1
|
Jahangiri Y, Morrison JJ, Mowery ML, Leach AJ, Musolf RL, Knox MF. Effectiveness and Safety of Large-Bore Aspiration Thrombectomy for Intermediate- or High-Risk Pulmonary Embolism. J Vasc Interv Radiol 2024; 35:563-575. [PMID: 38160751 DOI: 10.1016/j.jvir.2023.12.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/10/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To evaluate effectiveness and safety of large-bore mechanical thrombectomy of intermediate- or high-risk pulmonary embolism (PE) and factors associated with effectiveness. MATERIALS AND METHODS A retrospective review of 257 patients with intermediate- or high-risk PE who underwent mechanical thrombectomy using the Flowtriever system (Inari Medical, Irvine, California) between July 2019 and November 2021 was conducted. Data were analyzed using the linear regression and Kaplan-Meier methods with a Type 1 error set at 0.05. RESULTS Patients' mean age was 62 years, and 51% were male. PE risk was classified as high, intermediate-high, and intermediate-low in 37 (14%), 201 (78%), and 18 (7%) of the patients, respectively. Procedural technical success was 100%. The mean pulmonary artery pressure (MPAP) decreased from a mean of 32 mmHg (SD ± 9) before to 24 mmHg (SD ± 9) after thrombectomy (mean decrease, 8 mmHg [SD ± 6]; P < .0001). Immediate complications occurred in 2% of the patients. Postprocedural 30-day and all-time PE-attributable mortality in a mean of 1.3-year follow-up was 2% and 6%, respectively. In multivariate analysis, the presence of lower extremity DVT at presentation (β ± SE, -7.60 ± 3.22; P = .019) and a higher prethrombectomy MPAP (β ± SE, -0.19 ± 0.04; P < .001) were associated with lower degrees of decrease in MPAP in the intermediate-high-risk PE group. Among 14 patients with postthrombectomy PE-attributable mortality, 13 had postthrombectomy MPAPs of >20 mmHg. CONCLUSIONS Large-bore aspiration thrombectomy is a safe and effective treatment for reducing PAP in patients with intermediate- or high-risk PE. Postthrombectomy MPAPs of >20 mmHg might indicate postthrombectomy PE-attributable mortality in high-risk patients.
Collapse
Affiliation(s)
- Younes Jahangiri
- Corewell Health Interventional Radiology, Michigan State University, Grand Rapids, Michigan.
| | - James J Morrison
- Advanced Radiology Services, Interventional Radiology, Michigan State University, Grand Rapids, Michigan
| | - Myles L Mowery
- Corewell Health Interventional Radiology, Michigan State University, Grand Rapids, Michigan
| | - Aaron J Leach
- Corewell Health Interventional Radiology, Michigan State University, Grand Rapids, Michigan
| | - Ryan L Musolf
- Corewell Health Diagnostic Radiology, Michigan State University, Grand Rapids, Michigan
| | - Michael F Knox
- Advanced Radiology Services, Interventional Radiology, Michigan State University, Grand Rapids, Michigan
| |
Collapse
|
2
|
Kaufman C, Jahangiri Y, Otto B. Comparative Effectiveness of Cryoablation with Steroid and Lidocaine Versus Steroid and Lidocaine Alone for Treatment of Morton Neuroma: Protocol for a Randomized Controlled Trial. J Vasc Interv Radiol 2024:S1051-0443(24)00039-3. [PMID: 38272113 DOI: 10.1016/j.jvir.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/27/2024] Open
Affiliation(s)
- Claire Kaufman
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon.
| | - Younes Jahangiri
- Division of Interventional Radiology, Corewell Health West Michigan, Grand Rapids, Michigan
| | - Bettricia Otto
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
3
|
Jahangiri Y. Can Chat Generative Pretraining Transformer (ChatGPT) Be Used for Statistical Analysis of Research Data? J Vasc Interv Radiol 2023; 34:2242-2246.e2. [PMID: 37717655 DOI: 10.1016/j.jvir.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Younes Jahangiri
- Department of Interventional Radiology, Corewell Health West Michigan, 100 Michigan St NE, Grand Rapids, MI 49503.
| |
Collapse
|
4
|
Morrison J, Jahangiri Y, Mowery M, Leach A, Musolf R, Knox M. Abstract No. 72 Factors Associated with Overall Survival after Thrombectomy for Massive and Submassive Pulmonary Embolism. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
|
5
|
Lane OF, Jahangiri Y, Slater WA. Endovascular Treatment of Acute Obstructive Shock Associated with Inferior Vena Cava Filter Thrombosis. J Vasc Interv Radiol 2023:S1051-0443(23)00200-2. [PMID: 36863610 DOI: 10.1016/j.jvir.2023.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Affiliation(s)
- Olivia F Lane
- Michigan State University, College of Human Medicine, Grand Rapids, MI
| | - Younes Jahangiri
- Advanced Radiology Services, Corewell Health, 3264 North Evergreen Dr. NE, Grand Rapids, MI 49525.
| | - William A Slater
- Advanced Radiology Services, Corewell Health, 3264 North Evergreen Dr. NE, Grand Rapids, MI 49525
| |
Collapse
|
6
|
Jahangiri Y, Gabr A, Huber TC, Bochnakova T, Farsad K. Uterine Fibroid Embolization or Myomectomy: How Much Marketing Is Enough? Comparative Analysis of Public Search Trends in Google and Medical Publications in PubMed. J Vasc Interv Radiol 2023; 34:182-186. [PMID: 36414116 DOI: 10.1016/j.jvir.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/21/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022] Open
Abstract
To compare public popularity and volume of scientific publications regarding uterine fibroid embolization (UFE) and myomectomy. Google Trends and PubMed data were queried to assess temporal variations in online public search volumes and number of research publications for UFE and myomectomy. Time series analysis was used to identify meaningful temporal trends and forecast a future trend. Compared with UFE, myomectomy had significantly higher volumes of public online search and research publications, with an increasing trend over time (P < .0001). The forecasting models predicted a continuing increase in both public search volumes and number of research publications for myomectomy and static future trends in these metrics for UFE. This study signals significantly lower public popularity and research efforts for UFE compared with myomectomy for uterine fibroids. More effective marketing strategies and further research support will be needed to fill this gap.
Collapse
Affiliation(s)
- Younes Jahangiri
- Department of Interventional Radiology, Advanced Radiology Services, Spectrum Health, Grand Rapids, Michigan.
| | - Ahmed Gabr
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Timothy C Huber
- Department of Interventional Radiology, Jefferson Radiology, Hartford, Connecticut
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
7
|
Jahangiri Y, Draper R, Gressel G, Taber R, Morrison JC, Morrison JJ. Peritoneal seeding of embolic beads after uterine artery embolization. Radiol Case Rep 2022; 18:117-121. [PMID: 36340240 PMCID: PMC9630625 DOI: 10.1016/j.radcr.2022.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Incidental identification of peritoneal nodules during laparoscopy may present a diagnostic dilemma. The differential diagnosis includes a variety of benign and malignant entities such as peritoneal carcinomatosis. Case A 44-year-old G2P2 woman presented with recurrent menorrhagia and pelvic pain was found to have large uterine fibroids on imaging studies. Bilateral uterine artery embolization was performed with complete devascularization of the fibroid. Seven years later, she presented with similar symptoms. Imaging studies demonstrated a vascular uterine lesion. A total laparoscopic hysterectomy with bilateral salpingectomy was performed with no complications. During surgery, vesicular peritoneal implants were incidentally identified posterior to the uterus between the uterosacral ligaments. Biopsy and pathologic analysis of these nodules confirmed that they contained foreign material consistent with embolization beads. Pathologic analysis of the uterus demonstrated an intramural uterine fibroid, and presence of embolization beads in cervix, myometrium and bilateral peritubal regions. Conclusion Non-target peritoneal implantation of embolic beads after uterine artery embolization is a rare entity that can result in vesicular appearing nodules.
