SIR 2026

Educational Exhibit

Nonvascular Interventions

Abscess and Fluid Drainage

Session: Educational Exhibit Presentations - Portal hypertension/Transplant/GI

780 - Pictorial Guide for Performing Percutaneous Image-Guided Chemical and Mechanical Necrosectomy for Walled-off Pancreatic Necrosis

Monday, April 13, 2026

4:45 PM - 4:51 PM ET

Abstract Presenter(s)

Aysha Alani (she/her/hers)

Medical Student
Virginia Tech Carilion School of Medicine, United States

Author/Co-author(s)

CP

Cole Pieroni, BS

Medical Student
Virginia Tech Carilion School of Medicine, United States
Neil K. Jain, DO (he/him/his)

Integrated Interventional Radiology Resident
Medstar Georgetown University Hospital, United States
Nariman Nezami, MD

Attending
Georgetown University Medical Center, United States
Adam Fang, MD

Assistant Professor
University of Maryland School of Medicine, United States

Learning Objectives:

Review classifications of pancreatic fluid collections, including pseudocysts and walled-off pancreatic necrosis (WOPN).

Illustrate, via case-based approach, the step-by-step technique for percutaneous image-guided chemical and mechanical necrosectomy.

Discuss off-label use of AngioJet thrombectomy system for complex collections.

Background: WOPN may arise after acute pancreatitis and is typically managed with percutaneous or endoscopic ultrasound-guided drainage{1}{2}. In complex collections with loculations and debris, outcomes with standard approaches are limited, necessitating additional treatment with percutaneous image-guided chemical and mechanical necrosectomy. In 2022, Ghabili et al. demonstrated the safety and efficacy of percutaneous approaches for WOPN management with combined chemical and mechanical necrosectomy{3}. Further development with off-label use of AngioJet thrombectomy system (Boston Scientific; Marlborough, MA) and chemical debridement may enhance clearance of necrotic material, offering a viable alternative for challenging cases.

Clinical Findings/Procedure Details: Percutaneous access is obtained using CT or ultrasound, followed by drainage with 14-24 French catheters. After clinical stabilization, chemical necrosectomy using 3% hydrogen peroxide liquifies necrotic debris. Mechanical necrosectomy is subsequently performed using the AngioJet thrombectomy system. Originally designed for extraction of arterial and venous thrombus, this device produces high-pressure saline jets and continuous aspiration to mechanically fragment and evacuate solid material. This mechanism is advantageous for WOPN, where collections contain organized, fibrotic, and viscous debris. Serial imaging and clinical assessment guide the need for additional necrosectomy, catheter adjustment, and removal. This presentation highlights access planning, device use, and troubleshooting.

Conclusion and/or Teaching Points: Percutaneous image-guided chemical and mechanical necrosectomy is a valuable option for managing complex WOPN, especially when standard approaches fail. Off-label use of AngioJet thrombectomy system, in combination with chemical debridement, leverages established mechanical principles to address organized, fibrotic debris that is otherwise difficult to evacuate. Early experience suggests this approach is safe, feasible, and may improve clearance and reduce the need for invasive surgery. Continued refinement of these techniques may expand the interventional radiologist’s role in the multidisciplinary care of patients with severe pancreatitis.