We describe a 44-year-old man with end-stage renal disease who underwent insertion of a stent graft to repair a hemodialysis graft pseudoaneurysm. The indication for stent graft placement was an acute and rapidly enlarging intragraft pseudoaneurysm. The patient experienced no complications following the procedure, but he presented with two graft occlusions within the 2 months following the procedure.

We present a case of a 46 years old female with decompensated liver cirrhosis who developed severe intraperitoneal hemorrhage secondary to inadvertent liver puncture during a paracentesis which resulted in a combined hepatic arterial and portal venous injury. The arterial injury was managed with transarterial embolization. The portal venous injury was managed with percutaneous microwave ablation. This article also highlights the importance of evaluating both arterial injury as well as portal venous injury in the setting of hepatic bleeding, particularly in patients with portal hypertension.

No abstract

A modified technique for placement of the venous outflow component (VOC) of the Hemodialysis Reliable Outflow (HeRO) device (Hemosphere Inc, Minneapolis, Minn) is described. The purpose of the technique is to improve the system's trackability and facilitate device insertion in patients with central venous occlusion. Device preparation requires placement of a 6-mm × 4-cm angioplasty balloon within the leading end of the VOC. The leading 2 cm of the balloon are placed just distal to the radiopaque marker of the VOC. The balloon is inflated to profile and locked in this position within the leading end of the VOC. The VOC and balloon combination is advanced over the wire through the 20F peel-away sheath provided by the manufacturer. The described technique was used to successfully implant the HeRO device in 12 patients with central venous occlusion. This technique is recommended for placement of the VOC of the HeRO device in patients with central venous occlusions.