Collapse
Affiliation(s)
- Younes Jahangiri
- Advanced Radiology Services PC, Department of Interventional Radiology, Spectrum Health Medical Group, Michigan State University College of Human Medicine, Grand Rapids, MI 49525 USA
| | - Riley Draper
- Michigan State University College of Human Medicine, Grand Rapids, MI 49525 USA
| | - Gregory Gressel
- Department of Obstetrics, Gynecology and Reproductive Biology, Spectrum Health Medical Group, Michigan State University College of Human Medicine, Grand Rapids, MI 49525 USA
| | - Rodman Taber
- Department of Obstetrics, Gynecology and Reproductive Biology, Spectrum Health Medical Group, Michigan State University College of Human Medicine, Grand Rapids, MI 49525 USA
| | - Jane C Morrison
- Michigan Pathology Specialists, PC, Department of Pathology, Spectrum Health Medical Group, Michigan State University College of Human Medicine, Grand Rapids, MI 49525 USA
| | - James J Morrison
- Advanced Radiology Services PC, Department of Interventional Radiology, Spectrum Health Medical Group, Michigan State University College of Human Medicine, Grand Rapids, MI 49525 USA
- Corresponding author.
| |
Collapse
|
8
|
Li N, Ferracane J, Lewis S, Andeen N, Woltjer R, Farsad K, Kaufman J, Rugonyi S, Jahangiri Y, Uchida B, Gabr A, Li J, Yamada K, Al-Hakim R. Abstract No. 299 Impact of post-thrombotic vein wall biomechanics on luminal flow during venous angioplasty and stent placement: computational modeling results. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
9
|
Campos L, Jahangiri Y, Farsad K. Abstract No. 189 Muscle and fat composition changes in cirrhotic patients after portosystemic shunt creation as predictors of survival. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
10
|
Torkian P, Young S, Jahangiri Y, Rosenberg M, Shrestha P, Golzarian J, Talaie R. Abstract No. 534 Effects of lumbar spine construct and movements in May-Thurner syndrome using a detailed Finite Element Model (FEM). J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
11
|
Park Y, Demessie AA, Luo A, Taratula OR, Moses AS, Do P, Campos L, Jahangiri Y, Wyatt CR, Albarqi HA, Farsad K, Slayden OD, Taratula O. Targeted Nanoparticles with High Heating Efficiency for the Treatment of Endometriosis with Systemically Delivered Magnetic Hyperthermia. Small 2022; 18:e2107808. [PMID: 35434932 PMCID: PMC9232988 DOI: 10.1002/smll.202107808] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/01/2022] [Indexed: 05/31/2023]
Abstract
Endometriosis is a devastating disease in which endometrial-like tissue forms lesions outside the uterus. It causes infertility and severe pelvic pain in ≈176 million women worldwide, and there is currently no cure for this disease. Magnetic hyperthermia could potentially eliminate widespread endometriotic lesions but has not previously been considered for treatment because conventional magnetic nanoparticles have relatively low heating efficiency and can only provide ablation temperatures (>46 °C) following direct intralesional injection. This study is the first to describe nanoparticles that enable systemically delivered magnetic hyperthermia for endometriosis treatment. When subjected to an alternating magnetic field (AMF), these hexagonal iron-oxide nanoparticles exhibit extraordinary heating efficiency that is 6.4× greater than their spherical counterparts. Modifying nanoparticles with a peptide targeted to vascular endothelial growth factor receptor 2 (VEGFR-2) enhances their endometriosis specificity. Studies in mice bearing transplants of macaque endometriotic tissue reveal that, following intravenous injection at a low dose (3 mg per kg), these nanoparticles efficiently accumulate in endometriotic lesions, selectively elevate intralesional temperature above 50 °C upon exposure to external AMF, and completely eradicate them with a single treatment. These nanoparticles also demonstrate promising potential as magnetic resonance imaging (MRI) contrast agents for precise detection of endometriotic tissue before AMF application.
Collapse
Affiliation(s)
- Youngrong Park
- College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon, 97201, USA
| | - Ananiya A Demessie
- College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon, 97201, USA
| | - Addie Luo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, 505 NW 185th Avenue Beaverton, Portland, Oregon, 97006, USA
| | - Olena R Taratula
- College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon, 97201, USA
| | - Abraham S Moses
- College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon, 97201, USA
| | - Peter Do
- College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon, 97201, USA
| | - Leonardo Campos
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA
| | - Younes Jahangiri
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA
| | - Cory R Wyatt
- Department of Diagnostic Radiology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA
- Advanced Imaging Research Center, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA
| | - Hassan A Albarqi
- Department of Pharmaceutics, College of Pharmacy, Najran University, King Abdulaziz Road, Najran, 55461, Saudi Arabia
| | - Khashayar Farsad
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA
| | - Ov D Slayden
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, 505 NW 185th Avenue Beaverton, Portland, Oregon, 97006, USA
| | - Oleh Taratula
- College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon, 97201, USA
| |
Collapse
|
12
|
Li N, Ferracane J, Andeen N, Lewis S, Woltjer R, Rugonyi S, Jahangiri Y, Uchida B, Farsad K, Kaufman JA, Al-Hakim R. Impact of Postthrombotic Vein Wall Biomechanics on Luminal Flow during Venous Angioplasty and Stent Placement: Computational Modeling Results. J Vasc Interv Radiol 2022; 33:262-267. [PMID: 35221046 DOI: 10.1016/j.jvir.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/04/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022] Open
Abstract
This study characterized the impact of vein wall biomechanics on inflow diameter and luminal flow during venous angioplasty and stent placement, using postthrombotic and healthy biomechanical properties from an ovine venous stenosis and thrombosis model. Finite element analysis demonstrated more pronounced inflow channel narrowing in the postthrombotic vein compared with the healthy control vein during angioplasty and stent placement (relative inflow diameter reduction of 42% versus 13%, P < .0001). Computational fluid dynamics modeling showed increased relative areas of low wall shear rate in the postthrombotic vein compared with the normal vein (0.46 vs 0.24 for shear rate < 50 s-1; 0.13 vs 0.07 for shear rate < 15 s-1; P < .05), with flow stagnation and recirculation. Since inflow narrowing and low wall shear rate are associated with in-stent restenosis and reintervention, these computational results based on experimentally obtained biomechanical values highlight the significance of postthrombotic venous properties in optimizing venous intervention outcomes.
Collapse
Affiliation(s)
- Ningcheng Li
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Jack Ferracane
- School of Dentistry, Oregon Health and Science University, Portland, Oregon; Department of Biomaterials and Biomechanics, Oregon Health and Science University, Portland, Oregon
| | - Nicole Andeen
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Steven Lewis
- School of Dentistry, Oregon Health and Science University, Portland, Oregon; Department of Biomaterials and Biomechanics, Oregon Health and Science University, Portland, Oregon
| | - Randy Woltjer
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon
| | - Younes Jahangiri
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Barry Uchida
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Khashayar Farsad
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - John A Kaufman
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Ramsey Al-Hakim
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon.
