Adam Hatzidakis
University of Crete, Radiology, Faculty Member
We report two patients with Budd-Chiari syndrome, who underwent direct intrahepatic portosystemic shunt complicated by shunt thrombosis. Percutaneous AngioJet mechanical thrombectomy in combination with manual catheter aspiration and... more
We report two patients with Budd-Chiari syndrome, who underwent direct intrahepatic portosystemic shunt complicated by shunt thrombosis. Percutaneous AngioJet mechanical thrombectomy in combination with manual catheter aspiration and balloon disruption of the residual clot was successful, restoring patency of the thrombosed shunt.
A 69-year-old man with portal hypertension was admitted with decompensated alcoholic cirrhosis and diuretic resistant ascites. Ultrasound revealed partial portal thrombosis. Due to diuretic intolerance, transjugular intrahepatic... more
A 69-year-old man with portal hypertension was admitted with decompensated alcoholic cirrhosis and diuretic resistant ascites. Ultrasound revealed partial portal thrombosis. Due to diuretic intolerance, transjugular intrahepatic portosystemic shunt (TIPS) was decided during which a hepatic arterial branch was inadvertently catheterized. Finally, TIPS was created, but the patient continued gaining weight. Color-Doppler ultrasonography (CDUS) showed upper stent part patency with absence of flow in lower stent portion. Twenty-five days later, the patient presented melena. Endoscopy revealed blood emerging from the Vater papilla. Hepatic angiography revealed arteriovenous shunt between a hepatic arterial branch and the proximal part of the TIPS shunt. Covered stent placement restored sufficient TIPS flow. The patient deteriorated and died 1 month later. We found out that our major technical drawback was that we did not inject a small amount of contrast after puncturing the supposed portal vein, in order to confirm correct position of the needle.
ehçet's disease is a rare condition usually presenting with complex inflammatory manifestations like stomatitis, genital ulcerations, and iritis with sub-purulent products. The disease is common throughout the world, but is more... more
ehçet's disease is a rare condition usually presenting with complex inflammatory manifestations like stomatitis, genital ulcerations, and iritis with sub-purulent products. The disease is common throughout the world, but is more prevalent in the eastern Mediterra- nean countries and Japan (1). The disease is of unknown origin with a histopathological picture revealing affected tissues that are infiltrated by mononuclear monocytes.
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ABSTRACT Percutaneous transhepatic biliary drainage (PTBD) is a therapeutic procedure, which leads to the percutaneous drainage of the obstructed bile duct system. The underlying disease is either malignancy of the bile ducts itself, or... more
ABSTRACT Percutaneous transhepatic biliary drainage (PTBD) is a therapeutic procedure, which leads to the percutaneous drainage of the obstructed bile duct system. The underlying disease is either malignancy of the bile ducts itself, or of adjacent organs or structures such as pancreas, lymphnodes, the gallbladder, or the stomach. PTBD is also performed in benign conditions due to biliary stones or strictures, posttransplantation strictures, and after surgery (iatrogenic injuries).
... variceal bleeding [4–6]. Interventional radiology offers a valid treatment for portal hypertension in patients af-fected with Budd–Chiari syndrome following the devel-opment of the conventional TIPS procedure and lately with the DIPS... more
... variceal bleeding [4–6]. Interventional radiology offers a valid treatment for portal hypertension in patients af-fected with Budd–Chiari syndrome following the devel-opment of the conventional TIPS procedure and lately with the DIPS procedure [7–10]. Petersen described the ...
We report a case of an 80-year-old man, who underwent an endovascular repair of an abdominal aortic aneurysm. Surgical access was obtained from both common femoral arteries, and the procedure was uneventful. One month computed tomography... more
We report a case of an 80-year-old man, who underwent an endovascular repair of an abdominal aortic aneurysm. Surgical access was obtained from both common femoral arteries, and the procedure was uneventful. One month computed tomography (CT) follow-up was without findings. Two months after endovascular aortic aneurysm repair (EVAR), the patient complained of claudication on the left side associated with persistent pain, rigid swelling on the left groin area, and occasional febrile episodes within the last month. Ultrasonography showed fluid collection, and needle aspiration gained pus. It was thought to be local postsurgical infection, and the patient got antibiotics, but he did worse. One month later, computed tomography revealed focal left common femoral artery (CFA) stenosis, edematous appearance of subcutaneous soft tissue in the left groin area, and anterior displacement of the ipsilateral CFA in relation to the right side. Surgical exploration of the region revealed retained,...
