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Vascular liver diseases include a heterogeneous group of disorders affecting the micro- and the macro-circulation of the liver. Thrombosis and obstruction of the inflow (portal vein) and/or outflow venous system (Budd-Chiari syndrome), spontaneous porto-systemic shunts, diseases affecting the sinusoids, and hepatic vascular malformations are the most important vascular liver diseases. Thrombosis of the portal venous system and of the hepatic venous system occur most commonly and are potentially life-threatening conditions, while congenital and acquired pro-thrombotic diseases are major causal factors, together with local factors triggering thrombotic events. Despite their overall low prevalence, vascular liver diseases represent the second cause of portal hypertension in the Western world. Imaging techniques are of paramount importance in the diagnostic process, as well as in the follow-up of patients affected by these conditions. In this review, we focus on the role of ultrasonography in the management of vascular liver diseases by highlighting advantages and drawbacks of this imaging technique. In addition, we provide a state of the art presentation of the possibilities offered by ultrasound in the evaluation of vascular and parenchymal features in vascular liver diseases encompassing not only the use of grayscale imaging, but also the application of Doppler ultrasound, the measurement of hemodynamic parameters and the assessment of liver stiffness., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation (short version; the long version is published online)., (© Georg Thieme Verlag KG Stuttgart · New York.)

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation in clinical practice (long version)., (© Georg Thieme Verlag KG Stuttgart · New York.)

The fourth part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describes general aspects of endoscopic ultrasound-guided diagnostic and therapeutic interventions and assesses the evidence for endoscopic ultrasound-guided sampling. Endoscopic ultrasound combines the most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and safe and effective fine needle based tissue acquisition from these lesions. The guideline addresses the indications, contraindications, techniques, adverse events, training and clinical impact of EUS-guided sampling. Advantages and drawbacks are weighed in comparison with image-guided percutaneous biopsy. Based on the most current evidence, clinical practice recommendations are given for crucial preconditions and steps of EUS-guided sampling as well as for safe performance. Additionally, the guideline deals with the principles and reliability of cytopathological reporting in endoscopic ultrasound-guided sampling (long version)., (© Georg Thieme Verlag KG Stuttgart · New York.)

The fourth part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describes general aspects of endoscopic ultrasound-guided diagnostic and therapeutic interventions and assesses the evidence for endoscopic ultrasound-guided sampling. Endoscopic ultrasound combines the most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and safe and effective fine needle-based tissue acquisition from these lesions. The guideline addresses the indications, contraindications, techniques, adverse events, training and clinical impact of EUS-guided sampling. Advantages and drawbacks are weighed in comparison with image-guided percutaneous biopsy. Based on the most current evidence, clinical practice recommendations are given for crucial preconditions and steps of EUS-guided sampling as well as for safe performance. Additionally, the guideline deals with the principles and reliability of cytopathological reporting in endoscopic ultrasound-guided sampling (short version; the long version is published online)., (© Georg Thieme Verlag KG Stuttgart · New York.)

The third part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound (INVUS) assesses the evidence for ultrasound-guided and assisted interventions in abdominal treatment procedures. Recommendations for clinical practice are presented covering indications, contraindications, and safe and effective performance of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (long version)., (© Georg Thieme Verlag KG Stuttgart · New York.)

The third part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound assesses the evidence for ultrasound-guided and assisted interventions in abdominal treatment procedures. Recommendations for clinical practice are presented covering indications, contraindications, safety and efficacy of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (short version; a long version is published online)., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aims: In previous studies, the prevalence of hepatic vascular malformations (VMs) in a large Italian family with hereditary hemorrhagic telangiectasia (HHT) was examined by Doppler ultrasonography (US) as screening technique, and the relevant Doppler US findings were described and classified. Thereafter, Doppler US has been routinely used to screen HHT families for liver involvement. Hepatic VMs were evaluated and classified on the basis of Doppler US findings., Methods: Three hundred and forty-six subjects belonging to 64 pedigrees were checked for the presence of signs of HHT. All of them underwent abdominal Doppler US screening for hepatic VMs. Vascular abnormalities were classified as minimal if the hepatic artery was dilated in extrahepatic tract only and measured > 6 mm; as moderate if the hepatic artery was dilated in both intra and extrahepatic tract; and as severe if complex changes of the arterial hepatic branches were associated with hepatic and/or portal vein dilatation. Furthermore, Doppler parameters, both qualitative (flow direction, turbulence) and quantitative (peak flow velocity and resistivity index in hepatic artery, mean velocity in portal vein, diastolic peak flow velocity in hepatic veins), were entered into our VM classification., Results: HHT was found in 222 subjects, with hepatic VMs detected by Doppler US in 92 (41.4 %) (24 males, 68 females, mean age 52.2). Hepatic VMs were minimal in 11 subjects, moderate in 70, and severe in 11., Conclusions: On the basis of our proposed grading, hepatic VMs can be easily classified in subjects with HHT by Doppler US. Depending on the degree of hepatic vascular derangement, appropriate programs for follow up and/or therapy can be designed.

Purpose: To evaluate whether the combination of hepatic segmental transcatheter arterial embolization (TAE) with percutaneous radiofrequency (RF) ablation can increase the volume of coagulation necrosis to treat patients with large hepatocellular carcinoma (HCC)., Method: Fourteen patients with cirrhosis and HCC whose greatest diameter ranged from 3.8 to 6.8 cm (mean, 5.2 cm) underwent segmental TAE followed within 3 days by RF interstitial thermal ablation with an expandable needle electrode inserted into the tumour under sonographic guidance, after local anesthesia. We made one or more needle electrode insertions depending on tumor shape. Posttreatment necrosis was evaluated by ultrasonography, dynamic computed tomography (CT) and alpha-fetoprotein dosage in all cases, repeated every three to four months., Results: Tumor ablation was obtained in one session in 11 (78%) patients (with one needle electrode insertion in 8 patients), in two sessions in 1, in three sessions in 2. In a mean follow-up of 13.2 months (range 6-23) two patients died from unrelated causes; one patient showed multinodular HCC 6 months after the treatment; 4 patients developed new lesions, treated by a new course of RF ablation (3 cases) or by surgery (1 case); therefore 11/12 patients still in follow-up were disease-free. No fatal complications were observed. One month after the treatment, fluid collection at the site of the ablated tumor was observed in one patient which was percutaneously drained., Conclusions: Percutaneous RF thermal ablation performed after TAE effectively treated HCCs larger than tumors suitable for segmental TAE or RF application alone; the result was achieved in two thirds of the cases in a single session with only one needle electrode insertion.