| |
Collapse
|
13
|
Li N, Ferracane J, Andeen N, Lewis S, Woltjer R, Rugonyi S, Jahangiri Y, Uchida B, Farsad K, Kaufman JA, Al-Hakim R. Endovascular Venous Stenosis and Thrombosis Large Animal Model: angiographic, histological, and biomechanical characterization. J Vasc Interv Radiol 2021; 33:255-261.e2. [PMID: 34915165 DOI: 10.1016/j.jvir.2021.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Characterize an ovine endovascular radiofrequency ablation based venous stenosis and thrombosis model for studying venous biomechanics and response to intervention. MATERIALS AND METHODS Unilateral short-segment (n= 2) or long-segment (n = 6) iliac vein stenoses were created in eight adult sheep using an endovenous radiofrequency (RF) ablation technique. Angiographic assessment was performed at baseline, immediately after venous stenosis creation, and after 2-week (n = 6) or 3-month (n = 2) survival. Stenosed iliac veins and contralateral healthy controls were harvested for histological and biomechanical assessment. RESULTS At follow-up, the short-segment RF ablation group showed stable stenosis without occlusion. The long-segment group showed complete venous occlusion/thrombosis with formation of collateral veins. Stenosed veins showed significant wall thickening (0.28 mm vs 0.16 mm; p = 0.0175) and confluent collagen deposition compared to healthy controls. Subacute non-adherent thrombi were apparent at 2 weeks, which were replaced by fibrous luminal obliteration with channels of recanalization at 3 months. Stenosed veins demonstrated increased longitudinal stiffness (448.5 ± 5.4 kPa vs. 314.6 ± 1.5 kPa, p < 0.0001) and decreased circumferential stiffness (140.8 ± 2.6 kPa vs. 246.0 ± 1.6 kPa, p < 0.0001) compared to healthy controls. CONCLUSION Endovenous radiofrequency ablation is a reliable technique for creating venous stenosis and thrombosis in a large animal model with histological and biomechanical attributes similar to those seen in humans. This platform can facilitate understanding of venous biomechanics and testing of venous specific devices and interventions.
Collapse
Affiliation(s)
- Ningcheng Li
- Dotter Interventional Institute, Oregon Health & Science University
| | - Jack Ferracane
- School of Dentistry, Oregon Health & Science University; Biomaterials and Biomechanics, Oregon Health & Science University
| | | | - Steven Lewis
- School of Dentistry, Oregon Health & Science University; Biomaterials and Biomechanics, Oregon Health & Science University
| | | | - Sandra Rugonyi
- Biomedical Engineering, Oregon Health & Science University
| | - Younes Jahangiri
- Dotter Interventional Institute, Oregon Health & Science University
| | - Barry Uchida
- Dotter Interventional Institute, Oregon Health & Science University
| | - Khashayar Farsad
- Dotter Interventional Institute, Oregon Health & Science University
| | - John A Kaufman
- Dotter Interventional Institute, Oregon Health & Science University
| | - Ramsey Al-Hakim
- Dotter Interventional Institute, Oregon Health & Science University.
| |
Collapse
|
14
|
White P, Jahangiri Y, Farsad K, Kaufman J, Al-Hakim R. Lateral tilt during IVC filter placement does not predict the need for advanced filter retrieval techniques. Diagn Interv Radiol 2021; 27:644-648. [PMID: 34559049 DOI: 10.5152/dir.2021.19411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to determine if lateral inferior vena cava (IVC) filter tilt at placement predicts the need for subsequent advanced retrieval techniques. METHODS A retrospective chart review was performed of all Gunther Tulip IVC filter placements with subsequent retrievals between February 2015 and October 2017. Chart and imaging review was performed for patient, filter placement, and filter retrieval demographics/characteristics. Degree of agreement between two measurement sets was evaluated with the intraclass correlation (ICC) analysis. Categorical variables were compared with chi-square or Fisher exact test, as appropriate. Kendall rank correlation was used to measure correlation between categorical variables. RESULTS There was poor agreement between filter tilt angle at the time of placement and retrieval (ICC coefficient, 0.54). Mean difference ± standard deviation between tilt angle at the time of placement and retrieval was 4.6°±4.3° (p = 0.35). Among patient- or procedure-related factors, a common femoral vein access on placement (regression coefficient, -2.90; p = 0.039) was associated with a lower difference between placement and retrieval filter tilt angles compared to internal jugular vein access. Higher filter tilt angle measured at the time of retrieval (OR: 1.19, p = 0.025), hook embedment (OR: 77.3, p < 0.001), and a longer dwell time (OR: 1.25, p = 0.002) were associated with the need for advanced retrieval techniques. However, in univariate and multivariate analysis filter tilt angle at the time of placement was not associated with the subsequent need for advanced retrieval technique (p = 0.16). CONCLUSION Lateral tilt at the time of placement is poorly associated with lateral tilt at the time of retrieval and does not correlate with the need for advanced retrieval technique.
Collapse
Affiliation(s)
- Peter White
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Younes Jahangiri
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - John Kaufman
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Ramsey Al-Hakim
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
15
|
Huber TC, Jahangiri Y, Weinberg I, Giri J, Jaff MR, Kaufman J. Analysis of Costs and Payments for Inferior Vena Cava Filter Retrieval in the Medicare Population. J Vasc Interv Radiol 2021; 32:1164-1169. [PMID: 34332717 DOI: 10.1016/j.jvir.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022] Open
Abstract
Over the past decade, inferior vena cava (IVC) filter retrieval has been increasing, in part due to Food and Drug Administration recommendations and legal pressure. The costs and margin of IVC filter removal are poorly understood. Medicare claims data from 2016 for the 103 highest volume centers for IVC filter retrieval were examined. Pooled mean charges, costs, payments, and margin were calculated by institution. Mean ± SD charges, costs, and payments were $14,138.00 ± $8,400.48, $3,693.28 ± $2,294.27, and $1,949.82 ± $702.91, respectively. Average (range) margin was -$1,706.18 (-$7,509.93 to $362.77). The margin was negative in 99 of the 103 (96%) institutions evaluated. The most significant contributors to the total procedure cost were operating room, supplies, and recovery (44.5%, 23.5%, and 10.4%, respectively). While IVC filter retrieval is often medically indicated, it is typically associated with a financial loss under current reimbursement structure.
Collapse
Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon.
