No abstract

Iatrogenic arteriovenous fistula is a unique complication during pacemaker implantation. A 55‐year‐old man was posted for pacemaker implantation for recurrent unexplained syncope with trifascicular AV block. After axillary/subclavian venous puncture and introduction of RV lead, arterial spurting was immediately noticed as the the sheath was peeled away. After dissecting the overlying pectoralis muscle, deep sutures and manual compression achieved hemostasis. However, Subclavian arteriogram revealed an arteriovenous fistula from a lateral thoracic artery branch to the innominate vein. Hilal coils were deployed near the fistulous orifice, leading to complete resolution of the leak. After 3 days, pacemaker was implanted from right side. A multidisciplinary approach was the key to successful outcome.

Encouraging outcomes in terms of disease recurrence and overall survival need to be balanced with the risk of surgical drop out and perioperative complications when selecting patients for TACE prior to resection.

273 Background: The purpose of this work was to determine efficacy, toxicity, and patterns of recurrence after radiotherapy (endobilliary and/or external RT) with or without chemotherapy in patients with unresectable or post operative high risk extrahepatic bile duct cancer (EHBDC) and hilar cholangiocarcinoma (Klatskin tumours). Methods: From Aug 2005 to July 2012, 67 patients with non-metastatic EHBDC and hilar cholangiocarcinoma were treated with radiotherapy (endobilliary and / or EBRT) with or without chemotherapy at our institution. Sixty one patients had unresectable disease while remaining six patients were post operative patients. Twenty two patients received only endobilliary RT, 20 patients received only EBRT, while 25 patients received both. Concurrent Gemcitabine during EBRT was given in 10 patients. Histopathological diagnosis was available in 50 patients (75%). Median dose for EBRT and endobilliary RT was 45 Gy (range: 25 Gy to 57 Gy) and 14 Gy (range: 12 Gy to 20 Gy) respectively. Results: Median age was 54 years (range 23-76 years) and there were 37 men and 30 women. Median follow up for whole group was 6 months (range 1-28 months). Seven patients had complete response, 22 patients had partial response, 4 patients had stable disease, while 6 patients had progressive disease after EBRT. Twenty five patients were alive at last follow up. The median overall survival was 7 months and one year survival was 30% for whole group. Patients receiving EBRT (with or without endobilliary) had better survival as compared to patients receiving only endobilliary RT (median survival 13 months Vs 5 months, p=0.001). The main sites of distant disease progression were liver and peritoneum. Eighteen patients had developed cholangitis while 3 patients developed hematemesis due to duodenitis. Conclusions: Radiation in unresectable cholangiocarcinoma is feasible with acceptable clinical outcome and toxicity. Patients receiving EBRT has better outcome as compared to those receiving only endobilliary RT.

Medicine is an ever changing field and interventional radiology (IR) procedures are becoming increasingly popular because of high efficacy and its minimally invasive nature of the procedure. Management of disease processes in the extra cranial head and neck (ECHN) has always been a challenge due to the complex anatomy of the region. Cross sectional imaging of the ECHN has grown and evolved tremendously and occupies a pivotal and integral position in the clinical management of variety of head and neck pathologies. Advances in angiographic technologies including flat panel detector systems, biplane, and 3-dimensional rotational angiography have consolidated and expanded the role of IR in the management of various ECHN pathologies. The ECHN is at cross roads between the origins of great vessels and the cerebral vasculature. Thorough knowledge of functional and technical aspects of neuroangiography is essential before embarking on head and neck vascular interventions. The vessels of the head and neck can be involved by infectious and inflammatory conditions, get irradiated during radiotherapy and injured due to trauma or iatrogenic cause. The ECHN is also a common site for various hypervascular neoplasms and vascular malformations, which can be treated with endovascular and percutaneous embolization. This pictorial essay provides a review of variety of ECHN pathologies which were managed by various IR procedures using different approaches.