Two parallel needles with snare gastropexy device during gastrostomy in children.

A ferromagnetic T-fastener is often used in children during gastrostomy procedures. We describe the experience with the use of a new gastropexy device (two parallel needles with a snare) that uses a non-ferromagnetic anchor during primary percutaneous retrograde radiologic gastrostomy insertion in four children with a mean age of 6 years and 6 months (range: 2 years and 11 months to 9 years and 6 months). The new gastropexy device was safe and effective in children. It is advantageous for children requiring magnetic resonance (MR) examinations soon after gastrostomy insertion, especially in view of MR-related implications that result from the use of a ferromagnetic T-fastener.

Lung tattooing combined with immediate video-assisted thoracoscopic resection (IVATR) as a single procedure in a hybrid room: our institutional experience in a pediatric population.

BACKGROUND: Analysis of small pulmonary nodules in children poses an important diagnostic and therapeutic challenge for clinicians. OBJECTIVE: To review our experience of lung tattooing with immediate video-assisted thoracoscopic resection (IVATR) performed as a single procedure in a hybrid room for technical difficulties, complications and diagnostic yield of the procedure. MATERIAL AND METHODS: Retrospective analysis of 31 children (16 boys, 15 girls) who underwent lung tattooing of various lesions from January 2001 to July 2011. Data were collected from the Interventional Radiology database, Electronic Patient Chart (EPC) and PACS. RESULTS: A total of 34 lesions were treated in 31 children. Tattooing was performed on lung lesions with median size 3 mm and median depth 2 mm from pleura. Technical success was 91.1% and diagnostic yield was 100%. In seven children, it was combined with other interventional radiologic procedures. The median procedure time for lung tattooing and IVATR was 197 min. CONCLUSION: Lung tattooing with IVATR as a single procedure in a hybrid room is safe and effective in children with several inherent advantages, including avoiding the need to move the child from the interventional radiology suite to the operating room.

Fate, complications and MRI implications of retention anchor suture placed during gastrostomy in children.

Retrograde radiologic gastrostomy is one of several techniques used for placing a gastrostomy and is a common technique used in children. The use of a retention anchor suture (RAS) is an important component of this procedure. This pictorial essay explores the normal course and passage of the RAS, as well as abnormal migration, various complications and the implications of the RAS with regard to MRI safety.

Outcome in small aneurysms (<4 mm) treated by endovascular coiling.

BACKGROUND: Coiling of small aneurysms can be technically challenging. These aspects of coiling tend to be less problematic in medium to large aneurysms as they are more accommodating of microcatheters and coils. When physicians are asked their opinion regarding aneurysm coilability in small aneurysms, the decision often lies in the operator's feeling that they could reasonably exclude the aneurysm with a complication rate similar to larger aneurysms. The purpose of our study was to investigate the feasibility, intraprocedural rupture rates and long term durability of endovascular coiling for small (≤4 mm) aneurysms compared with non-small (>4 mm) aneurysms. To control for factors such as vessel tortuosity and aneurysm location, a control group was chosen matched to the study group both in age and aneurysm location. MATERIALS AND METHODS: A retrospective review of 360 intracranial aneurysms coiled at our institution between 2003 and 2008 was performed. For the control group, intracranial aneurysms coiled in the same period matched to location and age were chosen. RESULTS: The frequency of intraprocedural perforations was 4/34 (0.12) and 3/68 (0.04) for the small and non-small cohort, respectively (p=0.22). All patients who had a perforation in the small aneurysm groups had a good clinical outcome compared with 1/3 in the non-small group (two mortalities). The frequency of recanalization for the small and non-small groups was 3/34 (0.09) and 23/68 (0.33), respectively (p=0.006). There was no retreatments in the small aneurysm group and five (0.07) in the non-small group (p=0.116). CONCLUSION: Coiling of small (≤4 mm) aneurysms is feasible with a reasonable complication rate. There is a non-significant increase in frequency of intraprocedural rupture with coiling of small aneurysms compared with controls matched to aneurysm location and age but this is not associated with increased morbidity. Coiling of small aneurysms leads to durable results at long term follow-up.

Transjugular liver biopsy: a retrospective analysis of 601 cases.

PURPOSE: To perform a retrospective analysis of all transjugular liver biopsies (TJLBs) performed during a 77-month period. The authors discuss the technical modifications adopted to achieve better procedural success and histopathologic yield apart from the safety profile of this procedure during the study period. MATERIALS AND METHODS: Six hundred one consecutive patients underwent TJLB at the authors' institution during the study period. TJLB was performed when percutaneous biopsy was precluded, being judged unsafe. The left internal jugular vein (IJV) was accessed only when it was not possible to cannulate the right IJV, which was the routine access for this procedure. Biopsy samples were obtained from the right lobe after right hepatic vein cannulation. Left lobe biopsy was done only in select cases. In patients with shrunken liver and unfavorable hepatic veins for cannulation and in those with hepatic veno-occlusive disease, biopsy was performed with a transcaval approach under ultrasonographic (US) guidance, improving our technical success for this procedure over the years. RESULTS: The overall technical success rate for the procedure was 98.8 % (594/601), the histopathologic positivity was 97% (576/594), and the overall complication rate was 2.5% (15/601). CONCLUSIONS: With technical modifications such as transcaval liver biopsy and with access to US in the angiography suite, interventionalist can achieve higher technical success rates for this procedure. The authors' institutional experience with this procedure reiterates its high histopathologic positivity and safety profile both in adult and pediatric patients.