| | - Younes Jahangiri
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Ido Weinberg
- Department of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay Giri
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, Newton, Massachusetts
| | - John Kaufman
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
16
|
Yamada K, Jahangiri Y, Li J, Gabr A, Anoushiravani A, Kumagai K, Uchida B, Farsad K, Horikawa M. Embolic Characteristics of Imipenem-Cilastatin Particles in Vitro and in Vivo: Implications for Transarterial Embolization in Joint Arthropathies. J Vasc Interv Radiol 2021; 32:1031-1039.e2. [DOI: 10.1016/j.jvir.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022] Open
|
17
|
Li N, Ferracane J, Lewis S, Andeen N, Woltjer R, Farsad K, Kaufman J, Rugonyi S, Jahangiri Y, Uchida B, Gabr A, Li J, Yamada K, Al-Hakim R. Abstract No. 225 Venous large animal model for stenosis, thrombosis, and chronic occlusion: short-term results, with biomechanical analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
18
|
Gabr A, Li N, Panick C, O’Sullivan J, Stoner R, Tillotson M, Kaufman J, Kolbeck K, Jahangiri Y, Farsad K. Abstract No. 561 Morphometric tumor analysis and response assessment after Y90 radioembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
19
|
Jahangiri Y. Comment: Value of CT-Guided Percutaneous Irreversible Electroporation Added to FOLFIRINOX Chemotherapy in Locally Advanced Pancreatic Cancer: A Post Hoc Comparison. J Vasc Interv Radiol 2021; 32:765-766. [PMID: 33642157 DOI: 10.1016/j.jvir.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Younes Jahangiri
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, 97239
| |
Collapse
|
20
|
Han X, Taratula O, St Lorenz A, Moses AS, Albarqi HA, Jahangiri Y, Wu Q, Xu K, Taratula O, Farsad K. A novel multimodal nanoplatform for targeting tumor necrosis. RSC Adv 2021; 11:29486-29497. [PMID: 35479549 PMCID: PMC9040648 DOI: 10.1039/d1ra05658a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
Peri-necrotic tumor regions have been found to be a source of cancer stem cells (CSC), important in tumor recurrence. Necrotic and peri-necrotic tumor zones have poor vascular supply, limiting effective exposure to systemically administered therapeutics. Therefore, there is a critical need to develop agents that can effectively target these relatively protected tumor areas. We have developed a multi-property nanoplatform with necrosis avidity, fluorescence imaging and X-ray tracking capabilities to evaluate its feasibility for therapeutic drug delivery. The developed nanoparticle consists of three elements: poly(ethylene glycol)-block-poly(ε-caprolactone) as the biodegradable carrier; hypericin as a natural compound with fluorescence and necrosis avidity; and gold nanoparticles for X-ray tracking. This reproducible nanoparticle has a hydrodynamic size of 103.9 ± 1.7 nm with a uniform spherical morphology (polydispersity index = 0.12). The nanoparticle shows safety with systemic administration and a stable 30 day profile. Intravenous nanoparticle injection into a subcutaneous tumor-bearing mouse and intra-arterial nanoparticle injection into rabbits bearing VX2 orthotopic liver tumors resulted in fluorescence and X-ray attenuation within the tumors. In addition, ex vivo and histological analysis confirmed the accumulation of hypericin and gold in areas of necrosis and peri-necrosis. This nanoplatform, therefore, has the potential to enhance putative therapeutic drug delivery to necrotic and peri-necrotic areas, and may also have an application for monitoring early response to anti-tumor therapies. Au-Hyp-NP developed by encapsulation of gold and hypericin into PEG-PCL nanoplatform for fluorescence and X-ray tracking with tumor necrosis targeting.![]()
Collapse
Affiliation(s)
- Xiangjun Han
- Department of Radiology, First Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, USA
| | - Anna St Lorenz
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, USA
| | - Abraham S. Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, USA
| | - Hassan A. Albarqi
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, USA
| | - Younes Jahangiri
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon 97239-3011, USA
| | - Qirun Wu
- Department of Radiology, First Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China
| | - Ke Xu
- Department of Radiology, First Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China
| | - Olena Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon 97239-3011, USA
| |
Collapse
|
21
|
Rostambeigi N, Farsad K, Young S, Shrestha P, Jahangiri Y, Liang KW, Cretcher M, Golzarian J. Lower-Extremity Edema Is Common after Transjugular Intrahepatic Portosystemic Shunt Creation and Is Associated with Lower Survival: A Two-Institution Study. Radiology 2020; 298:221-227. [PMID: 33201792 DOI: 10.1148/radiol.2020201690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Transjugular intrahepatic portosystemic shunt (TIPS) creation is an accepted treatment of portal hypertension. Lower-extremity edema (LEE) is an underreported complication of TIPS creation. Purpose To assess the epidemiologic findings of LEE after TIPS creation and their association with patient survival. Materials and Methods The medical records of patients who underwent TIPS creation between January 2003 and April 2019 at Oregon Health and Science University and patients who underwent TIPS creation between January 2006 and December 2016 at University of Minnesota were retrospectively reviewed. Clinical, laboratory, and technical parameters, development and outcome of edema, and survival data were collected. LEE was defined as new-onset or worsened edema up to 1 year after TIPS creation. Cardiac ventricular function was evaluated with transthoracic echocardiography. Risk factors for LEE were evaluated with logistic regression analysis, and critical P values were additionally assessed by using the false discovery rate. Survival curves were compared by using the log-rank test. Results Three hundred thirty-four patients were included (mean age, 55 years ± 11 [standard deviation]; 208 men). TIPS creation was primarily performed for ascites (159 of 334 patients, 48%), gastrointestinal bleeding (127 of 334 patients, 38%), or a combination of bleeding and ascites (38 of 334 patients, 11%). One hundred seventy of the 334 patients (51%) developed LEE (new onset, 120; worsened edema, 50). Three of 170 patients (2%) had abnormal left ventricular ejection fraction. Multivariable analysis showed TIPS creation for ascites (odds ratio, 1.7; 95% CI: 1.04, 2.7; P = .03) and hepatic hydrothorax (odds ratio, 2.2; 95% CI: 1.1, 4.2; P = .02) was likely associated with LEE; however, it did not reach significance at a critical P value of .009. Among 164 patients with data on the outcome of LEE, LEE eventually improved in 94 (57%). The median survival of patients with LEE was lower than that of patients without LEE (38 months vs 71 months, respectively; P = .02). Conclusion Lower-extremity edema developed in more than 50% of study patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) creation, regardless of left ventricular function. There was suggestion that TIPS creation for ascites might be an underlying risk factor. Lower-extremity edema portends worse survival. © RSNA, 2020 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Nassir Rostambeigi
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| | - Khashayar Farsad
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| | - Shamar Young
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| | - Prashant Shrestha
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| | - Younes Jahangiri
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| | - Keng-Wei Liang
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| | - Maxwell Cretcher
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| | - Jafar Golzarian
- From the Mallinckrodt Institute of Radiology, Department of Vascular and Interventional Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, St Louis, MO 63110 (N.R.); Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Ore (K.F., Y.J., K.W.L., M.C.); and Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minn (S.Y., P.S., J.G.)
| |
Collapse
|
22
|
Li N, Mendoza F, Rugonyi S, Farsad K, Kaufman JA, Jahangiri Y, Uchida BT, Bonsignore C, Al-Hakim R. Venous Biomechanics of Angioplasty and Stent Placement: Implications of the Poisson Effect. J Vasc Interv Radiol 2020; 31:1348-1356. [PMID: 32682711 DOI: 10.1016/j.jvir.2020.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To characterize the Poisson effect in response to angioplasty and stent placement in veins and identify potential implications for guiding future venous-specific device design. MATERIALS AND METHODS In vivo angioplasty and stent placement were performed in 3 adult swine by using an established venous stenosis model. Iron particle endothelium labeling was performed for real-time fluoroscopic tracking of the vessel wall during intervention. A finite-element computational model of a vessel was created with ADINA software (version 9.5) with arterial and venous biomechanical properties obtained from the literature to compare the response to radial expansion. RESULTS In vivo angioplasty and stent placement in a venous stenosis animal model with iron particle endothelium labeling demonstrated longitudinal foreshortening that correlated with distance from the center of the balloon (R2 = 0.87) as well as adjacent segment narrowing that correlated with the increase in diameter of the treated stenotic segment (R2 = 0.89). Finite-element computational analysis demonstrated increased Poisson effect in veins relative to arteries (linear regression coefficient slope comparison, arterial slope 0.033, R2 = 0.9789; venous slope 0.204, R2 = 0.9975; P < .0001) as a result of greater longitudinal Young modulus in veins compared with arteries. CONCLUSIONS Clinically observed adjacent segment narrowing during venous angioplasty and stent placement is a result of the Poisson effect, with redistribution of radially applied force to the longitudinal direction. The Poisson effect is increased in veins relative to arteries as a result of unique venous biomechanical properties, which may be relevant to consider in the design of future venous interventional devices.
