Tunneled dialysis catheter utilization and patency: A retrospectiveprospective study from a tertiary care hospital in Karachi Pakistan.

Objectives: To assess the patency of tunnel dialysis catheters and their results in patients in a tertiary care setting. METHODS: The retrospective-prospective, observational study was conducted at the Department of Interventional Radiology, Liaquat National Hospital, Karachi, from September 2021 to February 2022, and comprised records of patients who underwent tunnel dialysis catheters placement from July 2019 to December 2020. Data regarding age, gender, residence, comorbidity, catheter placement site, use of antibiotics before catheter insertion, reasons for catheter removal, and total catheter days was retrieved from the medical record. Data was analysed using STATA 14. RESULTS: Of the 134 patients, 74(56.9%) were males and 56(43.1) were females. The overall median age was 65 years (interquartile range: 56.75-70.25 years). Catheters were electively removed in 97(72.4%) patients, while in 19(14.2%), 16(11.9%) and 2(1.5%) cases, catheters were removed due to infections, blockage and physical damage, respectively. Mortality due to catheter-related complications was not found. Incidence per 10,000 catheter days of overall infection, bacteraemia and other infections during one year was 8.4, 5.3 and 3.1, respectively. Overall infection-free survival rate was seen for 19 patients (survival rate=67.6%). Survival rate from catheter removal was seen in 36 patients (survival rate=53.2%). CONCLUSIONS: When all precautions were followed to circumvent catheter-related issues, tunnel dialysis catheters were found to be a viable option for haemodialysis until permanent access for dialysis is gained or a kidney transplant is performed.

Transarterial embolisation of cystic artery pseudo aneurysm: a rare complication of acute cholecystitis.

Pseudo aneurysm of cystic artery is an extremely rare complication which may occur in association with cholecystitis, liver biopsy, biliary interventions, pancreatitis and laparoscopic cholecystectomy. We report the case of a 55 years old male patient who presented with complaint of right upper quadrant pain, haematemesis and melena, he underwent CT scan abdomen that revealed perforated gall bladder with cystic artery pseudo aneurysm secondary to acute cholecystitis. An angiogram was performed that confirmed small cystic artery pseudo aneurysm. Selective embolisation of cystic artery was done, resulting in complete exclusion of pseudo aneurysm. The patient recovered completely.

Innovation in direct intrahepatic portosystemic shunt; a developing country experience.

Anticoagulants are the first-line treatment option for patients with Budd-Chiari syndrome (BCS); however, intervention is required when this fails. Although, the ultimate treatment is liver transplant, other radiological procedures are for the management of the disease and bridge to definitive therapy. TIPS (trans jugular intrahepatic portosystemic shunt) is a method used by interventional radiologists to create a shunt between portal vein and hepatic vein. At times it is technically not possible, in such cases, direct intrahepatic portosystemic shunt (DIPS) is performed. This patient underwent a successful DIPS procedure for BCS along with balloon dilatation (venoplasty) for inferior vena cava (IVC) stenosis.