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Hemobilia secondary to hepatic artery pseudoaneurysm: An unusual complication of bile leakage in a patient with a history of a resected Ⅲb Klatskin tumor

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World Journal of Gastroenterology 2005年第33期11卷 5229-5231页

作者： dimitrios siablis Zafiria G.Papathanassiou dimitrios Karnabatidis Nikolaos Christeas Constantine Vagianos Department of Interventional Radiology Medical School University of PatrasRioGreece Department of Surgery Medical School University of PatrasRioGreece

We report a case of a 74-year-old woman with a 16-year history of a double bilo-enteric anastomosis due to resected hilar cholangiocarcinoma [Type IIIb Klatskin tumor]. The patient presented with cholangitis secondary to benign anastomotic stenosis which resulted in a large intrahepatic biloma. In order to restore the patency of the anastomosis and overcome cholangitis, several attempts took place, including endobiliary stenting, balloon-assisted biloplasty and transhepatic billiary drainage. Anastomotic patency was achieved, complicated, however, by persistent upper gastro-intestinal bleeding, presented as hemobilia. A biloma-induced pseudoaneurysm of the left hepatic artery was diagnosed. This had ruptured into the biliary tract, and presented the actual cause of the hemobilia. Selective embolism of the pseudoaneurysm resulted in control of the hemorrhage, and was successfully combined with transhepatic dilatation of the anastomosis and percutaneous drainage of the biloma. The patient was ultimately cured and seems to be in excellent condition, 5 mo after treatment.

关键词： Hepatic artery pseudoaneurysm Hemobilia Embolization

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Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: Successful treatment with transcatheter arterial embolization. A case study and review of the literature

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World Journal of Gastroenterology 2006年第26期12卷 4264-4266页

作者： dimitrios siablis Zafiria G Papathanassiou dimitrios Karnabatidis Nikolaos Christeas Konstantinos Katsanos Constantine Vagianos Departments of Interventional Radiology and Surgery University Hospital of Patras RioGreece

Splenic arteriovenous fistula （SAVF） accounts for an unusual but well-documented treatable cause of portal hypertension. A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. Endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography （CT） and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.

关键词： Splenic artery aneurysm Splenic arteriovenous fistula Portal hypertension Transcatheter embolizaUon

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Virtual endoscopy of the urinary tract

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Asian Journal of Andrology 2006年第1期8卷 31-38页

作者： George C.Kagadis dimitrios siablis Evangelos N.Liatsikos Theodore Petsas George C. Nikiforidis Department of Medical Physics Department of Radiology Department of Urology School of MedicineUniversity of PatrasGR 26500 RionGreece Department of Radiology Department of Medical Physics

Technological breakthroughs have advanced the temporal and spatial resolutions of diagnostic imaging, and 3 dimensional （3-D） reconstruction techniques have been introduced into everyday clinical practice. Virtual endoscopy （VE） is a non-invasive technique that amplifies the perception of cross-sectional images in the 3-D space, providing precise spatial relationships of pathological regions and their surrounding structures. A variety of computer algorithms can be used to generate 3-D images, taking advantage of the information inherent in either spiral computed tomography or magnetic resonance imaging （MRI）. VE images enable endoluminal navigation through hollow organs, thus simulating conventional endoscopy. Several clinical studies have validated the diagnostic utility of virtual cystoscopy, which has high sensitivity and specificity rates in the detection of bladder tumor. Published experience in the virtual exploration of the renal pelvis, ureter and urethra is encouraging but still scarce. VE is a safe, non-invasive method that could be applied in the long-term follow-up of patients with ureteropelvic junction obstruction, urinary bladder tumors and ureteral and/or urethral strictures. Its principal limitations are the inability to provide biopsy tissue specimens for histopathologic examination and the associated ionizing radiation hazards （unless MR/is used）. However, in the case of endoluminal stenosis or obstruction, VE permits virtual endoluminal navigation both cephalad and caudal to the stenotic segment. To conclude, VE provides a less invasive method of evaluating the urinary tract, especially for clinicians who are less familiar with cross-sectional imaging than radiologists. （Asian J Androl 2006 Jan; 8： 31-38）

关键词： computed tomography three-dimensional imaging virtual endoscopy urethral stricture

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Percutaneous trans-hepatic bilateral biliary stenting in Bismuth Ⅳ malignant obstruction

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World Journal of Hepatology 2013年第3期5卷 114-119页

作者： dimitrios Karnabatidis Stavros Spiliopoulos Paraskevi Katsakiori Odissefs Romanos Konstantinos Katsanos dimitrios siablis Department of Interventional Radiology Patras University Hospital

AIM: To investigate the clinical efficiency of percutaneous trans-hepatic bilateral biliary metallic stenting for the management of Bismuth Ⅳ malignant obstructive disease. METHODS: Our hospital's database was searched for all patients suffering from the inoperable malignant biliary obstruction Bismuth Ⅳ, and treated with percutaneous bilateral trans-hepatic placement of selfexpandable nitinol stents. The indication for percutaneous stenting was an inoperable, malignant, symptomatic, biliary obstruction. An un-correctable coagulation disorder was the only absolute contra-indication for treatment. Bismuth grading was performed using magnetic resonance cholangiopancreatography. Computed tomography evaluation of the lesion and the dilatation status of the biliary tree was always performed prior to the procedure. All procedures were performed under conscious sedation. A single trans-hepatic track technique was preferred (T-configuration stenting) and a second, contra-lateral trans-hepatic track (Y-configuration stenting) was used only in cases of inability to access the contra-lateral lobe using a single track technique. The study's primary endpoints were clinical success, defined as a decrease in bilirubin levels within 10 d and patient survival rates. Secondary endpoints included peri-procedural complications, primary and secondary patency rates. RESULTS: A total of 35 patients (18 female, 51.4%) with a mean age 69 ± 13 years (range 33-88) were included in the study. The procedures were performed between March 2000 and June 2008 and mean time follow-up was 13.5 ± 22.0 mo (range 0-96). The underlying malignant disease was cholangiocarcinoma (n = 10), hepatocellular carcinoma (n = 9), pancreatic carcinoma (n = 5), gastric cancer (n = 2), bile duct tumor (n = 2), colorectal cancer (n = 2), gallbladder carcinoma (n = 2), lung cancer (n = 1), breast cancer (n = 1) or non-Hodgkin lymphoma (n = 1). In all cases, various self-expandable bare metal stents with diameters rangin

关键词： Bismuth Ⅳ Malignant biliary obstruction Percutaneous bilateral stenting Nitinol stents Palliative treatment Fluoroscopically-guided

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