Collapse
Affiliation(s)
- Ningcheng Li
- Dotter Interventional Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Francine Mendoza
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239; Department of Biomedical Engineering, Oregon State University, Corvallis, Oregon
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Khashayar Farsad
- Dotter Interventional Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - John A Kaufman
- Dotter Interventional Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Younes Jahangiri
- Dotter Interventional Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Barry T Uchida
- Dotter Interventional Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | | | - Ramsey Al-Hakim
- Dotter Interventional Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239.
| |
Collapse
|
23
|
Morrison JJ, Jiao A, Robinson S, Jahangiri Y, Kaufman JA. Prevalence of Musculoskeletal Symptoms in Interventional Radiologists. J Vasc Interv Radiol 2020; 31:1308-1314. [PMID: 32674871 DOI: 10.1016/j.jvir.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the prevalence of musculoskeletal symptoms, defined as aches, pains, discomfort, or numbness, by using a validated assessment tool among interventional radiologists. MATERIALS AND METHODS A Web-based survey using the Nordic Musculoskeletal Questionnaire was disseminated to interventional radiologist members by email in November 2015. Musculoskeletal symptoms were evaluated in 9 body areas. Information regarding participant demographics, practice details, use of radio-protective equipment, and exercise routines was also gathered. Univariate and multivariate analyses were performed to determine risk factors associated with more severe symptoms. RESULTS Of 4,096 SIR members at the time of the survey, 640 completed the questionnaire in its entirety (16% response rate). Respondents consisted of 69 females (11%) and 571 males (89%), with a mean age of 47.5 ± 10.2 years old, a mean body mass index of 25.5 ± 3.9 kg/m2, and a mean practice length of 17.1 ± 9.8 years. Prevalence of musculoskeletal symptoms was 88% in the 12 months preceding the survey. For those reporting musculoskeletal issues, 58% attributed the symptoms to work-related activities. Lower back (61%), neck (56%), and shoulder complaints (46%) were the most common. Symptoms prevented 21.2% of respondents from being able to work over the same time period. Multivariate analysis identified female gender, above-normal body mass index, and a practice length of 10 years or more as factors associated with a higher risk of moderate-to-severe symptoms. CONCLUSIONS Musculoskeletal symptoms are prevalent among interventional radiologists, the majority of which are attributed to work-related causes.
Collapse
Affiliation(s)
- James J Morrison
- Advanced Radiology Services, 3264 North Evergreen Drive, Grand Rapids, MI 49525; Michigan State University College of Human Medicine, Grand Rapids, MI.
| | - Albert Jiao
- Advanced Radiology Services, 3264 North Evergreen Drive, Grand Rapids, MI 49525
| | - Sean Robinson
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Younes Jahangiri
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR
| | - John A Kaufman
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR
| |
Collapse
|
24
|
Zu Q, Schenning RC, Jahangiri Y, Tomozawa Y, Kolbeck KJ, Kaufman JA, Al-Hakim R, Naugler WE, Nabavizadeh N, Kardosh A, Billingsley KG, Mayo SC, Orloff SL, Enestvedt CK, Maynard E, Ahn J, Lhewa D, Farsad K. Correction to: Yttrium-90 Radioembolization for BCLC Stage C Hepatocellular Carcinoma Comparing Child-Pugh A Versus B7 Patients: Are the Outcomes Equivalent? Cardiovasc Intervent Radiol 2020; 43:1425-1426. [PMID: 32548673 DOI: 10.1007/s00270-020-02554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The name of one of the co-authors was slightly misspelled. Kristian Enestvedt is listed currently as "Kristian K. Enestvedt" and should be listed instead as "C. Kristian Enestvedt."
Collapse
Affiliation(s)
- Qingquan Zu
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA.,Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Ryan C Schenning
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Younes Jahangiri
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Yuki Tomozawa
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Kenneth J Kolbeck
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - John A Kaufman
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Ramsey Al-Hakim
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Willscott E Naugler
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Nima Nabavizadeh
- Radiation Oncology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Adel Kardosh
- Medical Oncology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Kevin G Billingsley
- Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Skye C Mayo
- Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Susan L Orloff
- Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - C Kristian Enestvedt
- Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Erin Maynard
- Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Joseph Ahn
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Dekey Lhewa
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA.
| |
Collapse
|
25
|
Han X, Taratula O, Taratula O, Xu K, St Lorenz A, Moses A, Jahangiri Y, Yu G, Farsad K. Biodegradable Hypericin-Containing Nanoparticles for Necrosis Targeting and Fluorescence Imaging. Mol Pharm 2020; 17:1538-1545. [PMID: 32212709 DOI: 10.1021/acs.molpharmaceut.9b01238] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Necrosis targeting and imaging has significant implications for evaluating tumor growth, therapeutic response, and delivery of therapeutics to perinecrotic tumor zones. Hypericin is a hydrophobic molecule with high necrosis affinity and fluorescence imaging properties. To date, the safe and effective delivery of hypericin to areas of necrosis in vivo remains a challenge because of its incompatible biophysical properties. To address this issue, we have developed a biodegradable nanoparticle (Hyp-NP) for delivery of hypericin to tumors for necrosis targeting and fluorescence imaging. The nanoparticle was developed using methoxy poly(ethylene glycol)-b-poly(ε-caprolactone) and hypericin by a modified solvent evaporation technique. The size of Hyp-NP was 19.0 ± 1.8 nm from cryo-TEM and 37.3 ± 0.7 nm from dynamic light-scattering analysis with a polydispersity index of 0.15 ± 0.01. The encapsulation efficiency of hypericin was 95.05% w/w by UV-vis absorption. After storage for 30 days, 91.4% hypericin was retained in Hyp-NP with nearly no change in hydrodynamic size, representing nanoparticle stability. In an ovarian cancer cell line, Hyp-NP demonstrated cellular internalization with intracellular cytoplasmic localization and preserved fluorescence and necrosis affinity. In a mouse subcutaneous tumor model, tumor accumulation was noted at 8 h postinjection, with near-complete clearance at 96 h postinjection. Hyp-NP was shown to be tightly localized within necrotic tumor zones. Histological analysis of harvested organs demonstrated no gross abnormalities, and in vitro, no hemolysis was observed. This proof-of-concept study demonstrates the potential clinical applications of Hyp-NP for necrosis targeting.
Collapse
Affiliation(s)
- Xiangjun Han
- Department of Radiology, First Hospital of China Medical University, Shenyang, Liaoning 110001 P. R. China
| | - Olena Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, United States
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, United States
| | - Ke Xu
- Department of Radiology, First Hospital of China Medical University, Shenyang, Liaoning 110001 P. R. China
| | - Anna St Lorenz
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, United States
| | - Abraham Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon 97201, United States
| | - Younes Jahangiri
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon 97239-3011, United States
| | - Guibo Yu
- Department of Radiology, First Hospital of China Medical University, Shenyang, Liaoning 110001 P. R. China
| | - Khashayar Farsad
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon 97239-3011, United States
| |
Collapse
|
26
|
Gabr A, Jahangiri Y, Yamada K, Uchida B, Li J, Edwards J, Farsad K. Abstract No. 685 Direct versus total serum bilirubin: which is the better predictor of survival in patients undergoing transarterial therapies for hepatocellular carcinoma? J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
27
|
Meek R, Jahangiri Y, Kolbeck K, Farsad K. 3:36 PM Abstract No. 103 Percutaneous biliary drainage for malignant biliary obstruction to enable cancer therapy: how many patients actually make it to treatment? J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
28
|
Meek R, Jahangiri Y, Kolbeck K, Farsad K. 3:45 PM Abstract No. 104 Percutaneous management of biliary strictures following orthotopic liver transplantation: long-term outcomes analysis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
29
|
Jiao A, Farsad K, McVinnie DW, Jahangiri Y, Morrison JJ. Characterization of Iodide-induced Sialadenitis: Meta-analysis of the Published Case Reports in the Medical Literature. Acad Radiol 2020; 27:428-435. [PMID: 31178376 DOI: 10.1016/j.acra.2019.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/02/2019] [Accepted: 05/11/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the patient presentation of postcontrast sialadenitis and factors associated with its duration of symptoms through meta-analysis of case reports. BACKGROUND Acute iodide sialadenitis, or "iodide mumps," is a rare adverse reaction to iodinated contrast causing salivary gland swelling. The condition may be underdiagnosed, with researchers postulating that its true incidence may be close to 1-2%. METHODS AND MATERIALS This study was a meta-analysis performed using PRISMA Reporting Standards. A literature search with no language restriction was performed of the Medline database, primarily through PubMed, using keywords: "iodide mumps," "iodide sialadenitis," "sialadenitis," "salivary enlargement," "contrast reaction," "parotid swelling," and "submandibular swelling." Matching case reports and case series were reviewed, and data regarding the subjects' demographics, renal function, contrast administration, and symptoms were extracted. Uni- and multivariate linear regression analyses were applied to assess the predicting factors of a prolonged symptoms duration. RESULTS Sixty-five case reports and case series were identified, with 77 cases of iodide-induced sialadenitis. Two cases were unpublished and from the author's institution. Reported subjects' median age was 63 years, and 61% (47/77) were males. Median time to onset was 16 hours, and symptoms resolved in a median of 3 days after the initial onset. Twenty-seven subjects (35%, 27/77) were reported to have an impaired renal function at baseline. Administration of nonionic, low osmolarity contrast medium was reported most frequently (53%, 41/77). There was no difference in resolution of symptoms among subjects with impaired versus normal renal function. Symptoms were resolved in all cases over a median of 3 days with no statistically significant difference between those who received therapeutic intervention and those who did not (p = 0.430). Older age and longer time to onset were significantly associated with longer duration of symptoms in both uni- and multivariate linear regression models, and presence of tenderness demonstrated statistical significance associated with longer duration of symptoms in the univariate model. CONCLUSION Postcontrast sialadenitis is a rare reaction to iodinated contrast media. Older age and a longer time to onset of symptoms are associated with longer duration of symptoms.
