Interventional radiology‐operated percutaneous endoscopy has seen a recent resurgence with potential to return to the scope of Interventional Radiology practice. Endoscopy adds a new dimension to the Interventional Radiology armamentarium by offering a unique opportunity to diagnose and treat conditions under direct visualization with improved maneuverability. Cholecystoscopy (gallbladder endoscopy), as a method for percutaneous removal of gallstones, is an effective treatment option in patients with symptomatic cholelithiasis who are poor candidates for surgical cholecystectomy. This article presents a case of Interventional Radiology‐operated cholecystoscopy using ultrasonic lithotripsy and stone basket retrieval with an emphasis on the equipment, technique, and peri‐procedural management essential to the procedure, as well as a review of the literature.
The purpose of this study was to demonstrate the feasibility of percutaneous fluoroscopically-guided transcervical retrograde access into the thoracic duct following unsuccessful transabdominal cisterna chyli cannulation to perform thoracic duct embolization for the treatment of chylothorax. Five patients, including three (60%) women and two (40%) men, with median age of 62 years, underwent percutaneous transcervical thoracic duct access and embolization after failed transabdominal cisterna chyli cannulation for the treatment of chylothorax. In all patients, fluoroscopically-guided percutaneous transcervical retrograde access into the distal thoracic duct was achieved using a 21-gauge needle and an 0.018-inch wire. Following advancement of a microcatheter, retrograde lymphangiography was performed to identify the location of thoracic duct injury. A combination of 2:1 ethiodized oil to cyanoacrylate mixtures, platinum microcoils, or stent-grafts were used to treat the chylous leaks. Technical successes, procedure durations, fluoroscopy times, blood losses, immediate adverse events, clinical successes, and follow-up durations were recorded. Technical success was defined as cannulation of the distal thoracic duct using a transcervical approach followed by treatment of the thoracic duct injury. Adverse events were classified according to the Society of Interventional Radiology guidelines. Clinical success was defined as resolution of the presenting chylothorax. Percutaneous transcervical retrograde thoracic duct access and treatment was technically successful in all patients (n=5). Median procedure duration was 173 minutes (range: 136-347 minutes) with a median fluoroscopy time of 94.7 minutes (range: 47-125 minutes). Median blood loss was 10 mL (range: 5-20 mL). No minor or major adverse occurred. Clinical success was achieved in all patients (n=5). Median follow-up was 372 days (range:67-661 days). Percutaneous fluoroscopically-guided transcervical retrograde thoracic duct access is an effective and safe method to perform thoracic duct embolization following unsuccessful transabdominal cisterna chyli cannulation for the treatment of chylothorax.
To evaluate the effectiveness of uterine fibroid embolization (UFE) followed by planned hysteroscopic resection in the treatment of large, symptomatic submucosal fibroids. Materials: This retrospective study was approved by the Institutional Review Board at the authors' institution. Thirty patients with submucosal fibroids underwent UFE performed by two different interventional radiologists followed by hysteroscopic resection performed by three different gynecologists. Each patient received a pre-embolization pelvic MRI and 19 patients received a postembolization, pre-resection pelvic MRI. Pre-embolization fibroid size, percentage of target fibroid size at time of resection, estimated blood loss during resection, and pathologic description of the surgically resected fibroid, pre-and postoperative uterine size were evaluated, and patient symptoms were assessed by the gynecologist in follow-up appointments. Results: From August 2011 to August 2016, thirty patients with symptomatic leiomyomas were treated with bilateral UFE followed by hysteroscopic resection (median days from embolization to resection 35 days, range 21-91 days). The average uterine volume on pre-embolization MRI was 526.7 cm 3 , and all patients had a dominant submucosal fibroid with a maximum diameter of 4.4-6.0 cm. Post-embolization MRI demonstrated partial to complete necrosis of the target fibroid. In all cases, the fibroids were completely surgically resected in a single session with average blood loss less than 20 mL, and without complications. Following resection, all patients reported complete resolution of their pretreatment menorrhagia and pain at a median follow-up 118 days, mean 140 days. Conclusions: In patients with large symptomatic submucosal fibroids, UFE followed by planned hysteroscopic resection represents a potential treatment paradigm combining minimally invasive techniques with surgery to mitigate the most serious complications of either procedure performed in isolation.
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