Extreme IR. Extraordinary Cases in Interventional Radiology and Endovascular Therapies

Part I. Arteries: Thoracic and Abdominal Aorta and Iliac Arteries
1. Percutaneous Trans-Atrial Embolization of an Ascending Aortic Pseudoaneurysm
2. Complete Endovascular Arch Repair for Type A Aortic Dissection
3. COVID Aortic Clot
4. Transcaval Endoleak Repair Complicated by Onyx Leak into the IVC and Heart
5. Failed Endovascular Repair of Mycotic Aortic Arch Aneurysm Using the Atrial Septal Defect Occluder
6. Salvaging a Prematurely Unsheathed Fenestrated Aortic Arch Stent Graft
7. “Mind the Gap”: Bridging the Branched Graft Disconnect
8. Percutaneous Iliac Artery Type II Endoleak Embolization Complicated by Active Extravasation
9. “One Way In”: Percutaneous Transarterial Embolization of a Persistent Iliac Aneurysm
10. Percutaneous Ilio-Femoral Arterial Bypass
11. Branched Arterial Reconstruction and Recanalization of Occluded Right Lower Extremity Stents and Giant Femoral Anastomotic Pseudo Aneurysm in an Aortobifemoral Graft Patient
12. Managing Complex Iatrogenic Guidewire Dissection and a Damaged Stent
Part II. Arteries: Peripheral Vessels and Branches
13. Retrograde Puncture of the Profunda Femoris Artery to Facilitate Treatment of Critical Limb Ischemia
14. Endovascular Recanalization and Stenting of Chronic Superficial Artery Occlusion through the Dorsalis Pedis Artery
15. Deep Venous Arterialization with Ellipsys Side-to-Side Anastomosis
16. Shooting Your Way Out: Endovascular Arterial Bypass Via Gunsight
17. Unconventional Endovascular Salvage of an Iatrogenic Dissecting Fusiform Long Segment SFA Aneurysm
18. “Musashi” Snuffbox Access for Simultaneous Arterial and Venous Access
19. Modified SAFARI Technique: Using a Re-entry Device and a Target Balloon to Connect Antegrade and Retrograde Subintimal Lumina
20. Carotid Retrograde Rescue through the Anterior Communicating Artery
21. Combined Endovascular and “Minimally Invasive” Removal of Traumatic Nail Gun Injury to the Skull and Face
22. Common Carotid Artery Pseudoaneurysm
Part III. Venous
23. Ultrasonic Thrombectomy and Stent Placement for Life-Threatening SVC Syndrome in an Infant: Acute and Long-Term Outcomes
24. Sharp Recanalization of Chronic Total Venous Occlusions of the Superior Vena Cava at the Cavoatrial Junction
25. Balloon Targeted Sharp Recanalization and Neo-SVC Reconstruction Via Transhepatic Access
26. Extra-Anatomical Venous Bypass Through a Malignant Tumor for Palliation of Massive Arm Edema
27. Retrieval of Permanent VenaTech Filter with Retained Migrated Fragments in the Heart and Lung
28. Think Fast and Act Quick: Complex IVC Filter Removal
29. Stent-Excluded IVC Filter Causing Severe Abdominal Pain: The Porthole Retrieval Technique
30. AngioVac Thrombectomy of Two-Month-Old Iliocaval Thrombosis in a 15-Year-Old Resulting from Gunshot Wound and Surgical Caval Ligation
31. Single-Session Total IVC and Iliofemoral Endovascular Construction for Caval Agenesis
32. Neocaval Reconstruction Complicated by Endosac Collateral Bleeding
Part IV. Portal Hypertension
33. TIPS Surprise and Massive Extravasation: Never Underestimate a “Small” Splenic Aneurysm
34. Portal Hypertension due to a Pancreatic Pseudocyst Fistula into the Portal Vein: Treatment with Extended TIPS
35. Direct Transhepatic Varico-Caval Shunt for the Treatment of Portal Varices
36. Emergent Stent Graft for Traumatic Laceration of the Right Portal Vein
37. Angio-CT Guided Sharp Recanalization of Superior Mesenteric Venous Occlusion for Treatment of Bleeding Jejunal Varices