We report an unusual complication of ultrasound-guided percutaneous liver biopsy, in the form of a persisting iatrogenic bilio-cutaneous fistula. A patient with liver hilar tumor and malignant obstructive jaundice was initially treated by... more
We report an unusual complication of ultrasound-guided percutaneous liver biopsy, in the form of a persisting iatrogenic bilio-cutaneous fistula. A patient with liver hilar tumor and malignant obstructive jaundice was initially treated by successful placement of bilateral metallic stents and did well until mass biopsy was decided. The fistula created decreased patient's quality of life, and because the patient refused further interventions, fistula catheterization for embolization was proposed. We injected a gelatin matrix into the extrahepatic portion of the fistula and embolized the tract successfully.
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Research Interests: Stents, Catheterization, Humans, Male, Rupture, and 3 moreAged, Coronary Angiography, and Iatrogenic Disease
The balance between oxidants and antioxidants can play an important role in the initiation and development of liver diseases. Recently, we have described a new automated method for the determination of total antioxidant capacity (TAC) in... more
The balance between oxidants and antioxidants can play an important role in the initiation and development of liver diseases. Recently, we have described a new automated method for the determination of total antioxidant capacity (TAC) in human serum and plasma. We measured TAC and corrected TAC (CTAC -abstraction of interactions due to endogenous uric acid, bilirubin and albumin) in 52 patients with chronic liver diseases (41 patients with primary biliary cirrhosis (PBC), 10 patients with chronic hepatitis C and 13 patients with viral HCV cirrhosis) as well as in 10 healthy controls. In 23 PBC patients measurement were also done 6 mo after treatment with ursodeoxycholic acid (UDCA). The TAC assay was based on a modification of the crocin bleaching assay. The results were correlated with routine laboratory measurements and the histological stage of PBC. There were no significant differences in TAC between the various groups. However, CTAC was considerably increased in the PBC group c...
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Hepatic involvement in hereditary hemorrhagic telangiectasia is infrequent and poorly studied. We describe a 62-year-old woman with Rendu-Osler-Weber (ROW) disease and recurrent gastrointestinal bleeding episodes. Blood chemistry was... more
Hepatic involvement in hereditary hemorrhagic telangiectasia is infrequent and poorly studied. We describe a 62-year-old woman with Rendu-Osler-Weber (ROW) disease and recurrent gastrointestinal bleeding episodes. Blood chemistry was consistent with the presence of cholestasis. Imaging studies revealed prominent vascular abnormalities in the liver and focal intrahepatic bile duct dilatations. The intimate anatomic relationship of the vascular abnormalities to the dilated bile ducts suggests that external vascular compression could have caused their dilatation. To our knowledge, this mechanism has not been proposed in the literature as a possible explanation of biliary dilatation in patients with ROW.
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Mycotic abdominal aortic aneurysms although rare are accompanied by an extensive risk of morbidity and mortality. Surgical treatment is challenging, but it offers the only chance of survival. Extra-anatomic aortic reconstruction through... more
Mycotic abdominal aortic aneurysms although rare are accompanied by an extensive risk of morbidity and mortality. Surgical treatment is challenging, but it offers the only chance of survival. Extra-anatomic aortic reconstruction through uninfected tissues is feasible, providing a durable therapeutic option in the presence of severe infection.
A solid pseudopapillary neoplasm (SPN) is an extremely rare tumour of the pancreas that frequently occurs in young females and is mostly benign. SPN is a low-grade malignant tumour that may evolve years before symptoms start. However, the... more
A solid pseudopapillary neoplasm (SPN) is an extremely rare tumour of the pancreas that frequently occurs in young females and is mostly benign. SPN is a low-grade malignant tumour that may evolve years before symptoms start. However, the pathogenesis of this tumour remains unclear and there are no adequate reports of long-term results to evaluate the management and the long-term surgical control. We describe a new case of SPN with a 10-year follow-up, and review the world literature that accounts for approximately 322 cases. Moreover, a review of the current management and surgical tendencies in the treatment of SPN is considered. An SPN pancreatic tumour occurred in a 24-year-old female who complained of episodic mild abdominal pain sustained by a palpable epigastric mass. The tumour mass was detected by ultrasound and computer tomography and was localised at the tail of the pancreas adherent to the spleen. The preoperative diagnosis was uncertain and en-block distal pancreatectomy and splenectomy were performed. The size of the mass which weighed 300 g was 11 x 12 x 8 cm, and the tumour was strictly adherent and invaded the splenic hilum. Histologic examination confirmed a complete resection of the primary SPN that locally invaded spleen. The postoperative period was uneventful and after a 10-year follow-up the patient is free of symptoms. SPN should be considered in the differential diagnosis of large pancreatic masses, especially in young females. Radical resection, where technically feasible, should be considered the therapy of choice as it is a safe and effective control of the disease.
