.2 months (range: 1–16) after the primitive tumor resection. Results: The median clinical and imaging follow-up was 26 months (range: 24–36). Percutaneous RFA was technically feasible in one session under general anesthesia and CT guidance in all cases. On average, 2.8 tumors were ablated per patient (range: 1–6), and three of five procedures were bilateral. Three patients developed pneumothorax requiring drainage, but no severe complications were reported. Mean time between RFA and surgical resection of residual tumors was 2.5 months (range: 1–5). No local recurrences were noted, but one patient died due to metastatic evolution. Conclusion: Staged percutaneous RFA and surgical resection could be efficient with low morbidity for the management of multiple lung metastases of germ cell tumors.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

We present a case of popliteal venous aneurysm causing recurrent pulmonary embolism successfully treated by surgical resection.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

We present a case of a 33-year-old male who presented with hemoptysis for 12 days and productive cough for 6 months. Computed tomography and digital subtraction angiography showed an aberrant artery arising from the infradiaphragmatic aorta supplying the medial segment of the right lower lobe. Particle and coil arterial embolization of the aberrant artery resulted in complete resolution of hemoptysis and chronic cough at 1-year follow-up.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Bile duct stones are a known complication after a Roux-en-Y hepaticojejunostomy. Different minimally invasive stone extraction techniques, including endoscopic retrograde cholangiopancreatography with basket removal or the use of a choledocoscope through a mature T-tube tract, can be used. However, in some cases, they are unsuccessful due to complicated postsurgical anatomy or technical difficulty. In this report, we present a case where extracorporeal shockwave lithotripsy was used in conjunction with standard interventional techniques to treat bile duct stones.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]