How to "Get Out of Trouble" During Prostatic Artery Embolization.

Prostatic artery embolization can be an extremely challenging procedure often giving the operator the sense of "being in trouble." This feeling can occur during different stages of the procedure including initial identification of the prostatic artery, catheterization of the prostatic artery, and prevention of non-target ischemia via extra-prostatic anastomoses during embolization. This brief guide provides techniques developed from prior experience with these frustrating situations that could potentially help the prostatic artery embolization operator "get out of trouble."

Revascularization for critical limb ischemia using the SpiderFX embolic protection device in the below-the-knee circulation: initial results.

PURPOSE: To examine the safety and efficacy of the SpiderFX embolic protection device (EPD) in the below-the-knee (BTK) circulation in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: A single-center retrospective review was performed to identify patients with CLI and single-vessel runoff in whom the SpiderFX EPD was used in the BTK circulation. Technical success and device-related complications were the primary endpoints. Retrieval of macroscopic debris in the EPD, 1-year freedom from major adverse limb events (MALEs), and 30-day perioperative death were also evaluated. A major amputation, surgical bypass, endovascular thrombectomy, or endovascular thrombolysis was considered a MALE. Thirty-six patients (21 men; mean age, 75.8 y) treated between 2008 and 2013 had endovascular revascularization with use of the SpiderFX EPD in the BTK circulation. RESULTS: The SpiderFX EPD was successfully deployed in all cases; the technical success rate of revascularization was 100%. Two minor and zero major complications were observed related to the SpiderFX. Two MALEs, a major amputation and a subsequent surgical bypass, were observed in the cohort. All MALEs occurred within 1 year of treatment (1-y freedom from MALE rate, 90%). Debris was retrieved in the SpiderFX device in 47% of patients. CONCLUSIONS: The use of the SpiderFX EPD in the BTK circulation in patients with CLI is safe and frequently retrieves debris.

Recurrent cholecystitis and cholelithiasis in a gallbladder remnant 14 years after a converted cholecystectomy.

A 52-year-old man presented to the emergency department with a one-day history of epigastric pain. The patient reported a remote history of a "difficult" laparoscopic cholecystectomy that was converted to an open cholecystectomy in 1994. Further operative details were unavailable. Multiple radiologic studies were obtained, all demonstrating a saccular cystic structure in the gallbladder fossa containing calculi. A completion open cholecystectomy, or "recholecystectomy," revealed a remnant gallbladder with cholecystitis and cholelithiasis. Multimodality imaging findings are reviewed.