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Purpose To evaluate efficacy and safety of transjugular liver biopsy (TJLB) via the left hepatic vein in patients with left lobe–only liver transplants (LLOTs). Materials and Methods Retrospective review revealed 43 TJLBs performed in 26 patients with LLOTs (mean age 51.3 y; range, 18–73 y) between January 2009 and June 2016 at a single institution. A comparison group of 44 randomly selected TJLBs performed in 37 orthotopic whole liver transplant (OWLT) recipients (mean age 57.6 y; range, 35–74 y) during the same time period was evaluated. Patient demographics, type and age of transplant, technical success, adequacy of samples, number of portal tracts obtained, pathologic diagnosis, and complication rate were reviewed. Results Technical success was achieved in 98% (42/43) of LLOT procedures. TJLB failed in 1 patient with LLOT, in whom no patent hepatic veins were identified. Technical success was achieved in 100% (44/44) in the OWLT group. Mean (SD) number of needle passes was 4.12 (1.25) in the LLOT group vs 3.95 (1.28) in the OWLT group (P = .54). Mean (SD) specimen length was 1.16 (0.75) cm in the LLOT group vs 1.19 (0.58) cm in the OWLT group (P = .78). Mean (SD) number of portal tracts obtained in the LLOT group was 10.7 (5.26) vs 12.3 (4.68) in the OWLT group (P = .17). No major complications were observed in either group. Conclusions TJLB in adult patients with LLOTs appears safe and feasible, with favorable rates of technical success and adequacy of sampling.

Central venous stenosis in hemodialysis patients rarely causes venous hypertension and intracranial hemorrhage. A 54 year-old male with right arm arteriovenous fistula was transferred to our institution in a comatose state following right parietal venous infarction. Fistulography showed right brachiocephalic vein (BCV) occlusion with reflux into the right transverse sinus and obstruction of left internal jugular vein outflow due to the styloid process. Balloon venoplasty of the right BCV occlusion failed to improve the patient's status because of the delayed diagnosis. Headaches and neurologic symptoms in hemodialysis patients can herald intracranial hypertension due to central venous occlusion and needs prompt assessment with fistulography.

Purpose To compare the complication rate of the Denali and Option-ELITE inferior vena cava (IVC) filters. Materials and Methods All patients who had a Denali or Option-ELITE IVC filter placed between March 2014 and March 2016 were retrospectively identified from the electronic medical records. Of the 245 IVC filters placed, the positions of 93 devices (21 Denali and 72 Option-ELITE) were documented on follow-up computed tomography (CT) examinations obtained for reasons unrelated to filter placement. In situations where multiple CT studies were obtained after placement, each study was reviewed, for a total of 200 examinations. Images were assessed for filter complication including caval wall penetration by filter components, associated damage to pericaval tissues, filter tilt, migration, and fracture. Results Penetration of at least one strut was observed in 13% of all filters imaged by CT, (Denali: 14%; Option-ELITE: 13%; p = 1.00). No patients had damage to pericaval tissues or documented symptoms attributed to penetration. Neither the Denali nor the Option-ELITE filters demonstrated significant tilt (> 15 degrees of tilt), migration, or fracture. Compared with Denali; the Option-ELITE filter demonstrated an increasing strut penetration rate with longer indwell times (z = –3.67, p < 0.01). Conclusions No significant difference was observed between the rates of caval penetration of the Denali and Option-ELITE IVC filters assessed by CT. Additionally, no findings of filter fracture or migration were noted, suggesting that the Denali filter is non-inferior to the Option-ELITE filter with respect to penetration, fracture, tilt, and migration. The Option-ELITE filter demonstrated a time-dependent tendency toward greater strut penetration with longer indwell times.

