ObjectivesTo retrospectively evaluate the effectiveness of gastroesophageal stenting for post sleeve gastrectomy staple line leaks using removable self-expandable stents.MethodsBetween April 2012 and June 2015, 12 consecutive patients (6 males) with mean age of 34 years: (21-38 years) presented with staple line leak 1-8 weeks after the operation (mean 2.8 weeks). Patients underwent gastroesophageal stenting by interventional radiology. A total of 23 stents were deployed with mean length of 17.8 cm (7-24 cm) and mean diameter 25.6 mm (18-36 mm). Stent re-insertion was needed in 7 patients (9 procedure), while 6 patients required percutaneous collection drainage and 3 patients required endoscopic glue injection with clipping. Two stent removal procedures were carried out under endoscopic visualization after failed stent capture under fluoroscopy, while the remaining stents were successfully removed by interventional radiology.ResultsStent placement was technically successful in all patients. Stent migration occurred in 6 patients (50%). There is a tendency for stent migration with shorter stent length (R= -0.557, p=0.008). The mean duration of stenting was 60.5 days (14-137 days). All patients underwent stent removal and resumed oral intake with no recurrence of leak at a mean follow up time of 190 days (14-410 days). Complications included gastrointestinal bleeding (n=1), proximal esophageal stricture (n=1) and stent occlusion (n=1).ConclusionGastroesophageal stenting as a primary measure after diagnosis of early post sleeve gastrectomy leak appears to offer a safe and effective alternative option in obviating repeat surgical interventions. Minimally invasive interventions may still be required for the management of persistent leak.

Traumatic injuries to the inferior vena cava (IVC) are rare and among the most dreadful injuries encountered in evaluation of both penetrating and blunt traumatic settings. Clinical outcome of IVC injury is multifactorial with injuries being classically managed surgically. In this report, we present a case of 52 years old male patient with successfully treated blunt retrohepatic IVC injury utilizing arterial stent graft and anticoagulation regime without short-term complications. Evidence based standardized approach for endovascular management of IVC injury is not yet available. We hope that our report can contribute to worldwide procedure and postprocedural anticoagulation standardization.

Purpose: Retrospective review of the pattern and management techniques of arterial injuries related to central venous access with long-term outcomes. Materials and Methods: Between January 2007 and November 2017, a total of 20 patients (13 females) were included with the mean age of 63 (28-89 years) and mean body mass index of 25.75 (13.3-36.5). Venous access procedures included central venous catheter (CVC) placement, dialysis line insertion, or endovascular venous procedures. The study excluded patients who had arterial injuries related to arterial access, such as postarterial line placement, postangiography, or percutaneous coronary interventions. Results: Iatrogenic arterial injuries occurred after attempted venous access procedures involving the common femoral vein (n = 18) and subclavian vein (n = 2). Injuries were related to CVC placement (n = 5), temporary dialysis catheter (n = 14), and inferior vena cava filter insertion (n = 1). Nine patients had transarterial venous catheter insertion complicated by active bleeding from pseudoaneurysm and arteriovenous fistula. Other injuries included isolated fistula (n = 3), isolated pseudoaneurysm (n = 4), isolated branch injury (n = 2), and intra-arterial insertion (n = 2). Endovascular management included stent-graft placement (n = 14), embolization of bleeding vessel (n = 2), and thrombin injection for pseudoaneurysm (n = 2). Conservative management with manual compression achieved hemostasis in two patients. Technical success was achieved in 100%. One patient required repeat angiography and embolization of bleeding branch vessel following stent-graft placement to control bleeding fistula and pseudoaneurysm. Clinical success was achieved in all patients. Procedure-related complications included puncture site hematoma (n = 1) and partially occlusive thrombus/spasm of deep femoral artery after stent-graft placement. Six patients (33%) died within 20 days after the procedure (3-20 days) due to other comorbidities. Three additional patients (16%) died during the same hospital admission at the time of the procedure (38-114 days). There were no reported complaints related to possible stent-graft stenosis or occlusion at mean follow-up time of 5 years (50 days-8.64 years) in all seven patients who survived after stent-graft placement procedure. Conclusion: Despite technically successful endovascular management of arterial injuries related to venous access in critically ill patients, the mortality rate remains high due to other comorbidities. Allowing for the small sample size, stent-graft placement for arterial injuries in this cohort of patients appears to be an effective option with high long-term patency rate.

Purpose: The purpose of this study was to assess the safety and effectiveness of biodegradable stents in the management of benign anastomotic biliary strictures. Materials and Methods: This retrospective study included all consecutive adult patients who underwent percutaneous biodegradable stent insertion for benign anastomotic biliary strictures that were refractory to cholangioplasty or biliary drainage-dependent or preferred stent placement to avoid long-term tube dependence. Fourteen stents were used in 12 patients (9 males) with a mean age of 53 years (range: 23–72 years). Ten patients had liver transplant (7 – choledochocholedochal anastomosis and 3 – hepaticojejunal anastomosis). Two patients had primary sclerosing cholangitis with hepaticojejunal anastomosis. The mean time since surgery was 5.5 years (6 months–16 years). Ten patients had an average of three (range: 1–6) previous sessions of biliary dilatation. Two patients initially preferred stent placement to avoid long-term tube dependence. Results: Technical and clinical success was achieved in all cases. One patient died 2 months after stent insertion because of progressive liver cirrhosis. No re-intervention was required in 8 (72%) of the remaining 11 patients at a mean follow-up time of 234 days (96–539 days). Three liver transplant patients required re-intervention at a mean time of 287 days. There were one severe procedure-related complication (cholangitis and sepsis) and one mild complication (transient septicemia). Stent migration into the bowel occurred in one case a few days after insertion, but this required no re-intervention. No procedure-related mortality occurred. Conclusion: Biodegradable biliary stent may offer a safe and effective option to avoid tube dependence in patients with benign anastomotic biliary strictures.