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Image-guided percutaneous nephrostomy is a relatively safe and successful procedure for access to the renal collecting system for multiple purposes including relief of urinary obstruction, urinary diversion, access for endourologic procedures, and diagnostic testing. Although placing a percutaneous nephrostomy catheter is most times straightforward, providing immediate benefit for the patient and satisfaction for the practitioner, there can be situations that make the procedure more difficult or risky. A thorough review of the patient's imaging and medical record will help to set a path for success. However, there may be innuendos and unforeseen circumstances that occur. Having knowledge of most of these "stumbling blocks" and how to deal with them will keep you on the path. This paper serves to fill some of that mental file with the aim to increase clinical success.

Percutaneous biliary interventions have a well-established role in the management of hepatobiliary diseases. Good outcomes include recognizing and avoiding complications. This section will cover the "standard" technique of percutaneous biliary drainage, pearls to decrease the risk of problems, and approaches to treat those complications in patients undergoing percutaneous transhepatic cholangiography and percutaneous transhepatic biliary drainage.

The interdisciplinary model for the management of vascular anomalies relies essentially on effective collaboration and communication between various medical disciplines. In this paper, we discuss the various facets of an organized institutional collaborative model for managing these patients. The case for interdisciplinary collaboration, use of proper terminology, the vascular anomalies center (structure and work flow), referral bases, and collaboration with support group are briefly illuminated. The role of the interventionalists as primary members and leaders in this field is buttressed by the clinical knowledge and competent use of imaging modalities and minimally invasive interventions.