38. Double-Barrel Flow Reducing Stents for Hypoplastic Portal System Development in a Congenital Portosystemic Shunt [CPSS]
39. Embolization of a Large Inadvertent Iatrogenic Arterioportal Shunt
40. Pancreatitis-Related Portal Vein Aneurysm Treated with Stent-Assisted Coil Embolization
41. Percutaneous Porto-Mesenteric Venous Endoconduit Creation to Restore Portal Venous Flow
42. Mesocaval Shunt in Patient with Portocaval Transposition
43. Percutaneous Trans-Colonic Transhepatic Mesocaval Shunt Creation
44. Transcaval to Mesenteric Collateral Shunt Creation in a Patient with Chronic Spleno-Mesentero-Portal Thrombosis
45. Mirror Mirror: TIPS in Situs Inversus with Transfemoral Transcaval Guidance
46. Roller Coaster TIPS
47. Explant of a VIATORR TIPS Endoprosthesis Misplaced into the Common Bile Duct
48. Antegrade Transmesenteric Stenting of a Kinked Portal Vein After Acute Liver Transplant
49. Transcatheter Thrombolysis for Acute Massive Portal and Mesenteric Vein Thrombosis in the Postpartum Period
Part V. Visceral (Arterial & Venous)
50. Rendezvous Recanalization of an Occluded Hepatic Artery Stent Via Percutaneous Transhepatic Access
51. Percutaneous Trans-Needle Glue Embolization of an Isolated Visceral Aneurysm
52. Vascular Ehlers-Danlos Syndrome Complicated by Ruptured Hepatic Artery Pseudoaneurysm
53. Endovascular Recanalization of Hepatic Artery Thrombosis After Liver Transplantation
54. Celiac Trunk Avulsion Treated with Endograft and Embolization During Open Cardiac Massage
55. Pancreas Transplant Anastomotic Breakdown Treated with Stents and Thrombin
56. A Challenging High Flow Renal AVF with Giant Venous Aneurysm
57. Renal Artery Graft Anastomosis Gone Wrong: Bowel Ischemia
58. Complex Right Renal Artery Aneurysm Treatment with a Stent-Graft After Migration of an Intra-Aneurysmal Bare Stent
59. Endovascular Treatment of a Wide-Necked Proximal Celiac Artery Aneurysm
60. Coil Embolization of Large Uterine Artery Aneurysm During Pregnancy
Part VI. Biliary
61. Reconnecting the Bile Duct: Percutaneous Hepatico-Cholecysto-Enterostomy
62. Intrahepatic Neobiliary Duct Formation for Benign Biliary Obstructive Jaundice
63. Radiofrequency-Wire Guided Reconstruction and Neo-Duct Creation for Complete Right Extrahepatic Bile Duct Ligation after Robotic Cholecystectomy
64. Hilar Biliary Obstruction Treated with Extraordinary Extra-Anatomical Endoprostheses
65. Leave Only Liquid: Prophylactic Liquid Embolization of a Chronic Transpleural Biliary Drain Tract
66. Glue Embolization of a High Output Biliary Fistula After RFA
67. EVOH Embolization of a Subtle Arterio-Biliary Fistula: From Artery into the Bile Duct
68. Use of a Ventricular Septal Defect Device to Seal a Post-Ablation Gallbladder Wall Injury
Part VII. Interventional Oncology: Transarterial and Ablation
69. Complete Response to Intra-arterial Therapy of an Infiltrative Hepatocellular Carcinoma with Extensive Parasitization
70. Yttrium-90 Radiation Segmentectomy from the Internal Mammary Arteries
71. Neoadjuvant TACE for IVC Leiomyosarcoma with Non-target Embolization
72. Palliative Cryoablation
73. Shockingly Cold: Irreversible Electroporation and Cryoablation of Periportal Nodal and Serosal Metastases
74. Iterative Cryoablation of a Head and Neck Adenocarcinoma Recurrence
75. MRI-Guided Cryoablation of a Frontal Glioblastoma Recurrence After Surgery and Chemo-Radiotherapy
76. Percutaneous Cryoablation of a Precarious Pulmonary Nodule
77. Treatment of Renal Parenchymal Blowout After Cryoablation Using Balloon-Assisted Coil Embolization