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The concept of percutaneous management of malignant biliary obstruction has not significantly changed in the last two decades and is based on the successful drainage of bile toward the duodenum, which normalizes liver function and... more
The concept of percutaneous management of malignant biliary obstruction has not significantly changed in the last two decades and is based on the successful drainage of bile toward the duodenum, which normalizes liver function and prevents the development of cholangitis and sepsis. However, patient survival has changed slightly in the last two decades due to the advance of the diagnostic methods, chemo-radiotherapy protocols, and minimally invasive local control of the disease. Bare metal stents have not improved; however, newly developed covered biliary stents have been designed, and there is now evidence supporting their use in the clinical practice. However, other novel devices that may potentially offer benefit to patients with malignant biliary obstruction have been developed, such as drug-eluting biliary stents and intraductal ablation devices, and first feasibility trials have been published that offer encouraging results. These new technological developments, in combination with increased patient survival, bring new exciting data in this constantly developing area. The purpose of this review article is to investigate the latest published evidence on percutaneous minimal invasive palliation of malignant biliary disease and to delineate current trends.
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We report the case of a 78-year-old male patient with obstructive jaundice due to a pancreatic head neoplasm. The... more
We report the case of a 78-year-old male patient with obstructive jaundice due to a pancreatic head neoplasm. The patient's general condition did not permit an endoscopic approach and the presence of diffuse liver metastases prohibited hepatic puncture for percutaneous biliary drainage, therefore the transcolecystic transperitoneal approach was decided to be the safest decompression route. Through a gallbladder access, a Viabil-covered stent with a mesh extension was placed in the distal common bile duct, without complications. The patient died 8 months later without signs of stent dysfunction or necessity of reintervention. Transcholecystic transperitoneal access is a safe option when diffuse liver metastases prohibit the transhepatic approach, even in cases where placement of a covered stent is considered necessary.
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We report a case of simultaneous late migration of two ePTFE-FEP covered biliary endoprostheses (Viabil, W.L. Gore, Flagstaff, AZ, USA) that were percutaneously implanted for the treatment of malignant obstructive jaundice. The first... more
We report a case of simultaneous late migration of two ePTFE-FEP covered biliary endoprostheses (Viabil, W.L. Gore, Flagstaff, AZ, USA) that were percutaneously implanted for the treatment of malignant obstructive jaundice. The first Viabil covered stent was placed successfully without any evidence of dislocation or other complication during follow-up. Occlusion of the stent occurred 4 months later and was treated with the placement of a second stent of the same type. Thirteen months later the patient became symptomatic. Percutaneous transhepatic cholangiography (PTC) revealed the presence of a choledocho-duodenal fistula and the disappearance of the two endoprostheses previously implanted. A third metallic stent was then percutaneously positioned through the bilioenteric fistula. The computed tomography scan that followed for the detection of the metallic bodies did not reveal the dislocated metallic stents. Stent migration is a well-known complication of uncovered metallic stents, though Viabil stent migration is assumed to be most unlikely to happen due to the stent's anchoring barbs. Furthermore, the stent had already been tightly fixed by tumor over- and ingrowth, as recognized in previous imaging. This is a very unusual case, describing the disappearance of two metallic foreign bodies encapsulated by tumor.
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To determine the application and clinical effectiveness of ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease, and to evaluate the efficiency of stent coverage in preventing tumor ingrowth. During a 3-year... more
To determine the application and clinical effectiveness of ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease, and to evaluate the efficiency of stent coverage in preventing tumor ingrowth. During a 3-year period, 36 patients with malignant obstructive jaundice were treated with ePTFE/FEP-covered stents, with or without proximal side holes. The stricture was located in the lower common bile duct (CBD) in 18 cases, the upper CBD in 9, the lower common hepatic duct (CHD) in 6, and the upper CHD in 3 patients. Thirty-seven covered stents were percutaneously implanted. The technical success rate was 97%. Reintervention was required in 6 cases. The 30-day mortality rate was 40%, not procedure-related. Mean survival was 128 days. Primary patency rates were 100%, 55.5%, and 25% at 3, 6, and 12 months, respectively, while the assisted patency rate was 100% at 12 months. Stents without side holes had higher primary patency rates compared with those with side holes, where occlusion was always due to tumor ingrowth. Tumor ingrowth did not occur in the completely covered stents. No stent dysfunction due to sludge incrustation was found. Complications were 1 case of arterial laceration that occurred during percutaneous transhepatic cholangiography, and a subcapsular hematoma and 1 case of bile peritonitis, that both occurred during primary stenting. No complications followed the secondary stenting technique. ePTFE/FEP-covered metallic stents are safe and effective for palliation of malignant biliary disease. The presence of the ePTFE/FEP coating is likely to prevent from tumor ingrowth.
