[Answered]: Indication: 47-year-old patient with newly…

Indication: 47-year-old patient with newly obstructed biliary tube. The tube has minimal drainage. Procedures performed: 1. Antegrade cholangiogram through indwelling tube 2. Fluoroscopic exchange of indwelling biliary tube 3. Repeat antegrade cholangiogram 4. IV conscious sedation Techniques and findings: The patient was placed supine on the angiographic table. The right upper quadrant as well as the exiting tube were prepped and draped in normal sterile fashion. Injection of contrast was performed through the tube; however, the patient experienced pain, and there was minimal filling of the intrahepatic biliary tree. Following this, the tube was cut and exchanged over a 0.035 ring wire. Two additional side holes were cut into the tube, as was previously done. The proximal most tube lies within the intrahepatic right biliary tree. A gentle injection of contrast was performed, demonstrating marked clot throughout the biliary tree with patency of the tube. The tube was secured to the skin using a suture. A sterile bandage was placed. The tube was placed to external drainage. A total of 10 ml of Isovue 370 was injected. The patient received 2 mg Versed and 100 mcg fentanyl. Total fluoroscopy time was 5.7 minutes. Conclusion: Successful exchange of a 14-French biliary tube for internal/external drainage. 1 idc10cm 2 idc10pcs