Purpose To determine the clinical outcomes of patients who underwent image-guided drainage of peripancreatic fluid collections after simultaneous pancreas-kidney (SPK) transplantation. Materials and Methods A retrospective review of all patients who underwent peripancreatic fluid collection drainage after SPK, from January 2000 to August 2017, at a single institution was performed. Patient characteristics, surgical technique, medication regimen, microbial analysis, and clinical outcomes were reviewed. Thirty-one patients requiring a total of 41 drainages were included in this study. The median age was 44 years (range 30–58 years), and median time between SPK and drainage was 28 days (range 8 to 3,401 days). Fisher’s exact test, unpaired Student t -tests, and Pearson correlations were used for statistical analysis. Results Fever (51%) and abdominal pain (31%) were the most common presenting symptoms. The average amount of fluid drained at the time of drain placement was 97 mL (SD 240 mL). The average time spent with a drain in place was 33 days (SD 31 days). Microorganisms were isolated in the fluid of 22 of 41 drainages (54%), with mixed gastrointestinal flora being the most common. No further intervention was needed in 34 of 41 drainages (82%). However, drainage failed in 5 of 31 patients (16%), requiring surgical intervention with removal of the pancreas transplant. Conclusions Percutaneous drainage of peripancreatic fluid collections after SPK transplantation is a safe and effective treatment option.

Background: Ventral hernia repair (VHR) is one of the most common surgical procedures and is commonly associated with post procedural fluid collection formation. Purpose: To determine the clinical outcomes of percutaneous drainage of collections adjacent to mesh ventral hernia repair (VHR). Material and Methods: A retrospective review of all consecutive patients who underwent percutaneous drainage of fluid collections adjacent to mesh VHR was performed. Patient characteristics, mesh type, culture results, and clinical outcomes were reviewed. Clinical success was defined as mesh salvage and resolution of presenting signs and symptoms without surgical intervention. Results: A total of 14 patients were included (6 men, 8 women) with median age of 53 years (range: 22- 80 years). Median interval time between VHR and drain placement was 40 days (range: 15-1144 days). Pain was the most common presenting symptom, noted in 13 patients 93%), followed by erythema which was noted in 10 patients (71%). Percutaneous drain insertion was technically successful in all 14 patients (100%). Clinical success was achieved for five out of 14 patients (36%) whose mesh was salvaged. The other nine patients (64%) required mesh excision because of lack of clinical improvement. There was no statistically significant difference in drainage outcomes when comparing patient age, gender, mesh type, interval from surgery to drainage, or bacterial cultures. Conclusion: While percutaneous drainage of collections adjacent to mesh VHR may be successful in some cases, a majority of patients may ultimately require surgical mesh excision.

Venous thromboembolism (VTE) is an extremely common form of vascular disease and impacts a great number of patients worldwide. Acute deep vein thrombosis (DVT) is a subset of VTE and is traditionally been treated with anticoagulation. There is good quality data which suggests the use of catheter directed interventions for the treatment of acute DVT with the aim of reducing post-thrombotic syndrome (PTS). The present review will discuss the various therapies available for acute DVT, focusing on catheter directed interventions, ranging from traditional anticoagulation to the most novel forms of aspiration thrombectomy.

A major challenge in computer-aided detection (CAD) of polyps in CT colonography (CTC) is the detection of "difficult" polyps which radiologists are likely to miss. Our purpose was to develop a CAD scheme incorporating massive-training artificial neural networks (MTANNs) and to evaluate its performance on false-negative (FN) cases in a large multicenter clinical trial. We developed an initial polyp-detection scheme consisting of colon segmentation based on CT value-based analysis, detection of polyp candidates based on morphologic analysis, and quadratic discriminant analysis based on 3D pattern features for classification. For reduction of false-positive (FP) detections, we developed multiple expert 3D MTANNs designed to differentiate between polyps and seven types of non-polyps. Our independent database was obtained from CTC scans of 155 patients with polyps from a multicenter trial in which 15 medical institutions participated nationwide. Among them, about 45% patients received FN interpretations in CTC. For testing our CAD, 14 cases with 14 polyps/masses were randomly selected from the FN cases. Lesion sizes ranged from 6-35 mm, with an average of 10 mm. The initial CAD scheme detected 71.4% (10/14) of "missed" polyps, including sessile polyps and polyps on folds, with 18.9 (264/14) FPs per case. The MTANNs removed 75% (197/264) of the FPs without loss of any true positives; thus, the performance of our CAD scheme was improved to 4.8 (67/14) FPs per case. With our CAD scheme incorporating MTANNs, 71.4% of polyps "missed" by radiologists in the trial were detected correctly, with a reasonable number of FPs.