Against the Odds: A Novel Technique to Perform Cholangiography from a Percutaneous Approach through the Cystic Duct

Abstract

Percutaneous cholangiography is typically performed via a transhepatic approach and is reserved for patients with contraindications to traditional cholangiogram imaging modalities. For those with suspected cholelithiasis or choledocholithiasis who cannot undergo magnetic resonance imaging for diagnosis, percutaneous cholecystostomy with cholangiogram is a viable option. Endoscopic retrograde cholangiopancreatography may also be precluded due to anatomic or obstructive limitations, in which case, percutaneous transhepatic cholangiography (PTC) may be indicated for diagnosis. PTC may be difficult in a patient with minimal biliary tree dilatation, or tortuous cystic duct anatomy. In cases such as these, a steerable microcatheter (SMC) may be utilized to enable or expedite PTC. The technique to traverse and catheterize the cystic duct and opacify the gallbladder, bile ducts, and duodenum utilizing an SMC is described. This report outlines a non-vascular application of the SMC resulting in a successful cholangiogram, with reduced operative time and thus reduced radiation exposure to the patient.

Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion

“…Eadie et al described the use of the first establishment of an otherwise complicated percutaneous nephrostomy, using a steerable microcatheter [ 16 ]. Padilla et al described the first use of a steerable microcatheter to perform a technically challenging cholangiogram when a traditional guidewire would not traverse a tortuous biliary system [ 17 ]. The absence of the need for advancement of a steerable microcatheter over a guidewire alone alters the foundation of intervention and the traditional wire and catheter system.…”

Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology

“…The article 'Welcome to the New Era: A Completely Wireless Interventional Procedure' described the first vascular interventional application of the steerable microcatheter, which also disclosed the reduced procedural time [5]. Others have reported the surpassing functionality of steerable microcatheters over traditional wire and catheter systems in the extravascular setting [6-7]. Harmon et al first recognized how steerable microcatheters show promise in the reduction of radiation exposure and procedural time in patients with acute ischemic stroke [8].…”

SwiftNINJA steerable microcatheter: a new kid on the block for selective catheterization of vascular and valvular congenital lesions

“…The SwiftNINJA ® (Merit Medical Systems, Inc., USA) is a recent steerable microcatheter (SM) that allows operators to modify the angle and shape of its tip in real-time (8,9). This device has been reported exclusively in interventional radiology procedures, promising to improve the success and efficiency of super-selective vessel cannulation (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In 2022, we introduced this new device to our armamentarium and employed it upfront in tricky situations or as a bailout option for selective catheterization in children with challenging anatomies.…”