Collapse
Affiliation(s)
- Albert Jiao
- Michigan State University College of Human Medicine, Secchia Center, Grand Rapids, Michigan
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | | | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - James J Morrison
- Advanced Radiology Services, 3264 North Evergreen Drive, Grand Rapids, MI 49525.
| |
Collapse
|
30
|
Yamada K, Kumagai K, Jahangiri Y, Li J, Gabr A, Anoushiravani A, Uchida B, Farsad K, Horikawa M. Abstract No. 438 Tail artery access for transarterial experiments in rats: feasibility study in a survival model. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
31
|
Yamada K, Farsad K, Jahangiri Y, Li J, Gabr A, Anoushiravani A, Uchida B, Horikawa M. Abstract No. 434 Embolic characteristics of imipenem–cilastatin particles in vivo in the rat renal artery. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
32
|
Li J, Farsad K, Jahangiri Y. 3:09 PM Abstract No. 248 Bone density changes after transjugular intrahepatic portosystemic shunt creation in patients with cirrhosis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
33
|
Adachi A, Ohta K, Jahangiri Y, Matsui Y, Horikawa M, Geeratikun Y, Chansanti O, Yata S, Fujii S, Steinberger J, Keller FS, Farsad K. Treatment of pulmonary arteriovenous malformations: clinical experience using different embolization strategies. Jpn J Radiol 2020; 38:382-386. [PMID: 31912422 DOI: 10.1007/s11604-019-00916-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/26/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate embolization efficacy of pulmonary arteriovenous malformations (PAVM) using Amplatzer vascular plugs (AVP) and coils. MATERIALS AND METHODS Eighty-eight embolized simple PAVMs in 38 patients were retrospectively analyzed by follow-up CT. Mean age was 50.2 ± 15.6 years and 22 (57.9%) patients were females. Mean follow-up interval was 38.2 ± 28.4 months (median 29.9 months). Embolization devices included AVP I, AVP II, AVP 4, and coils. Technical success was defined as no visualization of an early draining vein at angiography after embolization. Treatment success was defined as complete disappearance or decrease in size of the venous aneurysm ≥ 70% at follow-up CT. RESULTS Technical success rate was 100% and treatment success rate evaluated by CT for the various embolization strategies was 100% for AVP I (n = 6), 100% for AVP I + coils (n = 5), 83.3% for AVP II (n = 6), 40.0% for AVP II + coils (n = 5), 87.5% for AVP 4 (n = 8), 50.0% for AVP 4 + coils (n = 8), and 78.0% for coils alone (n = 50). No statistically significant difference in embolization efficacy was seen between different devices (P = 0.083). Although not statistically significant, combination use of coils with AVPs demonstrated lower rates of clinical embolization success (P = 0.053). CONCLUSION Embolization of PAVMs demonstrated high technical and treatment success rates with available embolic devices. No significant statistical differences were demonstrated between AVPs. However, the need for both coils and AVPs may suggest a more complicated underlying lesion at risk for recurrence.
Collapse
Affiliation(s)
- Akira Adachi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan.
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA.
| | - Kengo Ohta
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Younes Jahangiri
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Yusuke Matsui
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Masahiro Horikawa
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Yindee Geeratikun
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Radiology, Rajavithi Hospital, Bangkok, Thailand
| | - Orapin Chansanti
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shinsaku Yata
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Jonathan Steinberger
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Frederick S Keller
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
34
|
Taechariyakul T, Keller FS, Jahangiri Y. Endovascular Treatment of Tracheoinnominate Artery Fistula: Case Report and Literature Review With Pooled Cohort Analysis. Semin Thorac Cardiovasc Surg 2019; 32:77-84. [PMID: 31425754 DOI: 10.1053/j.semtcvs.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/11/2022]
Abstract
To pool data from published cases of tracheoinnominate artery fistula (TIF) treated with surgical or endovascular techniques along with reporting a case of similar presentation. A total of 261 cases in 137 published case reports and case series were identified through a comprehensive systematic literature review. Data regarding patient characteristics, treatment, and follow-up were extracted. A local case of a 14-year-old boy with TIF due to longstanding tracheostomy treated with stent-graft placement was added to the data. Comparison of the complication rates between surgical vs endovascular interventions was done with the chi-square test. Factors associated with longer survival were assessed by the Cox regression analysis. Thirty-three (12.6%) of the reported cases were treated endovascularly, 137 (52.3%) were treated surgically, and 92 (35.1%) were reported with no definitive treatment. Mean age was 34 ± 22 years, and 61% were males. The mean time interval between tracheotomy placement and bleeding was 1 ± 2.5 years. A lower procedure-related complication (30% vs 50%, P = 0.045) and 30-day mortality (9% vs 23%, P = 0.008) rates had been reported with percutaneous approaches compared to surgery. No percutaneous procedure was reported prior to year 2000. In multivariate analysis stratified by publication year, a shorter tracheostomy-to-bleeding time (year) was significantly associated with higher hazards of death (hazard ratio: 1.22, P = 0.017). Type of intervention (percutaneous vs surgery) was not associated with postintervention survival (adjusted hazard ratio: 0.78, P = 0.558). Endovascular stent grafting can have a comparable postprocedural survival and lower complication rates vs open surgical repair in treatment of TIF.
Collapse
Affiliation(s)
| | - Frederick S Keller
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Younes Jahangiri
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon.
| |
Collapse
|
35
|
Liang KW, Jahangiri Y, Tsao TF, Tyan YS, Huang HH. Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters. J Vasc Interv Radiol 2019; 30:1335-1342.e1. [PMID: 31375447 DOI: 10.1016/j.jvir.2019.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/20/2019] [Accepted: 04/28/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma. MATERIALS AND METHODS A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated. RESULTS A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (-29.06 mm Hg; 95% confidence interval [CI], -33.93 to -24.19), DBP (-16.03 mm Hg; 95% CI, -18.33 to -13.73), and the number of antihypertensive medications used (-1.43; 95% CI, -1.97 to -0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration. CONCLUSIONS Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.
