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Purpose: To determine the adverse events (AEs) rate associated with percutaneous transhepatic biliary drainage (PTBD) and identify risk factors for their occurrence., Materials and Methods: This single-center retrospective study included 2310 PTBD (right-side: 1164; left-sided: 966; bilateral: 180) interventions for biliary obstruction (benign/malignant) in 449 patients between 2010-2020. Patients with percutaneous cholecystostomy alone were excluded. There were 455 initial drain placements (66 with cholangioplasty) and 1855 exchanges (202 with cholangioplasty). Stents were placed in 163 procedures (metal: 156; plastic: 86). Demographic and procedural variables were assessed using multivariable logistic regression., Results: A total of 745 AEs were recorded. The three most common AEs were peri-catheter bile leak (331/745; 44.4%), catheter occlusion (110/745; 14.7%), and drain dislodgement (103/745; 13.8%). There was a significantly higher overall AE rate amongst patients with malignant biliary obstruction compared to benign [29.8% vs. 17.6%; p=0.0065; odds ratio (OR)=1.57(1.13-2.18)]. Intra-procedure cholangioplasty was associated with decreased AE rate for initial drains and overall procedures [OR=0.48 (0.25-0.90); p=0.02 and OR=0.63 (0.45-0.89); p=0.0092]. Finally, a right-sided drain was associated with an increased overall AE rate for initial drains and overall procedures [OR=1.62 (1.02-2.55); p=0.04 and OR=1.43 (1.05-1.91); p=0.02]., Conclusion: Malignant obstruction and right-sided drains are associated with a higher risk of PTBD-related AEs, while intra-procedure cholangioplasty reduces risk. These findings offer insights into how this high-impact procedure can be performed more safely and effectively., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To identify risk factors for rupture, and to determine outcomes of endovascular treatment of median arcuate ligament (MAL) compression-related visceral artery aneurysms (VAAs)., Methods and Materials: A retrospective review of patients who presented with MALC-related VAAs was performed from 1999 to 2021. A total of 21 patients (12 men) and 39 VAAs associated with MAL compression were encountered (mean age, 59 years). Imaging studies were reviewed for the number, morphology/size, and recurrence of aneurysms. Statistical analysis was performed to identify risk factors for rupture., Results: Ten patients presented with acute rupture, and 12 patients were symptomatic with nonspecific abdominal pain. Twenty-two aneurysms were fusiform in morphology and 17 aneurysms were saccular in morphology. Of the 14 aneurysms that presented with acute hemorrhage, 12 (86%) were fusiform in morphology (odds ratio, 9.0; P < .01). The mean aneurysm size was 1.3 cm, and the mean ruptured size was 0.6 cm. Thirty-one aneurysms were treated by endovascular techniques, and technical success was achieved in all cases. Fourteen patients were found to have an Arc of Buhler. No procedure-related adverse events occurred. No patient underwent surgical ligament release. The mean time of follow-up was 3.2 years, and no aneurysms recurred after endovascular treatment., Conclusions: MAL compression-associated VAAs are an important clinical entity that should be treated even at small sizes, particularly if they are fusiform in morphology. Endovascular therapy is safe and feasible and results in durable aneurysm exclusion., (Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.)

Rationale and Objectives: This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses., Materials and Methods: Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner., Results: Voluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity., Conclusions: Implementation of a low-dose protocol for CT-guided biopsies resulted in 21% and 36% of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)