Purpose: To compare the safety and clinical outcomes of combined transjugular intrahepatic portosystemic shunt (TIPS) plus variceal obliteration to those of TIPS alone for the treatment of gastric varices (GVs). Materials and Methods:A single-center, retrospective study of 40 patients with bleeding or high-risk GVs between 2008 and 2019 was performed. The patients were treated with combined therapy (n ¼ 18) or TIPS alone (n ¼ 22). There were no significant differences in age, sex, model for end-stage liver disease score, or GV type between the groups. The primary outcomes were the rates of GV eradication and rebleeding. The secondary outcomes included portal hypertensive complications and hepatic encephalopathy. Results:The mean follow-up period was 15.4 months for the combined therapy group and 22.9 months for the TIPS group (P ¼ .32). After combined therapy, there was a higher rate of GV eradication (92% vs 47%, P ¼ .01) and a trend toward a lower rate of GV rebleeding (0% vs 23%, P ¼ .056). The estimated rebleeding rates were 0% versus 5% at 3 months, 0% versus 11% at 6 months, 0% versus 18% at 1 year, and 0% versus 38% at 2 years after combined therapy and TIPS, respectively (P ¼ .077). There was no difference in ascites (13% vs 11%, P ¼ .63), hepatic encephalopathy (47% vs 55%, P ¼ .44), or esophageal variceal bleeding (0% vs 0%, P > .999) after the procedure between the groups. Conclusions:The GV eradication rate is significantly higher after combined therapy, with no associated increase in portal hypertensive complications. This translates to a clinically meaningful trend toward a reduction in GV rebleeding. The value of a combined treatment strategy should be prospectively studied in a larger cohort to determine the optimal management of GVs. ABBREVIATIONSBATO ¼ balloon-occluded antegrade transvenous obliteration, BRTO ¼ balloon-occluded retrograde transvenous obliteration, EV ¼ esophageal varice, GV ¼ gastric varice, HE ¼ hepatic encephalopathy, PSG ¼ portosystemic pressure gradient, TIPS ¼ transjugular intrahepatic portosystemic shunt From the Department of Radiology (K.

Dialysis access interventions are frequently performed by interventional radiologists. Several commercially available percutaneous thrombolytic devices can help restore patency to thrombosed arteriovenous access circuits. The Arrow-Trerotola Percutaneous Thrombolytic Device is one such device, and has a long track record of safe and effective use. However, like any medical device, complications can occur during its use. This article describes three complications and associated management strategies utilizing fundamental interventional radiology techniques of balloon tamponade, stent placement, and snare mediated foreign body retrieval.

Pancreas transplantation is an exciting therapy which has been used for several decades in the treatment of diabetes mellitus. It can be performed as either a whole organ or islet cell transplant. The role of interventional radiologists in the management of whole organ transplants is evolving and includes treatment of postoperative complications and graft biopsy to evaluate for rejection. An in-depth understanding of the transplant anatomy and variations is a fundamental tool in performing these interventions successfully. Islet cell transplantation entails delivery of purified donor pancreatic islet cells into the recipient portal vein. Because of their expertise in image-guided access to the portal system, interventional radiologists play a crucial role in this procedure. The purpose of this article is to review the indications, anatomy, complications, and outcomes of both whole organ and islet cell pancreas transplants, followed by a discussion of the role of interventional radiologists in each procedure.