TIPS is an established interventional therapy for complications of portal hypertension. Although TIPS remains a relatively safe procedure, direct procedure-related morbidity rates are as high as 20%. The technical complexity of this intervention increases the risk for methodologic mishaps during all phases of TIPS placement, including venous access and imaging, transhepatic needle puncture, shunt insertion, and variceal embolization. Thus, interventional radiologists require a thorough stepwise understanding of TIPS insertion, possible adverse sequela, and technical tips and tricks to maximize the safety of this procedure.
TAE controlled GI bleeding with high technical success, safety, and efficacy, and should be considered when endoscopic therapy is not feasible or unsuccessful.
SAE was performed with high technical success and efficacy, but the outcomes showed nontrivial morbidity rates. Elderly patients with thrombocytopenia and hydrothorax after SAE, and patients who require secondary interventions, should be monitored for complications.
Radiofrequency ablation (RFA) has become an important tool in the armamentarium of interventional oncology, particularly in the treatment of primary hepatocellular carcinoma and metastatic tumors. This procedure has proven to be an effective adjunct in treating hepatic tumors as a bridge to liver transplantation, and has a low complication profile. Although adverse events are rare and usually minor, a notable negative outcome is dissemination and implantation of viable tumor cells into the route of applicator entry, or tract seeding. Counter to the goal of treating a patient's cancer, this results in metastatic disease. In this report, the authors present 2 cases of tract seeding after RFA, methods of detection, and means of reducing the incidence of this relatively rare, but significant, complication.
Microwave ablation is a developing treatment option for unresectable lung cancer. Early experience suggests that it may have advantages over radiofrequency (RF) ablation with larger ablation zones, shorter heating times, less susceptibility to heat sink, effectiveness in charred lung, synergism with multiple applicators, no need for grounding pads, and similar survival benefit. Newer microwave ablation devices are being developed and as their use becomes more prevalent, a greater understanding of device limitations and complications are important. Herein we describe a microwave lung ablation complicated by bronchocutaneous fistula (BCF) and its treatment. BCF treatment options include close monitoring, surgical closure, percutaneous sealant injection, and endoscopic plug or sealant in those who are not surgical candidates.
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