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The evolution of ultrasound (US) techniques has greatly improved the evaluation of many parameters in dialysis vascular access, which is typically achieved through an arteriovenous fistula (AVF) or graft (AVG). These techniques include grayscale B-mode, color Doppler, power Doppler, spectral Doppler, non-Doppler US flow imaging techniques, contrast-enhanced US, and elastography. In conjunction with a patient’s medical history and physical examination, US provides crucial information about the native vascular bed prior to the surgical creation of an arteriovenous anastomosis. It also tracks the maturation progress of the newly created AVF or AVG and aids in diagnosing potential complications of the vascular access. These complications include thrombosis, steal syndrome, aneurysms, pseudoaneurysms, hematomas, infection, ischemic neuropathy, exacerbation of preexisting congestive heart failure, and stenosis.

Aortic injury is a frequently encountered condition that can present as a life-threatening emergency. When this injury occurs in the retroperitoneal portion of the aorta, it can be difficult to diagnose and treat because of the location. Although surgical repair remains the mainstay of treatment, surgery might not be an option for some patients. We have presented a case of a 54-year-old nonoperative candidate who had experienced iatrogenic retroperitoneal abdominal aortic rupture with pseudoaneurysm formation. The patient was successfully treated with the novel use of a proven technique: direct percutaneous embolization of the pseudoaneurysm sac via a translumbar approach under image guidance.

Purpose: Hepatoblastoma is the most common primary neoplasm of the liver in the pediatric population, usually diagnosed during the first 5 years of life. Patients with large or peripheral hepatoblastomas are at risk for rupture and peritoneal hemorrhage. Image-guided, minimally invasive interventions are offered for controlling hemorrhage. Case presentation: We present a 2-year-old female with an 11.8 cm hepatoblastoma in the right hepatic lobe involving segment 4A, who developed hemodynamic instability on day 8 of induction chemotherapy. Imaging revealed intraperitoneal hemorrhage secondary to her ruptured hepatoblastoma. The patient was successfully treated by celiac artery angiogram and transarterial bland embolization. Conclusion: Transarterial bland embolization of large hepatoblastomas may control and even prevent intraperitoneal/intracapsular hemorrhage, and may also enhance the efficacy of systematic chemotherapy in the pediatric patients with advanced hepatoblastoma.

Most patients have a time limited indication for inferior vena cava filtration. When the indication has expired, a retrievable inferior vena cava filter should be removed percutaneously, unless the risks of retrieval outweigh the benefits. Over time, long term indwelling inferior vena cava filters may experience complications, such as strut penetration, migration, thrombosis, tilt, fracture, and inferior vena cava stenosis. Long term indwelling retrievable inferior vena cava filters may become embedded in the wall of the inferior vena cava, making percutaneous retrieval difficult. However, this is not always the case, and they also may be easily and safely removed using simple techniques. We present a case of a long term indwelling retrievable inferior vena cava filter that was easily removed using simple techniques, 16.5 years after placement.

An excluded calyx is a rare, acquired urologic condition where there is discontinuity between a portion of the renal collecting system with the remainder of the collecting system. Re-establishment of reliable long-term communication between the excluded calyx and the remaining collecting system is crucial for preservation of renal function and possible relief of symptoms. In this manuscript, we discuss two such cases where a previously undescribed novel procedure is used for treatment of this uncommon condition, where percutaneous antegrade transcatheter techniques were used to establish long-term urinary drainage. The first case discusses an excluded calyx in a 17-year-old male who suffered left renal injury after a high speed motor vehicle accident, where the kidney was divided by the injury and subsequently required creation of a neoinfundibulum in order to maintain continuity of the collecting system. The second case involves a 39-year-old female who underwent resection of a renal cell carcinoma, later developing an excluded calyx where radiofrequency wire recanalization was performed and the neoinfundibular track underwent serial retrograde balloon dilation, resulting in a continuous collecting system. Both patients have done well for more than 2 years after neoinfundibulum creation, showing that this novel technique should be considered a viable and safe procedure in the treatment of this rare condition.

Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States and usually occurs secondary to venous thromboembolism. Inferior vena cava (IVC) filters are minimally invasive intravascular devices placed in patients who are at increased risk for venous thromboembolism leading to PE, however, has a contraindication to medical anticoagulation therapy. The longest reported case of a retrievable IVC filter has remained in place and successfully removed in a living patient has been 4753 days (13 years). We present a case of an uneventful, successful IVC removal with a dwell time of 6033 days (16 years).