Purpose: Why and how to decide whether femoral or jugular approach should be used for shunt catheterization for a successful balloon-occluded retrograde transvenous obliteration (BRTO) procedure. Materials and Methods: Sixteen patients had undergone BRTO for variceal bleeding (11 cases) and encephalopathy (5 cases) with the femoral (13) and jugular approach (5). In two patients, both femoral and jugular approaches were used. There were four failed shunt catheterizations with the femoral or jugular approach two each. In all patients, the inferior vena cava (IVC) to shunt distance (ISD) was measured on the reformatted coronal computed tomography image. Results: The IVC to shunt distance (ISD) was between 2.0 and 3.5 cm in 13 patients and >3.5 cm in five. Two patients were having both proximal gastrorenal and distal splenorenal shunts. The ISD was >3.5 cm in two patients with failed initial femoral approach and < 3.5 cm in two other patients with failed initial jugular approach. In each of the four failures, the alternative approach resulted in obtaining a successful BRTO. Conclusion: The femoral approach is recommended for catheterization of the gastrorenal shunt for BRTO when the shunt joins the renal vein within 3.5 cm from the IVC. However, when the shunt is farther than 3.5 cm from the IVC, the jugular approach is suitable for a BRTO procedure.
Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. Cryoablation therapy, which uses rapid freeze and thaw cycles to destroy diseased tissue, is the standard nephron-sparing option for RCC treatment. This case report suggests cryoablation as an effective therapy for hematuria in RCC. A 52-year-old male patient with Stage IV RCC presented to the ED with hematuria and flank pain. He was catheterized, and several blood clots were removed from the bladder. Embolization was considered, however renal angiography failed to demonstrate a tumoral blush and no target for embolization was identified. In lieu of continued large volume hematuria, cryoablation of the tumor was offered as a potential therapy. We describe a case of successful treatment of clinically significant hematuria in a patient with RCC with cryoablation.
Migraine is a common disorder with a range of available abortive and prophylactic treatments. Sphenopalatine ganglion blockade is an effective and safe option for treatment and prevention of migraine disorders. We present an instructional article for sphenopalatine ganglion blockade, including recommended patient selection, treatment procedure, and clinical follow up.
A bronchobiliary fistula (BBF) is a rare abnormal communication between the biliary tree and bronchial system. The majority of cases are the result of biliary obstruction or injury, with the major symptomatology of cough and biliptysis. The initial management of BBFs is variable but aims to decompress the biliary system allowing for diversion and passive healing of the fistula tract. Definitive management is with surgical fistulectomy. New minimally invasive therapeutic approaches utilizing endoscopic or percutaneous methodology have been described with some success. We present the successful treatment of a BBF that developed secondary to chemotherapy-induced biliary stricturing (CIBS) with a novel percutaneous embolization approach using a vascular plug and liquid embolic agent.