American Journal of Interventional Radiology

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Authors: Ravi Kagali

We present a case of an 81-year-old female diagnosed with metastatic carcinosarcoma from a primary peritoneal Müllerian malignancy after endovascular biopsy of a large mass within her left renal vein extending into the inferior vena cava (IVC) after workup for increasing back and abdominal pain over one and a half months. Biopsy of the mass was performed with digital subtraction angiography using a combination of transjugular liver biopsy set as well as suction aspiration. We propose that suction aspiration of an intravascular mass is a safe and efficacious procedure to obtain accurate diagnosis.

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Authors: Nischal G Kundaragi

We describe the third case of successful transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites due to cirrhosis in a known case of situs inversus totalis.

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Authors: Jesse Chen

Suprapubic catheter placement is a common method of bladder diversion. To date, there are limited reports describing safe placement of large-bore (18–28 F) catheters as smaller catheters often clog and require upsizing procedures. We retrospectively evaluate the image-guided percutaneous placement of large-bore catheters by interventional radiologists in our institution, totaling 51 catheters in 51 patients over 5 years. We successfully placed a large-bore catheter in 96% (49/51) of first attempts with no post procedural complications. This data demonstrates that percutaneous placement of large-bore suprapubic catheters by interventional radiologists is a safe and less-invasive bladder diversion alternative to traditional blind or open surgical techniques.

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Authors: Shiraz Rahim

This article outlines a case performed at our instutition that involved direct sharp recanalization of the superior vena cava (SVC) as a way to bypass chronic venous thrombus using a combination of ultrasound and CT guidance. The case is of a patient requiring a Denver shunt for chronic chylous ascites. His prior shunts placed in the right internal jugular and subclavian veins became thrombosed repeatedly. His left subclavian vein was resected with subsequent occlusion of the graft. The brachiocephalic vein was narrowed likely after his mediastinal lymph node dissection. Revision of the Denver shunt could therefore only be done by directly cannulating into the proximal SVC away from the thrombosed right internal jugular vein. This case outlines the use of CT as an adjunct to standard ultrasound or fluoroscopic guided sharp needle recanalization which has not previously been described in the literature and offers clinicians an additional tool to help treat long-segment thrombus and preserve important vessels for venous access.

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Authors: James Ryan Loftus

The transdiscal approach has been described for nerve block and neurolysis of the hypogastric and celiac plexuses for chronic pain relief; however reports utilizing transdiscal approach for biopsy of aortocaval lymph nodes or other retroperitoneal masses are scarce. Traditional posterior paravertebral, lateral, or anterior approaches are often not technically feasible for core biopsy of aortocaval lesions due overlying bowel, organs, or vessels. In aortocaval or other retroperitoneal lesions inaccessible by traditional techniques the transdiscal method is invaluable in providing a linear approach that avoids the major vessels, organs, and bowel and allows for core biopsy. This case report demonstrates the use of transdiscal approach for core biopsy of aortocaval lesions otherwise inaccessible by traditional approaches