Temporary placement of stent grafts in postsurgical benign biliary strictures: a single center experience.

OBJECTIVE: To evaluate the effect of temporary stent graft placement in the treatment of benign anastomotic biliary strictures. MATERIALS AND METHODS: Nine patients, five women and four men, 22-64 years old (mean, 47.5 years), with chronic benign biliary anastomotic strictures, refractory to repeated balloon dilations, were treated by prolonged, temporary placement of stent-grafts. Four patients had strictures following a liver transplantation; three of them in bilio-enteric anastomoses and one in a choledocho-choledochostomy. Four of the other five patients had strictures at bilio-enteric anastomoses, which developed after complications following laparoscopic cholecystectomies and in one after a Whipple procedure for duodenal carcinoma. In eight patients, balloon-expandable stent-grafts were placed and one patient was treated by insertion of a self-expanding stent-graft. RESULTS: In the transplant group, treatment of patients with bilio-enteric anastomoses was unsuccessful (mean stent duration, 30 days). The patient treated for stenosis in the choledocho-choledochostomy responded well to consecutive self-expanding stent-graft placement (total placement duration, 112 days). All patients with bilio-enteric anastomoses in the non-transplant group were treated successfully with stent-grafts (mean placement duration, 37 days). CONCLUSION: Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant.

Endovascular treatment of lower gastrointestinal bleeding from systemic-to-mesenteric venous collateral vessels caused by inferior vena cava occlusion: report of two cases.

The present report describes two cases of chronic lower gastrointestinal bleeding caused by systemic-to-mesenteric venous collateral vessels resulting from longstanding inferior vena cava obstruction. They were successfully treated with caval balloon angioplasty and stent placement. No recurrent bleeding was seen at 15 and 24 months of follow up, respectively.

Percutaneous transosseous embolization of internal iliac artery aneurysm type II endoleak: report of two cases.

This report describes two cases of successful treatment of an internal iliac artery aneurysm (IIAA) type II endoleak utilizing a percutaneous transosseous access that could not be treated using an endovascular or standard percutaneous approach. A direct percutaneous approach through bone was chosen to avoid vital structures and the surrounding bowel. The procedure was successful and required minimal fluoroscopy time compared with other treatment options. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.

Retrievability of optional inferior vena cava filters with caudal migration and caval penetration: report of three cases.

The present report describes the safe retrieval of caudally migrated optional inferior vena cava (IVC) filters with significant IVC penetration. Three patients had optional IVC filters placed for deep vein thrombosis/pulmonary emboli and contraindications for anticoagulation. Subsequent imaging showed caudal migration and penetration of the filter legs through the IVC wall. All filters were removed without major complications. One patient experienced abdominal pain after filter removal, which required no treatment. Caudal migration of optional filters with IVC wall penetration by the filter legs may be more common with new filter designs in which the secondary and primary struts are separated.