Collapse
Affiliation(s)
- Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Hsin-Hui Huang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C.
| |
Collapse
|
36
|
Taratula OR, Taratula O, Han X, Jahangiri Y, Tomozawa Y, Horikawa M, Uchida B, Albarqi HA, Schumann C, Bracha S, Korzun T, Farsad K. Transarterial Delivery of a Biodegradable Single-Agent Theranostic Nanoprobe for Liver Tumor Imaging and Combinatorial Phototherapy. J Vasc Interv Radiol 2019; 30:1480-1486.e2. [PMID: 31202675 DOI: 10.1016/j.jvir.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess selective accumulation of biodegradable nanoparticles within hepatic tumors after transarterial delivery for in vivo localization and combinatorial phototherapy. MATERIALS AND METHODS A VX2 hepatic tumor model was used in New Zealand white rabbits. Transarterial delivery of silicon naphthalocyanine biodegradable nanoparticles was performed using a microcatheter via the proper hepatic artery. Tumors were exposed via laparotomy, and nanoparticles were observed by near-infrared (NIR) fluorescence imaging. For phototherapy, a handheld NIR laser (785 nm) at 0.6 W/cm2 was used to expose tumor or background liver, and tissue temperatures were assessed with a fiberoptic temperature probe. Intratumoral reactive oxygen species formation was assessed using a fluorophore (2',7'-dichlorodihydrofluorescein diacetate). RESULTS Nanoparticles selectively accumulated within viable tumor by NIR fluorescence. Necrotic portions of tumor did not accumulate nanoparticles, consistent with a vascular distribution. NIR-dependent heat generation was observed with nanoparticle-containing tumors, but not in background liver. No heat was generated in the absence of NIR laser light. Reactive oxygen species were formed in nanoparticle-containing tumors exposed to NIR laser light, but not in background liver treated with NIR laser or in tumors in the absence of NIR light. CONCLUSIONS Biodegradable nanoparticle delivery to liver tumors from a transarterial approach enabled selective in vivo tumor imaging and combinatorial phototherapy.
Collapse
Affiliation(s)
- Olena R Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon
| | - Xiangjun Han
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR 97239
| | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR 97239
| | - Yuki Tomozawa
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR 97239
| | - Masahiro Horikawa
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR 97239
| | - Barry Uchida
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR 97239
| | - Hassan A Albarqi
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon
| | - Canan Schumann
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon
| | - Shay Bracha
- Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| | - Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR 97239.
| |
Collapse
|
37
|
Jahangiri Y, Pathak P, Tomozawa Y, Li L, Schlansky BL, Farsad K. Muscle Gain after Transjugular Intrahepatic Portosystemic Shunt Creation: Time Course and Prognostic Implications for Survival in Cirrhosis. J Vasc Interv Radiol 2019; 30:866-872.e4. [PMID: 31053265 DOI: 10.1016/j.jvir.2019.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/05/2018] [Accepted: 01/05/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To examine the association of transjugular intrahepatic portosystemic shunt (TIPS) creation with muscle gains and patient mortality, and to identify the timeframe of these changes. MATERIALS AND METHODS Patients with cirrhosis undergoing TIPS creation with available abdominal computed tomography before and after TIPS from 2004-2015 were included (n = 76). The primary indications for TIPS included refractory ascites (52.6%) or variceal bleeding (47.4%). Axial truncal muscle area and attenuation were measured at the L4 level using free-hand region of interest technique, and pre- and post-TIPS values were compared. The association of TIPS-related muscle changes with mortality was evaluated using Cox multiple regression. Logistic regression analysis was performed to evaluate associations of baseline muscle area and clinical variables with post-TIPS changes. RESULTS TIPS creation was associated with significant increases in psoas, paraspinal, and total muscle areas (P < .001, 0.004, and 0.002), and psoas muscle attenuation (P = .022) at a median of 13.5 months after TIPS. Maximal muscle gains occurred within 6 months after TIPS creation (P < .001). Muscle gain at 1-year after TIPS was independently associated with lower mortality (psoas hazard ratio [HR] 0.14, P = .016; paraspinal HR 0.15, P = .016; abdominal HR 0.05, P = .005; core HR 0.06, P = .001; and total HR 0.05, P = .003). Baseline demographic or clinical variables were not associated with muscle gain after TIPS. CONCLUSIONS TIPS creation was strongly associated with truncal muscle gains and attenuation in patients with cirrhosis. Maximal muscle gain occurred within 6 months after TIPS creation. TIPS-related increased muscle mass was independently associated with lower patient mortality.
Collapse
Affiliation(s)
- Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Priya Pathak
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Yuki Tomozawa
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Lei Li
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Barry L Schlansky
- Department of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
| |
Collapse
|
38
|
Al-Hakim R, Hedge JC, Jahangiri Y, Kaufman JA, Galuppo R, Farsad K. Palmar Warming for Radial Artery Vasodilation to Facilitate Transradial Access: A Randomized Controlled Trial. J Vasc Interv Radiol 2019; 30:421-424. [PMID: 30819486 DOI: 10.1016/j.jvir.2018.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To investigate the efficacy of palmar warming to induce radial artery vasodilation. MATERIALS AND METHODS After informed consent was obtained, healthy volunteers (n = 45) were randomized 2:1 in palmar warming and control groups, respectively, for this prospective, randomized, single-blind clinical trial (NCT03620383). The palmar warming group was given a warm, commercially available, air-activated heat pack (Kobayashi Consumer Products LLC, Dalton, Georgia) to hold in the left hand for palmar warming. The control group was given a deactivated version of the same heat pack. Left radial artery cross-sectional area (CSA) measurements were obtained at baseline and in 5-minute intervals up to 20 minutes in both groups. Differences in the trends of changes in the radial artery CSA between palmar warming and control groups were examined with the age- and sex-adjusted repeated measure analysis of variance. Propensity score-matched treatment effect analysis was conducted to quantify the effect of heat on radial artery CSA. RESULTS The palmar warming group and the control group were significantly different in terms of subject sex (males/females: 7/23 and 10/5, respectively; P = .005) and baseline CSA (2.5±0.2 mm2 vs 3.2±0.3 mm2, respectively; P = .014). Radial artery CSA showed an increasing trend over time in the palmar warming group compared to a stable trend over time in the control group (P < .0001). Propensity score-matched comparison showed a 43.9% increase (95% confidence interval: 34.1%-53.8%) in CSA in the palmar warming group compared to the control group (P < .0001). CONCLUSIONS The palmar warming technique is effective at dilating the radial artery and may be a beneficial technique to facilitate transradial access.
