Background:Transcatheter arterial chemoembolisation (TACE) is the treatment of choice for intermediate stage hepatocellular carcinoma (HCC). Doxorubicin-loaded drug-eluting beads (DEB)-TACE is expected to improve the performance of conventional TACE (cTACE). The aim of this study was to compare DEB-TACE with cTACE in terms of time-to-tumour progression (TTP), adverse events (AEs), and 2-year survival.Methods:Patients were randomised one-to-one to undergo cTACE or DEB-TACE and followed-up for at least 2 years or until death. Transcatheter arterial chemoembolisation was repeated ‘on-demand'.Results:We enrolled 177 patients: 89 underwent DEB-TACE and 88 cTACE. The median number of procedures was 2 in each arm, and the in-hospital stay was 3 and 4 days, respectively (P=0.323). No differences were found in local and overall tumour response. The median TTP was 9 months in both arms. The AE incidence and severity did not differ between the arms, except for post-procedural pain, more frequent and severe after cTACE (P<0.001). The 1- and 2-year survival rates were 86.2% and 56.8% after DEB-TACE and 83.5% and 55.4% after cTACE (P=0.949). Eastern Cooperative Oncology Group (ECOG), serum albumin, and tumour number independently predicted survival (P<0.05).Conclusions:The DEB-TACE and the cTACE are equally effective and safe, with the only advantage of DEB-TACE being less post-procedural abdominal pain.

Biliary leaks complicating hepaticojejunostomy (HJA) or fistulas from cut surface are severe complications after liver transplantation (LT) and split-liver transplantation (SLT). The aim of the study was to describe our experience about the safety and efficacy of radiological percutaneous treatment without dilatation of intrahepatic biliary ducts. From 1990 to 2006, 1595 LTs in 1463 patients were performed in our center. In 1199 LTs (75.2%), a duct-to-duct anastomosis was performed, and in 396 (24.8%), an HJA was performed. One hundred twenty-nine anastomotic or cut-surface bile leakages occurred in 115 patients. Sixty-two biliary leaks occurred in 54 patients with HJA; in 48 cases, an anastomotic fistula was found. Cut-surface fistulas occurred in 14 cases: 5 in right SLTs and 5 in left SLTs. Twenty-two patients were treated with 23 percutaneous approaches for 17 HJA fistulas and 6 cut-surface leaks without intrahepatic bile duct dilatation. Two percutaneous therapeutic approaches were used: percutaneous transhepatic biliary drainage (PTBD) for fistula alone and PTBD with percutaneous drainage of biliary collection in patients with both complications. PTBD was successful in 21 cases (91.3%); the median delay from catheter insertion and leak resolution was 10.3 days (range: 7-41). The median maintenance of drainage was 14.8 days. In 1 patient, fistula recurrence after PTBD needed a surgical approach; after that, an anastomotic fistula was still found, and a new PTBD was successfully performed. In another patient, PTBD was immediately followed by retransplantation for portal vein thrombosis. There were no complications related to the interventional procedure. In conclusion, biliary fistulas after HJA in LT or after SLT can be successfully treated by PTBD. The absence of enlarged intrahepatic biliary ducts should not be a contraindication for percutaneous treatment. Liver Transpl 14:611-615, 2008. © 2008 AASLD. Received June 26, 2007 accepted October 31, 2007. Biliary complications after liver transplantation (LT) have an incidence of 10% to 30% 1 ; reduced-size LT, split-liver transplantation (SLT), and living-donor LT are associated with increased rates of biliary complications.2 A lower rate of complications directly related to hepaticojejunostomy (HJA) versus duct-to-duct anastomosis has been described.3-5 Surgical repair and endoscopic management have been reported to successfully treat post-LT biliary fistulas from duct-to-duct anastomosis, but when the biliary leaks complicate HJA or they rise from the cut surface of the liver, an endoscopic approach is not possible. The aim of this study was to evaluate the safety and efficacy of percutaneous treatment of post-LT biliary leakages occurring in HJA or in split-liver recipients in the absence of biliary tree dilatation. PATIENTS AND METHODSFrom 1990 to 2006, 1595 LTs in 1463 patients were performed in our center; in 1199 LTs (75%), a duct-toAbbreviations: HLA, hepaticojejunostomy; LT, liver transplantation; PTBD, percutaneous transhepatic biliary drainag...

A classification by gravity and frequency attests post-TIPS HE as a manageable risk. Monitoring of bilirubin and INR may help on clinical management risk stratification.

The technical success of TIPS may not lead to haemodynamic and clinical success. Complications are often due to impaired coagulation and inadequacy of the stent-graft. Early mortality is only influenced by pre-existing clinical and laboratory factors.

A patient required lead extraction of a dual chamber implantable cardioverter defibrillator system for a chronic pocket infection. Using a right subclavian approach, the right ventricular leads were removed by dilation/counter traction. During the procedure, the tip of the atrial lead was cut and, while the body of the lead was extracted, the tip embolized into a distal branch of the right pulmonary artery. Despite its distal location, we were able to extract the lead tip by an Amplatz goose neck snare kit for intravascular foreign body retrieval, commonly used by interventional radiologists, in cooperation with our radiology staff.