Biliary Interventions: Stones to Stents

Role of Interventional Radiology in the Management of Infection

Interventional radiology (IR) is plays a crucial role in the management of localized infections, utilizing percutaneous access to loculated fluid collections for drainage and source control. Interventions have been developed in multiple organs and systems and used over decades, allowing the IR physician to provide patient care in many cases where surgical options are not optimal. In this review, we will examine the emergent, urgent, and routine nature of various IR procedures in the infectious context and timelines for each in regards to the decision making process. An algorithmic approach should guide the clinician's decision making for IR procedures in both large academic centers and smaller community hospitals. This approach and the pertinent procedural technique are described for multiple systems and organs including the biliary tree, gallbladder, genitourinary tract, and thoracic, abdominal, and pelvic abscesses. Increased awareness of the abilities and limitations of IR physicians in clinical scenarios needs to be implemented, to allow multispecialty input in efforts to decrease morbidity and mortality.

The interventional radiological management of cholangiocarcinoma

The successful management of cholangiocarcinoma requires the collaboration of several clinical disciplines. Modern imaging can demonstrate the liver and the surrounding structures in exquisite detail. Complete surgical resection offers the only potential for cure. The judgement of whether resection is feasible requires precise staging of the tumour. Unfortunately, in most cases, imaging delineates an advanced and inoperable tumour, requiring non-surgical palliative treatment, usually by means of endoscopic or percutaneous radiological techniques. The management of hilar lesions can be problematic requiring substantial experience and skill.