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Background: Thoracic duct injury is a rare complication of head and neck surgery. Thoracic duct embolization (TDE) has been proposed to manage postoperative chyle leaks. Methods: Twelve patients who underwent lymphangiography for a chyle leak after head and neck surgery (M:F = 5:7, mean 55 years) were retrospectively reviewed. Lymphangiographic findings, technical success, complications, and clinical outcomes were analyzed. Results: Chyle leak was identified and TDE attempted in 11 of 12 patients. Three patients required repeat TDE. Technical success of TDE was 86% (12/14). Clinical success for patients with technically successful TDE was 90% (9/10). Median time until drain removal was 2.1 days in nine patients with clinical success. Two major complications were encountered, chylothorax after initial TDE, requiring additional TDE and in one case surgical TD ligation. Conclusions: TDE is a safe treatment for chyle leaks after head and neck surgery with high technical and clinical success rates. [ABSTRACT FROM AUTHOR]

From 2015 to 2019, 9 patients underwent ultrasound-guided intranodal lymphangiography for the treatment of a chyle leak following thoracic outlet decompression surgery. Chyle leaks were identified by Lipiodol (Guerbet, Roissy, France) extravasation near the left supraclavicular surgical bed in all patients. The technical success rate of thoracic duct embolization was 67% (6 of 9), including fluoroscopic transabdominal antegrade access (n = 4) and ultrasound-guided retrograde access in the left neck (n = 2). Clinical success was achieved in 89% of patients (8 of 9). The mean interval from lymphangiography to drain removal was 6.6 days (range, 4-18 d). No patients had a chyle leak recurrence during clinical follow-up (mean, 304 d). [ABSTRACT FROM AUTHOR]

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Purpose: We aimed to evaluate the safety and effectiveness of cryoablation in the treatment of low-flow malformations, specifically venous malformation (VM) and fibroadipose vascular anomaly (FAVA).Methods: We conducted a retrospective review of 11 consecutive patients with low-flow malformations (14 lesions; 9 VM, 5 FAVA), median lesion volume 10.8 cm3, (range, 1.8-55.6 cm3) with a median age of 19 years (range, 10-50 years) who underwent cryoablation to achieve symptomatic control. Average follow-up was at a median of 207 days postprocedure (range, 120-886 days). Indications for treatment included focal pain and swelling. Technical success was achieved if the cryoablation ice ball covered the region of the malformation that corresponded to the patient's symptoms. Clinical success was considered complete if all symptoms resolved and partial if some symptoms persisted but did not necessitate further treatment.Results: The technical success rate was 100%. At 1-month follow-up, 13 of 14 lesions (93%) had a complete response and one (7%) had a partial response. At 6-month follow-up 12 of 13 (92%) had a complete response and 1 (8%) had a partial response. A total of 6 patients underwent primary cryoablation. Out of 9 VM cases, 7 had prior sclerotherapy and 2 had primary cryoablation. Out of the 5 FAVA cases, 1 had prior sclerotherapy and the remaining 4 cases underwent primary cryoablation. There were 3 minor complications following cryoablation including 2 cases of skin blisters and 1 case of transient numbness. These complications resolved with conservative management.Conclusion: Cryoablation is safe and effective in the treatment of low-flow vascular malformations, either after sclerotherapy or as primary treatment. [ABSTRACT FROM AUTHOR]

We propose an algorithm for management after transjugular intrahepatic portosystemic shunt (TIPS) placement according to clinical manifestations. For patients with an initial good clinical response, surveillance Doppler ultrasound is recommended to detect stenosis or occlusion. A TIPS revision can be performed using basic or advanced techniques to treat stenosis or occlusion. In patients with an initial poor clinical response, a TIPS venogram with pressure measurements should be performed to assess shunt patency. The creation of a parallel TIPS may also be required if the patient is symptomatic and the portal pressure remains high after TIPS revision. Additional procedures may also be necessary, such as peritoneovenous shunt (Denver shunt) placement for refractory ascites, tunneled pleural catheter for hepatic hydrothorax, and balloon-occluded retrograde transvenous obliteration procedure for gastric variceal bleeding. A TIPS reduction procedure can also be performed in patients with uncontrolled hepatic encephalopathy or hepatic failure. [ABSTRACT FROM AUTHOR]

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This information will be essential for IRs being involved in geniculate artery embolization (GAE) not only for the treatment of refractory hemarthrosis post total knee replacement (TKA) but also for the treatment of mild to moderate osteoarthritis (OA). As more IRs venture into GAE embolization for the treatment of OA, an in-depth knowledge of the anatomy and potential pitfalls is essential so that complication rates remain low and potentially improve overtime. 2021; 44; 1: 1-9. 10.1007/s00270-020-02687-z. 33135117Epub 2020 Nov 1 PMID: 33135117 4 Bagla S, Piechowiak R, Sajan A, Orlando J, Hartman T, Isaacson A. Multicenter randomized sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis. [Extracted from the article]

Abstract: Purpose: To determine whether exclusion of pseudoaneurysms with the use of a covered stent in prosthetic arteriovenous (AV) hemodialysis access grafts impacts the incidence of eventual AV graft infection. Materials and Methods: Review of an interventional radiology database for prosthetic AV graft interventions involving stent deployment anywhere within the AV graft circuit revealed 235 interventions in 174 patients between November 2004 and December 2008. Incidence of AV graft infection was analyzed based on stent type (bare metal vs covered), location, and indication for stent deployment on a per-stent, per-procedure, and per-graft basis. Results: A total of 16.3% of the stent-implanted AV grafts were eventually surgically excised as a result of graft infection. Covered stents used to treat an intragraft pseudoaneurysm were more commonly associated with subsequent graft infection compared with bare or covered stents deployed within the graft for other reasons: 42.1% versus 18.2% (P = .011). Stents deployed in an intragraft location were also associated with a higher incidence of graft infection compared with those deployed at the venous anastomosis or outflow vein: 26.9% versus 6.9% (P < .001). No significant difference was identified in infection rates between bare and covered stents. Conclusions: Covered stent exclusion of intragraft pseudoaneurysms demonstrated a significant correlation with eventual prosthetic AV graft infection. [Copyright &y& Elsevier]