Rendezvous Technique for Advanced Pancreatic Duct Interventions.

Interventional radiology can be used to perform complex pancreatic duct (PD) interventions in cases in which PD abnormalities limit the feasibility of an endoscopic approach. A multidisciplinary approach with gastroenterology using the rendezvous technique can improve procedural success. The establishment of through-and-through access to the PD via a combined percutaneous and endoscopic approach can be used when endoscopy alone fails. In this study, 3 cases are presented in which the rendezvous technique was successfully employed to access the PD for subsequent interventions.

Splenic trauma: endovascular treatment approach.

The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used. Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.

Small bowel transplant: state-of-the-art vascular and nonvascular imaging.

BACKGROUND: Small bowel transplant (SBT) is a surgical procedure that may be used in patients with pathology resulting in severe intestinal failure resistant to conventional forms of surgical and nonsurgical treatment. Intestinal failure is defined as the failure of enterocytes to absorb sufficient macronutrients, water, and/or electrolytes to sustain homeostasis and/or promote growth. With the advancement of surgical techniques and advancements in perioperative transplant management, SBT has become an increasingly common treatment for intestinal failure, with survival rates for SBT comparable to those for other solid organ transplants. MATERIALS AND METHODS: This review provides background on SBT, its variations, and the associated preoperative and postoperative imaging studies with regard to surgical planning and anticipated complications. RESULTS AND CONCLUSIONS: With the increasing use of SBT, radiologists will be expected to be familiar with the diagnostic studies and available endovascular interventions associated with this procedure.

Hepatic capsular retraction: An updated MR imaging review.

Hepatic capsular retraction is a morphologic descriptor that refers to invagination or focal flattening of the typical smooth contour of the liver capsule. It is an uncommon finding that, when combined with other imaging features and clinical context, can help to refine the differential diagnosis in patients with liver lesions. Although this descriptor has historically been used in reference to a small subset of benign and malignant lesions, the differential has since been expanded with the discovery of new entities causing capsular retraction as well as with novel and increased use of liver-directed treatment techniques. Additionally, modern imaging techniques now allow for improved detection and characterization of capsular retraction. In this review, we discuss these common and uncommon causes of capsular retraction, with an emphasis on findings from body MRI.