Interventional radiology in the liver and pancreas

The application of interventional radiographic procedures in the management of patients with liver and pancreatic pathology continues to expand. Percutaneous hepatobiliary interventional procedures that have received considerable attention in the past year include technical refinements of the transjugular intrahepatic portosystemic shunt procedure used in patients with portal hypertension and esophageal varices, transshunt embolotherapy of persistent varices in patients with small-caliber mesocaval shunts, percutaneous and transcatheter embolotherapy of hepatic malignancies in patients with primary or metastatic lesions, and MR angiography in the preoperative evaluation of patients awaiting liver transplantation. Other topics reviewed include percutaneous and transvenous biopsy of orthotopic liver transplants, management of bile leaks and strictures after liver transplantation, use of a biopsy gun and larger gauge needles to obtain specimens for histologic analysis in patients with orthotopic liver and pancreatic transplants, percutaneous treatment of caval and hepatic venous stenoses in patients with Budd-Chiari syndrome using self-expanding stainless steel stents, percutaneous treatment of patients with hepatic Echinococcus granulosus cysts, and percutaneous managements of iatrogenic hepatic vascular injuries. General diagnostic evaluation and interventional procedures highlighted include using selective intra-arterial injection of calcium to localize small insulinomas. Recent review papers describing complications of percutaneous transabdominal fine-needle biopsy are analyzed. The diagnostic and therapeutic options available for treating patients with hepatic and pancreatic diseases are summarized in greater detail.