Image-Guided Biliary Interventions: How to Recognize, Avoid, or Get Out of Trouble.

Percutaneous biliary interventions have a well-established role in the management of hepatobiliary diseases. Good outcomes include recognizing and avoiding complications. This section will cover the "standard" technique of percutaneous biliary drainage, pearls to decrease the risk of problems, and approaches to treat those complications in patients undergoing percutaneous transhepatic cholangiography and percutaneous transhepatic biliary drainage.

Percutaneous Gastrostomy: How to Recognize, Avoid, or Get Out of Trouble.

Placement of gastrostomy tubes can be done with different techniques. The radiologic-guided tube placement relies on image guidance for safe placement of the tube. A thorough knowledge of the immediate and delayed hazards is essential. This article outlines the potential complications and how to recognize, avoid, and treat them. Several clinical examples are included. Key Words: gastrostomy, complication, feeding tubes, image guidance.

Image-Guided Nephrostomy Interventions: How to Recognize, Avoid, or Get Out of Trouble.

Image-guided percutaneous nephrostomy is a relatively safe and successful procedure for access to the renal collecting system for multiple purposes including relief of urinary obstruction, urinary diversion, access for endourologic procedures, and diagnostic testing. Although placing a percutaneous nephrostomy catheter is most times straightforward, providing immediate benefit for the patient and satisfaction for the practitioner, there can be situations that make the procedure more difficult or risky. A thorough review of the patient's imaging and medical record will help to set a path for success. However, there may be innuendos and unforeseen circumstances that occur. Having knowledge of most of these "stumbling blocks" and how to deal with them will keep you on the path. This paper serves to fill some of that mental file with the aim to increase clinical success.

Arterial hemostasis using the Duett sealing device.

Using a liquid procoagulant, the Duett sealing device employs a distinctly different mechanism than other available devices for attaining hemostasis after femoral arterial puncture. Approved for use with 5 to 9 Fr sheath sizes, the Duett incorporates the typical vascular sheath in the closure procedure. Moreover, the liquid procoagulant, containing a mixture of thrombin and collagen, provides instant hemostasis and does not leave foreign material in the artery or in the subcutaneous tissues. Several studies, including one comparing the Duett to standard manual compression (SEAL), have shown the safety of the device as well as decreased times to ambulation. In addition, time to hemostasis was significantly decreased in patients receiving anticoagulation or antiplatelet therapy. The Duett sealing device is simple to use, safe, effective and a viable alternative to other available devices and/or manual compression.