Research Interests: Cardiovascular, Palliative Care, Treatment Outcome, Stents, Humans, and 15 moreFemale, Male, Follow-up studies, Aged, Middle Aged, Adult, Success Rate, Time Factors, Retrospective Studies, prosthesis Design, Polytetrafluoroethylene, Prosthesis Implantation, Mortality rate, Obstructive Jaundice, and Reoperation
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We describe a case of a 28-year-old man who presented with symptomatic, right-sided, large adrenal cyst recurrence 9 months after laparoscopic decortication. Final treatment was achieved by means of percutaneous aspiration and ethanol... more
We describe a case of a 28-year-old man who presented with symptomatic, right-sided, large adrenal cyst recurrence 9 months after laparoscopic decortication. Final treatment was achieved by means of percutaneous aspiration and ethanol ablation. On 6-month follow-up the patient was asymptomatic and the cyst remained minimised. In our opinion, percutaneous treatment with alcohol ablation of primary benign symptomatic or recurrent uncomplicated adrenal cysts should be considered as an effective alternative method when patients are frail or surgery fails to resolve the problem.
Research Interests: Humans, Male, Ethanol, Adult, Case reports, and 4 moreSuction, Sclerotherapy, Laparoscopy, and BMJ Case Reports
We report a case of an 86-year-old female patient who presented with a septic, right ureteric obstruction, caused by a symptomatic Bochdalek hernia. The patient was initially managed with percutaneous nephrostomy and final treatment was... more
We report a case of an 86-year-old female patient who presented with a septic, right ureteric obstruction, caused by a symptomatic Bochdalek hernia. The patient was initially managed with percutaneous nephrostomy and final treatment was achieved by placement of an external-internal nephroureteral double pigtail.
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Percutaneous cholecystostomy is an established drainage procedure for the management of high-risk patients with acute cholecystitis. However, percutaneous image-guided access to the gallbladder may not be limited to the simple placement... more
Percutaneous cholecystostomy is an established drainage procedure for the management of high-risk patients with acute cholecystitis. However, percutaneous image-guided access to the gallbladder may not be limited to the simple placement of a drain, but may also be used as an alternative approach to the biliary tree through the catheterization of the cystic duct, for a variety of other more complicated conditions. Percutaneous transcholecystic interventions may be performed in both malignant and benign disease. In the case of malignant jaundice, the transcholecystic route may be used when the liver parenchyma is occupied by metastatic lesions and transhepatic access is not possible. In benign conditions, access through the gallbladder may offer a solution if the biliary tree is not dilated. The transcholecystic access may then be route of insertion of large sheaths, internal drainage catheters, lithotripsy devices, stone retrieval baskets, and stents. The purpose of this review is to...
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Gastric outlet (GO) obstruction in an adult is usually caused by intrinsic gastric or duodenal lesions or pancreatic tumours. This study describes a case of a 77-year-old man who developed GO obstruction due to extrinsic compression from... more
Gastric outlet (GO) obstruction in an adult is usually caused by intrinsic gastric or duodenal lesions or pancreatic tumours. This study describes a case of a 77-year-old man who developed GO obstruction due to extrinsic compression from a large gastroduodenal artery aneurysm under rupture. This cause of GO obstruction has never previously been reported in the literature.