Collapse
Affiliation(s)
- Ramsey Al-Hakim
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
| | - J Cody Hedge
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - John A Kaufman
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Roberto Galuppo
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| |
Collapse
|
39
|
Liang K, Jahangiri Y, Tomozawa Y, Yamada K, Farsad K, Liang K. 04:21 PM Abstract No. 178 Solitary predictors of the hepatic venous pressure gradient: are complex models necessary? J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
40
|
Jahangiri Y, Rahmani R, Nabavizadeh N, Degnin C, Chen Y, Tomozawa Y, Geeratikun Y, Hung A, Thomas C, Kolbeck K, Schenning R, Kaufman J, Farsad K. 03:00 PM Abstract No. 179 Combination therapy with TACE+ablation vs. TACE + SBRT for hepatocellular carcinoma (HCC): comparative analysis with propensity score–weighted cohorts. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
41
|
White P, Jahangiri Y, Farsad K, Kaufman J, Al-Hakim R. 03:45 PM Abstract No. 194 Does lateral tilt during inferior vena cava filter placement result in subsequent need for advanced retrieval technique? J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
42
|
Farsad K, Bagai S, Jahangiri Y, Uchida B, Graham T, Liang K, Han X, Li C, Najmabadi K, Agah R. 04:21 PM Abstract No. 392 Trans-pulmonary artery selective chemotherapy delivery to lung using a double balloon-occlusion catheter: feasibility study in swine. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
43
|
Torkian P, Yaseri M, Kaufman J, Jahangiri Y. 03:45 PM Abstract No. 107 Symptomatic hepatic hemangiomas treated with transcatheter arterial chemoembolization (TACE): systematic review and meta-analysis. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
44
|
Li N, Farsad K, Kaufman J, Jahangiri Y, Uchida B, Al-Hakim R. 03:54 PM Abstract No. 389 Iron particle coating of venous endothelium for in vivo fluoroscopic visualization and real-time biomechanical analysis. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
45
|
Al-Hakim RA, Kaufman JA, Jahangiri Y, Uchida BT, Farsad K. Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation. J Vasc Interv Radiol 2019; 30:271-273. [PMID: 30717966 DOI: 10.1016/j.jvir.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ramsey A Al-Hakim
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - John A Kaufman
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Barry T Uchida
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| |
Collapse
|
46
|
Nabavizadeh N, Jahangiri Y, Rahmani R, Degnin C, Chen Y, Geeratikun Y, Hung A, Thomas CR, Kolbeck K, Schenning R, Kaufman J, Farsad K. Combination therapy with TACE + ablation versus TACE + SBRT for hepatocellular carcinoma (HCC): Comparative analysis with propensity score-weighted cohorts. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
443 Background: To assess the relative efficacy and toxicity associated with TACE+Ablation (Ablation) or TACE+SBRT (SBRT) in a large cohort of patients with unresectable HCC. Methods: Patients with HCC undergoing Ablation or SBRT from 2006-2016 with available follow up were included. Treatment groups were different at baseline regarding tumor stage (BCLC A, B and C: 96%, 4%, 0% (Ablation) vs. 73%, 14% and 13% (SBRT), P < 0.001) and severity of liver disease (CTP A, B, and C: 55%, 45% and 0% (Ablation) vs. 50%, 41%, and 9% (SBRT), P = 0.007). Propensity scores were calculated with age, sex, BCLC stage, CTP class, etiology of liver disease, tumor number, and diameter to balance the cohorts. Average treatment effects on survival with multivariable propensity score-weighted competing risk Cox regression models were evaluated, with BCLC stage, number of treated tumors and liver transplant as additionally controlled variables. Primary outcome was overall survival (OS). Secondary outcomes were progression-free survival (PFS), local tumor control and hepatotoxicity. Treatment-related hepatotoxicity was defined as a two point change in CTP within six months after treatment. Results: 192 subjects were included (101 Ablation, 91 SBRT; median age=60 years, 75% men). Liver disease included HCV (78%), alcohol (35%) and NASH (8%). Liver transplant-adjusted 1- and 2-year OS rates were significantly greater for Ablation vs SBRT (88% vs. 75% and 77% vs. 50%, P<0.001). 1-and 2-year PFS rates were significantly greater for Ablation vs. SBRT (84% vs. 65% and 75% vs. 51%, P < 0.001). 1- and 2- year local tumor control rates were similar with both strategies (99% vs. 91% and 94% vs. 87%, P=0.298). Propensity score-weighted multivariable analysis showed significantly higher OS (sHR: 2.31, P = 0.006) and PFS rates (sHR:1.75, P = 0.008) with Ablation compared to SBRT. Ablation was also associated with lower post-treatment hepatotoxicity compared with SBRT (5% vs. 12%, P = 0.001). Conclusions: TACE+Ablation demonstrated higher OS/PFS and lower post-treatment hepatotoxicity compared with TACE+SBRT. Local disease control up to two years was equivocal, potentially suggesting equipoise for bridge to transplant.
Collapse
Affiliation(s)
| | | | | | | | - Yiyi Chen
- Oregon Health and Science University, Portland, OR
| | | | - Arthur Hung
- Oregon Health & Science University Department of Radiation Oncology, Portland, OR
| | | | | | | | - John Kaufman
- Oregon Health & Science University, Portland, OR
| | | |
Collapse
|
47
|
Abstract
BACKGROUND Inflammation and platelet activation have been shown to be involved in acute thromobogenicity following venous occlusive conditions. The aim of this study was to identify the association of baseline platelet count and neutrophil/lymphocyte ratio (NLR) with venous stent failure. Methods and Results: Patients who underwent technically successful iliocaval venous stent placement with available baseline complete blood count and follow-up stent patency data were selected (n=50). Stent failure was defined as >50% stenosis or occlusion at follow-up angiography, contrast-enhanced CT, MRI or duplex US. Median patient age was 49.5 years (range, 13-76 years), and 62% were female. Median follow-up time was 10.2 months (range, 0.1-76.4 months). Stent failure occurred in 13 patients (26%) after a median of 1.2 months (range, 1 day-76.4 months). On multivariable-adjusted Cox modeling, baseline platelets (HR, 2.28; P=0.004) and WBC count (HR, 2.03; P=0.013) were significantly associated with stent failure on follow-up; neutrophils (HR, 16.10; P=0.050); and NLR (HR, 12.19; P=0.050) had borderline significance. Compared with patients without stent failure, those with early, but not late, stent failure had higher baseline platelets (P=0.031) and neutrophils (P=0.025), and NLR (P=0.026). CONCLUSIONS Baseline platelet count and NLR are associated with early but not late failure of iliocaval venous stents. This suggests different pathophysiologic mechanisms and a role for both platelet activation and inflammatory mechanisms in early rather than late stent thrombosis. Future research is needed to better explain this novel finding.
Collapse
Affiliation(s)
- Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - Masayuki Endo
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - Ramsey Al-Hakim
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - John A Kaufman
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| |
Collapse
|
48
|
Tomozawa Y, Jahangiri Y, Farsad K, Kolbeck K, Kaufman J. 3:09 PM Abstract No. 262 Long-term toxicity after radioembolization with yttrium-90 for neuroendocrine tumor liver metastases. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Pathak P, Jahangiri Y, Li L, Schlansky B, Farsad K. 3:45 PM Abstract No. 287 Increase in muscle mass after transjugular intrahepatic portosystemic shunt (TIPS) creation is a prognostic indicator for survival in cirrhosis. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
50
|
Jahangiri Y, Ashwell Z, Farsad K. Percutaneous renal artery revascularization after prolonged ischemia secondary to blunt trauma: pooled cohort analysis. Diagn Interv Radiol 2018; 23:371-378. [PMID: 28870883 DOI: 10.5152/dir.2017.16415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to identify factors related to technical and clinical success of percutaneous revascularization for blunt renal arterial trauma. METHODS All cases of percutaneous revascularization for blunt renal arterial trauma were searched in the available literature. We included a case of iatrogenic renal artery occlusion at our institution treated by percutaneous stenting 20 hours after injury. A pooled cohort analysis of percutaneous revascularization for blunt renal artery injury was then performed to analyze factors related to technical and clinical success. Clinical failure was defined as development of new hypertension, serum creatinine rise, or significant asymmetry in split renal function. RESULTS A total of 53 cases have been reported, and 54 cases were analyzed including our case. Median follow-up was 6 months. Technical success was 88.9% and clinical success was 75%. Of 12 treatment failures (25%), 66.7% occurred during the first postprocedure month. Time from injury to revascularization was not a predictor of clinical success (OR=1.00, P = 0.681). Renal artery occlusion was significantly associated with clinical failure (OR=7.50, P = 0.017) and postintervention antiplatelet therapy was significantly associated with treatment success (OR=0.16, P = 0.043). At 37-month follow-up, the stented renal artery in our case remained patent and the patient was normotensive with preserved glomerular filtration rate. CONCLUSION Percutaneous revascularization for blunt renal arterial injury resulted in relatively high technical and clinical success. Time-to-revascularization was independent of successful outcomes. Clinical success was significantly associated with a patent renal artery at the time of intervention and with postprocedure antiplatelet therapy.
Collapse
Affiliation(s)
- Younes Jahangiri
- Department of Interventional Radiology, Charles T. Dotter Institute, Oregon Health and Science University, Portland, Oregon, USA.
| | | | | |
Collapse
|