age can then be taken depending on the outcome of the aspiration and the nature of the fluid.

Investigation of the biliary tract is an area where IR has had a very positive impact. The biliary tree is relatively inaccessible in many children because of the biliary enteric anastomosis usually present. Percutaneous transhepatic cholang-iography (PTC) can provide information regarding biliary strictures, leaks, bile cultures and most importantly provides an opportunity for possible corrective measures.

Transhepatic insertion of biliary stents has provided long term and in many cases permanent correction of postoperative biliary strictures. Balloon dilatation of strictures and passage of indwelling stents provide both short and long-term palliation and even permanent solutions to biliary strictures. Stents may be left in place for 8-12 weeks after which they may be removed. Repeated dilatations may be necessary. Placement of permanent stents in the biliary tree has been attempted but long term results have not been gratifying because of the build up of sludge in these stents with resulting obstruction and sepsis.

Vascular interventions are less common. Diagnostic arteriography and venography following transplantation have become less often used as the diagnostic accuracy of ultrasound has improved.

Arterial infusion of thrombolytic agents has been used to treat arterial thrombosis with little to support further use of this technique. Venous obstructions however have been successfully approached through interventional radiology.

Posttransplant portal vein and hepatic vein stenoses have been successfully treated by using transhepatic or transvenous introduction of balloon dilators followed in some instances by placement of permanent indwelling vascular stents. Long term patency of portal veins treated for stenotic areas has been well documented. Hepatic vein lesions may be more difficult to treat because of the confluence of the hepatic veins with the inferior vena cava making stent placement more difficult.

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