Background: To evaluate efficacy of percutaneous transluminal angioplasty (PTA) for the endovascular management of arteriovenous fistula (AVF) dysfunction in patients with end-stage renal disease (ESRD) Methods: A total of 135 consecutive patients with ESRD (mean +/- SD age: 58.8 +/- 9.4 years, 74.8% were males) who underwent endovascular treatment for a dysfunctional native AVF were included in this retrospective single-center study. Data on patient demographics, etiology of ESRD, characteristics of AVF, stenotic segments, PTA parameters and postoperative recurrence and patency rates within the 12 months were recorded. Results: Technical and clinical success rates of PTA were 100.0% and 97.0%, respectively. Dysfunction recurrence rate was 30.4%. In patients with vs. without presence of recurrent AVF dysfunction, there was higher percentage of males (P=0.030), older age (P=0.018), diabetic or hypertensive rather than polycystic etiology (P<0.001), younger AVF (P<0.001), longer-segment stenosis (P=0.019) and lower median number (P=0.038) of stenotic segments. Presence of hypertension (OR 12.23, 95% CI: 4.29 to 34.85, P<0.001) and age of the AVF (OR 1.04, 95% CI: 1.00 to 1.08, P=0.029) were significant determinants of increased risk of recurrent AVF dysfunction. Conclusions: Our findings emphasize favorable safety and efficacy of PTA in the management of dysfunctional hemodialysis AVFs in terms ofhigh technical and clinical success and low rates of residual stenosis, complications and post-PTA recurrence of AVF dysfunction. Male gender, older patient age, younger AVF and longer-segment stenosis were associated with higher likelihood of AVF failure, whereas hypertension and age of AVF were the two significant determinants of increased risk of post-PTA recurrence of AVF dysfunction.

Trans-arterial chemoembolization (TACE) has become a widely accepted treatment in unresectable hepatocellular carcinoma (HCC). We aimed at comparing the efficacy of Degradable Starch Microspheres (DSMs)-TACE with 50 ± 7 µm versus 300–500 μm Drug Eluting Beads (DEB)-TACE in terms of initial clinical and radiological treatment response parameters. A total of 54 patients with unresectable HCC who underwent DEB-TACE (n = 25) or DSMs-TACE (n = 29) were included in this retrospective study. Baseline demographic and clinical characteristics, duration of follow-up, local recurrence and survival status, as well as treatment outcome including treatment response via modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria, viable and total tumor diameter and serum alpha-fetoprotein (AFP) levels were analyzed in both study groups. No significant difference was noted between the two groups in terms of local recurrence (31.6 vs. 16.7%) or mortality (73.9 vs. 85.7%) rates after 36-month and 12-month follow-up, respectively. DSMs-TACE vs. DEB-TACE was associated with significantly higher complete response rate (27.6 vs. 0.0%, p = 0.011) and significant decrease in serum AFP levels (p = 0.013). Both DSMs-TACE with 50 ± 7 µm microspheres and 300–500 μm DEB-TACE are effective for local control of unresectable HCC. Our findings revealed superiority of DSMs-TACE over DEB-TACEnin terms of initial clinical and radiological tumor response; though no significant difference was noted between the two patient groups in terms of local recurrence or mortality during follow up.

Background: The present study aims to evaluate the effectiveness of ultrasound-guided percutaneous alteplase (t-PA) injection for the treatment of long segment ( ≥14cm) thrombi in the efferent veins of native arteriovenous fistulas in hemodialysis patients. Methods: A total of 9 patients who underwent t-PA application under ultrasound guidance in the interventional radiology clinic between 2019 and 2021 were included in the study. During the intervention, information such as thrombosed segment length, t-PA dose, number of sessions, presence of aneurysmal segment, bleeding after the intervention and the need for percutaneous transluminal angioplasty (PTA) were recorded. Restoring the flow in the fistula was considered the successful outcome. All statistical evaluations were performed with the IBM SPSS Statistics 21 software (version 21.0; SPSS Inc, Chicago, Illinois) for Windows. Results: Mean age of the patients was 48.7±14 years, the fistula age was 28.7±11 months, the thrombosis age was 3.5±2 days, and the thrombosed segment length was 17.7±2.9 cm. Post-intervention bleeding that did not require treatment was encountered in 2 patients, and stenosis in the proximal fistula was encountered in 6 patients. PTA was applied to 7 patients after t-PA. After the interventions, effective flow was provided in all patients. Conclusion: Ultrasound-guided percutaneous t-PA injection should be considered as an effective intervention which is less invasive, can be performed as an outpatient intervention and has fewer complications, even if the thrombi segments are long (>10 cm). This technique avoids the potential endothelial damage and saves the cost of the mechanical devices.

Hiatus hernia is defined as herniation of the abdominal elements through the esophageal hiatus into the madiastinum. Type IV hiatal herniation is the rarest of all paraoesaphagial hernias. Herniation of pancreas is extremely rare. A 63-year-old male was admitted to the department of oncology with a periauricular squamous cell carcinoma (SCC). Abdominal CT was performed for organ metastasis. No metastasis was found, but hiatal herniation of the stomach along with the body of the pancreas into the thorax was observed. To our knowledge, this is the first case of herniated pancreatic body complicated with a carcinoma in the literature.