At CIRSE 2026, interventional radiologists presented innovative techniques that create new vascular and biliary pathways, targeting previously inaccessible cases where conventional approaches fail. These groundbreaking interventions demonstrate how creative problem-solving and unconventional access methods can successfully treat patients with few remaining treatment options.
- Six technically challenging cases were presented spanning venous intervention, biliary disease, interventional oncology, lymphatic embolization, and pediatric intervention
- A percutaneous splenorenal shunt was created for a patient with chronic portal vein thrombosis where conventional TIPS was not feasible
- A non-anatomical biliary pathway was successfully created into the duodenum using sharp recanalization and covered metal stent placement, avoiding surgery for over four years
- A retroperitoneal lymphatic leak producing four liters daily was resolved using real-time ultrasound-guided embolization instead of conventional intralymphatic methods
- Image-guided irreversible electroporation successfully treated recurrent oropharyngeal cancer in a previously irradiated field while preserving swallowing and speech function
“Sometimes the solution is not another catheter or another guidewire, but another way of thinking,” said Dr. Stavros Grigoriadis of Attikon University Hospital in Greece, capturing the spirit of a CIRSE 2026 session in which interventional radiologists created new vascular and biliary pathways, targeted previously inaccessible leaks, and used unconventional access to treat patients with few remaining options.
The “Amazing Interventions” session, held on 6 September in Copenhagen, brought together six technically challenging cases spanning venous intervention, biliary disease, interventional oncology, lymphatic embolization and pediatric intervention.
Dr. Carolin Sobotta of University Medicine Göttingen presented a percutaneous splenorenal shunt in a 64-year-old man with chronic portal vein thrombosis following severe pancreatitis. Thrombosis also affected the superior mesenteric and splenic veins, resulting in severe portal hypertension and gastroesophageal varices. Conventional TIPS was not feasible, while surgery carried considerable morbidity and bleeding risk.
Her team instead used an electrified CTO wire to cross from the splenic venous system towards the left adrenal vein, where a snare captured and externalized the wire. This converted a difficult free-space crossing into a stable rail for deployment of a covered stent graft and creation of the shunt.
Creating a new biliary pathway
Another route had to be invented for a patient presented by Dr. Timothy Fotheringham of the Royal London Hospital. Following surgery, conventional recanalization of a benign biliary obstruction proved impossible. Fotheringham used sharp recanalization, additional percutaneous access and snares to create a non-anatomical pathway into the duodenum, followed by placement of a retrievable covered metal stent.
“Creating your own bile duct actually works,” he said. More than four years after removal of the original stent, the patient had avoided surgery, although restenosis required further covered-stent treatment.
Rethinking the target and the approach
Innovation also came from changing imaging strategy. Grigoriadis treated a postoperative retroperitoneal lymphatic leak producing more than four liters of output per day. When conventional intralymphatic embolization failed, the team returned to ultrasound and used escaping Lipiodol as a real-time target for direct percutaneous embolization. Output fell from four liters daily to zero.
In oncology, Dr. Sarah Verdan of Rede D'Or in São Paulo reported image-guided irreversible electroporation for locally recurrent oropharyngeal squamous cell carcinoma in a previously irradiated field. Surgery risked major functional morbidity and further radiotherapy was ruled out. Three months after IRE, pain and dysphagia had improved, swallowing and speech were preserved, and MRI showed no persistent true diffusion restriction. Six-month follow-up was reported as favorable.
The session also extended these approaches into children, including complex central venous reconstruction in a 20-month-old child and emergency embolization of a high-flow hepatic AVM in a 1.9-kg premature neonate.
