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This is a case report describing a rare cause of massive duodenal ulcer hemorrhage resulting from the erosion of the supraduodenal branch of the left hepatic artery. This arterial branch is not a well known variation and is rarely recognized as a source of duodenal bleeding.

An 82-year-old man with a history of colorectal cancer presented with metastatic disease to the liver (Couinaud segment 8). We describe the techniques that we employed to successfully perform radiofrequency ablation of a liver metastasis near the dome of the diaphragm utilizing subphrenic infusion of normal saline. The aim of this technique was to prevent thermal injury of the diaphragm.

Patients with renal impairment and/or contrast allergies pose a challenge with regard to diagnostic evaluations. CO 2 may serve as a suitable alternative intravascular contrast agent in these patients with arteriographic applications, including evaluation of peripheral vascular disease, and venographic applications, such as transjugular intrahepatic portosystemic shunt procedure, to name a few. Unique properties of CO 2 , such as low viscosity, lack of an allergic reaction, and renal toxicity, have afforded it its diagnostic capabilities. However, certain properties of CO 2 also pose a technical challenge in terms of its delivery. Although it remains a relatively safe alternative contrast agent, potential adverse effects have been reported and exist.

Stent fractures are commonly seen in the arterial circulation and there is paucity of literature describing venous stent fractures particularly in the central venous circulation. In this case series, we describe three patients on hemodialysis who underwent right brachiocephalic vein (BCV) stent placement for severe stenosis in two patients and occlusion in one patient. Over the course of time, these patients clinically presented with arm swelling, pain, and difficulty in dialysis because of stenosis related to stent fracture and intimal hyperplasia. Two of these patients were successfully treated by restenting.

To retrospectively evaluate the efficacy and complications of endobronchial stent placement for the management of airway complications following lung transplant.From 1992 to 2003, tracheobronchial stenting was performed on 25 lung transplant recipients (16 male and 9 female; mean age 51.6 years; range 21-65 years). A total of 27 lesions were treated and 27 stents were deployed (nine bronchomalacia, 12 bronchial stenosis, three bronchial stenosis and bronchomalacia both and three anastomotic dehiscence). The clinical and bronchoscopic follow-up ranged from 1 month to 69 months.The technical success was 100%. Eighty-four percent of patients had immediate relief in dyspnea. The overall complication rate following stent placement was 0.049 per patient per month (23 complications/471 patient months). Stent migration and granulation tissue formation were the most frequent complications. The mean percentage change in FEV-1 was significantly greater than zero at 1 month and 6 months (P.05) post-stent placement. The mean percentage change in FEV-1 was marginally greater than zero at 12 months (P=.07).The mean percentage change in FVC was marginally greater than zero at 1 month and 6 months (P=.08) post-stent. It was not significantly greater than zero at 12 months (P=1.00).Tracheobronchial stent placement provides effective palliation of postoperative airway complications in lung transplant with morbidity that can be managed effectively by available treatment options. Airway stenting may be used as a primary management option for airway complications after lung transplantation as a large number of patients are not suitable candidates for repeat surgery.

Tracheobronchial stents play a major role in the management of tracheobronchial stenoses and/or bronchomalacia. A very few techniques have been described in literature to remove misplaced or malpositioned tracheobronchial stents. This is a case report describing a technique to retrieve a malpositioned stent utilizing Amplatz gooseneck snare.

Editor: Percutaneous transhepatic biliary drainage (PTBD) is an invasive procedure that carries the risk of several complications such as pain, infection, cholangitis, sepsis, and hemobilia. Hemobilia occurs in approximately 2.6%–9% of patients undergoing PTBD (1). Hepatic arteriobiliary fistula after PTBD is a well-known complication and is usually associated with a pseudoaneurysm. Treatment of a hepatic arteriobiliary fistula with embolization of the catheter track or the bleeding branch of the hepatic artery has already been described (2,3). In recent years, covered stents are increasingly being used for the management of arterial injuries. Herein, we describe the use of an endobiliary covered stent in a patient with advanced carcinoma of the head of the pancreas to treat an iatrogenic hepatic arteriobiliary fistula. A 71-year-old man with a history of pancreatic carcinoma was referred from an outside hospital for the evaluation of persistent bleeding around an internal-external biliary drainage catheter (which manifested as blood-soaked dressings) and possible internalization of the internal-external biliary drainage catheter. An 8-F internal-external biliary drainage catheter (Cook, Bloomington, Indiana) had been placed at an outside hospital. Review of the contrast medium–enhanced computed tomographic (CT) scans of the abdomen showed a pancreatic mass at the head and uncinate process measuring approximately 4.3 3.9 cm with multiple enlarged peripancreatic nodes and hepatic ductal dilatation. The hepatic artery and