Research Interests: Case Report, Humans, Male, Clinical Sciences, European, and 5 moreAged, Aneurysm, X ray Computed Tomography, Stomach, and Duodenum
Our objective was to compare the effectiveness of percutaneous cholecystostomy (PC) vs conservative treatment (CO) in high-risk patients with acute cholecystitis. The study was randomized and comprised 123 high-risk patients with acute... more
Our objective was to compare the effectiveness of percutaneous cholecystostomy (PC) vs conservative treatment (CO) in high-risk patients with acute cholecystitis. The study was randomized and comprised 123 high-risk patients with acute cholecystitis. All patients fulfilled the ultrasonographic criteria of acute inflammation and had an APACHE II score ≥12. Percutaneous cholecystostomy guided by US or CT was successful in 60 of 63 patients (95.2%) who comprised the PC group. Sixty patients were conservatively treated (CO group). One patient died after unsuccessful PC (1.6%). Resolution of symptoms occurred in 54 of 63 patients (86%). Eleven patients (17.5%) died either of ongoing sepsis (n=6) or severe underlying disease (n=5) within 30days. Seven patients (11%) were operated on because of persisting symptoms (n=3), catheter dislodgment (n=3), or unsuccessful PC (n=1). Cholecystolithotripsy was performed in 5 patients (8%). Elective surgery was performed in 9 cases (14%). No further t...
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... Adam Hatzidakis, MD, PhD, EBIR, FCIRSE. ... Eric Kullman, Farshad Frozanpor, Claes Söderlund, Stefan Linder, Per Sandström, Anna Lindhoff-Larsson, Ervin Toth, Gert Lindell, Eduard Jonas, Jacob Freedman, Martin Ljungman, Claes Rudberg,... more
... Adam Hatzidakis, MD, PhD, EBIR, FCIRSE. ... Eric Kullman, Farshad Frozanpor, Claes Söderlund, Stefan Linder, Per Sandström, Anna Lindhoff-Larsson, Ervin Toth, Gert Lindell, Eduard Jonas, Jacob Freedman, Martin Ljungman, Claes Rudberg, Bo Ohlin, Rebecka Zacharias, Carl ...
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A case of recurrent abdominal wall abscess following percutaneous cholecystostomy (PC) is presented. Transperitoneal PC was performed in an 82-year-old female with calculous cholecystitis. Symptoms resolved and the catheter was removed 29... more
A case of recurrent abdominal wall abscess following percutaneous cholecystostomy (PC) is presented. Transperitoneal PC was performed in an 82-year-old female with calculous cholecystitis. Symptoms resolved and the catheter was removed 29 days later. The patient came back 5 months later with a superficial abscess that was drained and 8 months post PC with a fistula discharging clear fluid. Ultrasonography revealed the tract adjacent to an area of inflammation containing a calculus, whereas CT failed to depict the stone. Subsequent surgery confirmed US findings. To our knowledge, this is the first report of a dislodged bile stone following percutaneous cholecystostomy.
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The aim of this study was to establish whether using a percutaneously inserted metallic coil as a target facilitates the radiofrequency (RF) ablation of tumors poorly seen on unenhanced computed tomography (CT) or ultrasound (US) studies.... more
The aim of this study was to establish whether using a percutaneously inserted metallic coil as a target facilitates the radiofrequency (RF) ablation of tumors poorly seen on unenhanced computed tomography (CT) or ultrasound (US) studies. We inserted a metallic coil percutaneously via a 21-gauge needle under CT guidance into five tumors during the phase of contrast enhancement in five patients. The coil was subsequently used as a target to guide placement of the RF electrode under fluoroscopic guidance. The precision of position was then checked with CT or US. We also carried out a small experimental study to establish the effect of metallic coils on the pattern of coagulation induced by RF. Placement of a metallic coil into the tumor enabled rapid and accurate placement of the RF electrode. The tumors were ablated with no adverse effects. The experimental study showed that the area of coagulation extends predictably along the coil. The application of the above technique is useful when using RF to ablate tumors poorly visualized on US and unenhanced CT.
Research Interests: Computed Tomography, Ultrasound, Computer assisted orthopaedic surgery, Humans, Liver, and 18 moreUltrasonography, Female, Animals, Fluoroscopy, Male, Hepatocellular Carcinoma, Experimental Study, Contrast-Enhanced Ultrasound, Radiofrequency Ablation, Clinical Sciences, Metals, European, Aged, Swine, Radiofrequency, Catheter ablation, Electrodes, and Sensitivity and Specificity
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Arteriovenous malformations of the head and neck are rare lesions with unclear pathogenesis. They usually present during childhood, growing proportionately to the child. Although preoperative superselective embolization followed by... more
Arteriovenous malformations of the head and neck are rare lesions with unclear pathogenesis. They usually present during childhood, growing proportionately to the child. Although preoperative superselective embolization followed by surgical resection is the treatment of choice, complete removal is often not feasible, leading to high recurrence rates. The case of a patient with an arteriovenous malformation of the floor of the mouth diagnosed late in her adulthood and its management are presented.