78. Art of Ablation: Technologic Synergy of Fused Images and Guidance
79. Pelvic Metastasis Treated with Irreversible Electroporation (IRE)
80. Iatrogenic Pneumothorax for Creation of a Safe Percutaneous Window for Liver Ablation
Part VIII. Vascular Malformations and Arteritidies
81. Stop and Listen to the Birds Sing and Then Go With the Flow
82. Bleomycin Orbital Sclerotherapy of a Retro-Orbital Low Flow Lymphovenous Malformation
83. Percutaneous Sclerotherapy of a Bleeding Nasal Arteriovenous Malformation
84. Venous Outflow Embolization for Obliteration of a Massive Lower Extremity AVM
85. Primum Non Nocere, or the Wrong and the Right AVM Treatment
86. 3D Printing Facilitates Embolization of Persistent Mixed Complex/Diffuse Pulmonary Arteriovenous Malformation
87. Endovascular Stenting of Pulmonary Stenosis from Takayasu Arteritis
Part IX. Hemodialysis Access
88. Fluoroscopic and Trans-Esophageal Echocardiographic Guided Removal of Dialysis Access Stents Migrated to the Heart and Pulmonary Artery
89. Embolization of Extensive, Persistent Surgical Hemodialysis Antecubital Arteriovenous Fistula Causing Severe Arm Edema
90. Recreation of Disrupted AV Graft Venous Anastomosis Using Translumenal Needle Puncture of Venous Target Balloon
91. Insertion of a Long-Term Central Venous Catheter at the Subclavian Vein Through a “Full Metal Covered Stent Jacket”
92. Brachial Plexopathy After Creation of Alternate Venous Outflow in a Dialysis Patient
Part X. Non-Vascular (Biopsy, Misc)
93. Percutaneous Biopsy of an Intra-abdominal Mass Surrounded by Intestines: A Needle and Guidewire Technique
94. Percutaneous Debridement of Hepatic Echinococcal Cyst
95. Antegrade Removal of Covered Metallic Ureteral Stent Placed for 4 Years
Part XI. Ortho
96. Reconstruction of the Posterior Pelvic Angle with an Interlocking Screw-Cement Construct
97. Ceruicis Spina Emendo
98. Subcutaneous Embedded Kyphoplasty Cannula Extraction: The Excalibur
Part XII. Lymphatic
99. Transhepatic Lymphangiogram with Complex Central Lymphatic Leak Embolization
100. Retrograde Glue Embolization of Retroperitoneal Lymphatic Leak After Mycotic Aortic Aneurysm Repair
101. Retrieval of Pulmonary Glue Embolus During Transabdominal Lymphatic Embolization

This book presents 101 unique and extraordinary cases in interventional radiology (IR) and endovascular therapy. Extreme IR is an internationally recognized event that Dr. Ziv Haskal created and held in early 2000's at mountaintop venues, then at successive Society of Interventional Radiology annual conference meetings, and later, published monthly within the Journal of Vascular and Interventional Radiology (JVIR) for which he was editor-in-chief for 10 years. The ever-popular Extreme IR sessions at conferences have drawn more than 5,000 attendees. Cases are presented in a rapid-fire format designed to maximize relevancy, excitement, and unique knowledge. This book aims to replicate that experience for a wider audience. The book is divided into twelve sections, including venous, portal hypertension, and biliary, arterial, oncology, etc. cases. Most cases span two pages and include large, illustrative images with bullet-pointed text to present essential information in a concise and focused fashion. The global list of authors exemplifies the extraordinary breadth of the cases for interventional radiologists, endovascular specialists. It is ideal for interventional radiologists and endovascular specialists at all levels of seniority and training.