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PURPOSEWe aimed to determine the safety and effectiveness of percutaneous endobiliary radiofrequency ablation of malignant biliary obstructions with a temperature-controlled radiofrequency ablation device.METHODSIn this single center retrospective study, a total of 62 consecutive patients with malignant biliary obstruction were evaluated. Thirty patients who underwent endobiliary radiofrequency ablation with metallic stent placement were in the study group and 32 patients who underwent only metallic stenting were in the control group. Outcomes of this study were technical success, complications related to the procedure, stent patency, and overall survival.RESULTSAll procedures were technically successful in both groups. There was no procedure-related mortality in either group. Procedural complication rates were similar between the groups. Although statistically not significant, the only two major complications (hemobilia requiring endovascular treatment) were in the control group. Median primary stent patency was significantly longer in the study group than in the control group (223 days vs. 158 days; P = 0.016). Median survival rates were also longer in the study group (246 days vs. 198 days; P = 0.004).CONCLUSIONPercutaneous endobiliary radiofrequency ablation is safe and feasible with this novel radiofrequency ablation device in patients with malignant biliary obstruction. Percutaneous endobiliary radiofrequency ablation has a potential to improve both stent patency and survival.

PURPOSEWe aimed to obtain typical values for head, neck, chest, and abdominal computed tomography (CT) examinations from routine patients in 2018, and to review our data with national and international diagnostic reference levels (DRLs).METHODSSingle-phase head, neck, chest, and abdominal CT scans of adults performed in 64-slice CT in 2018 were included in this study. Radiation dose parameters of CT scans were obtained from the picture archiving and communication system of our hospital. Volumetric CT dose index (CTDIvol) and dose length product (DLP) values were recorded. Effective dose (ED) and scan length was calculated. A 16 cm diameter phantom is referenced for head CT, and 32 cm diameter phantom is referenced for neck, chest, and abdominal CT. Descriptive statistics of the variables were given according to the normality testing.RESULTSMedian CTDIvol value was 53 mGy for the head, 13.1 mGy for the neck, 8.3 mGy for the chest, and 8.6 mGy for the abdomen. Median DLP value was 988 mGy.cm for the head, 299 mGy.cm for the neck, 314 mGy.cm for the chest, and 457 mGy.cm for the abdomen. Median ED value was 2.07 mSv for the head, 1.76 mSv for the neck, 4.4 mSv for the chest, and 6.8 mSv for the abdomen. Considering national DRLs, median CTDIvol values of head, chest, and abdomen were lower, whereas median DLP and ED values of head and chest were higher. For the abdomen, the median DLP and ED values were lower.CONCLUSIONOverall radiation dose parameters obtained in this study points out the need for optimization of head CT examinations in our institution.

Abstract Background Hepatic arterioportal fistulas are rare, abnormal, direct communications between hepatic artery and portal venous system. Treatment options shifted from surgery to endovascular interventions. Catheterization may be challenging. We report a case of a hepatic arterioportal fistula treated successfuly with Amplatzer Vascular Plug II via percutaneous transhepatic hepatic artery access after failed transfemoral approach. Case presentation 58 year old woman presented with right heart failure, kidney insufficiency and massive ascites related to portal hypertension caused by hepatic arterioportal fistula. She had a history of previous abdominal surgery. Colour Doppler ultrasound and computed tomography revealed a giant portal vein aneurysm related to large hepatic areterioportal fistula. Endovascular treatment was planned. Catheterization of the hepatic artery could not be realized due to severe tortuosity and angulation of the celiac artery and its branches. Access to the hepatic artery was obtained directly via percutaneous transhepatic route and fistula site was embolized with Amplatzer Vascular Plug II and coils. Immediate thrombosis of the aneurysm sac and draining portal vein was observed. Patients clinical status improved dramatically. Conclusion Transcatheter embolization is the first choice of the treatment of hepatic arterioportal fistulas but the type of the therapy should be tailored to the patient and interventional radiologist should decide the access site depending on his own experience if the routine endovascular access can not be obtained.