Percutaneous biopsy and drainage procedures in the abdomen using a modified coaxial technique

A modified coaxial technique for biopsy and drainage procedures in the abdomen is described. This technique involves initial placement of a 23-gauge needle into an abdominal organ or mass. Once proper position is obtained, the hub of the needle is removed and a 19-gauge or larger needle is placed over the 23-gauge needle. Through this larger needle, either multiple biopsies are performed or guidewire exchange for a larger catheter is accomplished. The technique was used in performance of seven biopsy procedures, one biliary drainage procedure, and three nephrostomies.     

Technical note: Percutaneous fine needle aspiration biopsy using a modified coaxial technique

A modified coaxial technique for the biopsy of small or deeply situated lesions using computed tomographic (CT) guidance is described. A 22-gauge needle was passed coaxially through an outer 18-gauge introducing needle and aspiration biopsy was performed. This modified coaxial technique allows for multiple biopsies to be obtained safely, expeditiously, and repeatedly.     

Percutaneous drainage of pancreatic pseudocysts: technique and problems

In 18 patients, 27 of thirty two pseudocysts were successfully drained percutaneously. The first 26 were drained directly and the last six drained transgastrically. Failures resulted from tube blockage by necrotic phlegmon in three and pancreatico-cutaneous fistulation in two with obstructed pancreatic ducts. Transgastric drainage is preferred as it appears to prevent chronic pancreatico-cutaneous fistula formation.     

Percutaneous vertebral biopsy through intact bone: a coaxial bone transgressing technique with 18 gauge needle

Advancement of radiologic technologies allows the detection of vertebral lesions at an earlier stage, thereby increasing the proportion of vertebral lesions that are surrounded by intact bone when they are detected. While biopsy guns are effective in obtaining good-quality tissue samples of osteolytic bone lesions, lesions that are covered by intact bone are not accessible with a biopsy gun. For percutaneous biopsy of osteolytic vertebral lesions, an intact-bone transgressing technique is described in which a simple, inexpensive and small-calibre (18-gauge) instrument is used to allow multiple passage of 20-gauge biopsy guns for effective tissue sampling. In this series consisting of metastatic and myeloproliferative lesions, the effectiveness and safety of this well-tolerated technique are demonstrated in thoracic and lumbar vertebrae.     

Sialography: a simplified technique.

A simplified method of sialography is described. A wedged catheter tip positioned in the duct prevents backward leakage of contrast material into the oral cavity.     

A simplified percutaneous hepatogastric drainage technique for malignant biliary obstruction

We describe a technique to bypass a malignant biliary obstruction by creating a direct connection between the left biliary tree and the stomach. First, adherence between the left liver parenchyma and the stomach is achieved by a Cope anchor system. Then, the left biliary tree and stomach are connected by Colapinto needle puncture of the stomach from a left biliary duct with the needle inserted through a 9 Fr transhepatic sheath. Over a stiff guidewire, a Ring drainage catheter is placed. Later, the Ring catheter is replaced by a metallic stent. Four patients with malignant biliary obstruction underwent this procedure. The mean survival time was 77 days with maximum follow-up of 171 days. Neither obstruction nor dislocation of the metallic stents occurred.Presented at the 18th CIRSE Meeting, Budapest 1993     

Percutaneous coaxial needle biopsy using the spacer technique: a novel and easy modification to increase procedure safety

We describe a novel but easy modification to percutaneous coaxial needle biopsy technique using readily available standard equipment to enable a predefined variable sampling length to be achieved. This technique involves the insertion of a carefully measured spacer between the coaxial cutting needle and guide needle. This can minimise the sampling length required to biopsy any given lesion, minimising the volume of traumatised tissue and preventing unnecessary penetration of tissues deep to smaller lesions, thus increasing procedure safety.     

FluoroCT guided biopsies: a simplified technique

We report the use of a specific handle we designed for interventional procedures guided by fluoro-CT. This handle, easy to use and low cost, improves the procedures reducing dramatically the procedure time.     

Percutaneous radiologic gastrostomy with a simplified gastropexy technique under ultrasonographic and fluoroscopic guidance: experience in 154 patients

Purpose: To evaluate the effectiveness and safety of percutaneous radiologic gastrostomy (PRG) under ultrasonographic (US) and fluoroscopic guidance using a simplified gastropexy technique.

Material and Methods: One hundred and fifty-four (154) patients (mean age 73, range 22-93 years) were referred for PRG. Indication for PRG was neurologic disease, head/neck cancer, and other disease in 73%, 15%, and 12%, respectively. Initially, the stomach was filled with 300-500 cm³ of tap water via a nasogastric tube. The fluid-filled stomach was punctured under US guidance. A guidewire and a single T-fastener were introduced. Under fluoroscopic guidance, the tract was dilated over the guidewire until a 16F dilator with a peel-away sheath could be introduced. During dilatation, the external suture string to the T-fastener was held tight to fixate the gastric wall. A 14F balloon-retained gastrostomy tube was introduced and inflated. The T-fastener was then released, and the gastrostomy tube was retracted gently to affix the gastric wall to the abdominal wall (tube gastropexy). Technical success was assured by aspiration of gastric fluid and fluoroscopically by injection of a water-soluble contrast medium.

Results: The primary technical success rate was 98%. At 30-day follow-up, 3.2% had major complications and 14% minor complications. Three patients (1.9%) died of complications related to the procedure. Thirteen cases (8%) of simple tube displacement without other complications occurred.

Conclusion: PRG guided by US and fluoroscopy is a relatively safe technique with a high success rate, provided the stomach can be properly distended with fluid. However, tube gastropexy alone does not seem to protect against early dislodgement.     

Percutaneous abscess drainage

Literature published in the past year has focused on controversy over the indications for percutaneous abscess drainage, particularly drainage of hepatic, splenic, and renal abscesses. Percutaneous abscess drainage for intra-abdominal abscesses with enteric communication, perivascular abscesses, infected abdominal tumors, tuboovarian abscesses, and pancreatic collections is also reviewed.