Hemodialysis vascular access dysfunction remains a major cause of morbidity and repeated interventions. Stenosis related to neointimal hyperplasia and altered hemodynamics leads to access flow limitation and thrombosis, particularly in AVFs. While percutaneous transluminal angioplasty is the standard first-line treatment, durability is often limited, resulting in frequent reinterventions. Drug-coated balloons, most commonly paclitaxel-based, have been introduced to inhibit restenosis and have demonstrated improved target lesion patency compared with conventional balloon angioplasty in several randomized trials, though outcomes vary by lesion location and study design. This narrative review summarizes the current evidence for drug-coated balloon angioplasty in dysfunctional arteriovenous access, discusses key trial endpoints, reviews safety and practical considerations, and highlights ongoing controversies and future directions.

We report a 54‑year‑old woman with chronic pancreatitis, duodenal obstruction, massive ascites, and refractory thrombocytopenia who developed septic obstructive cholangitis after occlusion of a plastic common bile duct (CBD) stent. Endoscopic exchange failed and PTBD was prohibitively risky. Transjugular intrahepatic biliary stenting (TIBS) provides an alternative route that avoids transperitoneal hepatic capsule puncture. Via right internal jugular access, the right hepatic vein was catheterized, a posterior sectoral bile duct punctured, and a guidewire crossed the distal CBD stricture. A 12 × 80 mm self‑expandable metallic stent was deployed and the transhepatic tract embolized with coils. The patient experienced rapid clinical and biochemical recovery (bilirubin, 13.3 to 1.37 mg/dL) over 9 days postprocedure without any hemorrhagic complications. TIBS is a decisive, life‑saving alternative when standard routes are not possible.

<b>Purpose</b><br/>Tumor location influences the effectiveness and safety of RFA. This study evaluated RFA outcomes as first-line therapy for HCC <3 cm, focusing on tumor location impact. <br/><b>Materials and Methods</b><br/>In this retrospective cohort study, 281 patients with newly diagnosed HCC <3 cm in up to three lesions treated with RFA between 2003 and 2019 were analyzed. The tumor location was categorized as superficial (outer third), mid-portion (middle third), or deep (near vena cava), using an imaginary line from the liver surface to the vena cava. Perivascular tumors were defined as those abutting portal or hepatic veins. Recurrence-free survival (RFS) among location groups was compared with risk factors analyzed via Cox regression. <br/><b>Results</b><br/>Patients (mean age, 61.1 ± 11.1 years) were predominantly male (73.3%), hepatitis B virus surface antigen–positive (66.2%), and of Child-Pugh class A (97.5%). Deep tumors had shorter RFS than superficial/mid-portion tumors (HR, 1.87; 95% CI, 1.20 to 2.93; p = 0.005), as did perivascular versus non-perivascular tumors (HR, 1.87; 95% CI, 1.16 to 3.00; p = 0.008). Group C (deep + perivascular, n = 10) had shorter RFS than group A (no risk factors: HR, 3.12; 95% CI, 1.50 to 6.45; p = 0.002) and group B (one risk factor: HR, 1.59; 95% CI, 1.05 to 2.40; p = 0.028). Multivariable analysis identified tumor depth, perivascular location, size >2 cm, creatinine, and prothrombin time as independent predictors of shorter RFS. <br/><b>Conclusion</b><br/>Tumor depth and proximity to vasculature independently predict RFS in small HCCs treated with RFA, highlighting the role of tumor location in determining patient prognosis.