Publications by authors named "Hassan Albadawi"

81 Publications

Percutaneous liquid ablation agent for tumor treatment and drug delivery.

Sci Transl Med 2021 Feb;13(580)

Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA.

Percutaneous locoregional therapies (LRTs), such as thermal ablation, are performed to limit the progression of hepatocellular carcinoma (HCC) and offer a bridge for patients waiting for liver transplantation. However, physiological challenges related to tumor location, size, and existence of multiple lesions as well as safety concerns related to potential thermal injury to adjacent tissues may preclude the use of thermal ablation or lead to its failure. Here, we showed a successful injection of an ionic liquid into tissue under image guidance, ablation of tumors in response to the injected ionic liquid, and persistence (28 days) of coinjected chemotherapy with the ionic liquid in the ablation zone. In a rat HCC model, the rabbit VX2 liver tumor model, and 12 human resected tumors, injection of the ionic liquid led to consistent tumor ablation. Combining the ionic liquid with the chemotherapy agent, doxorubicin, resulted in synergistic cytotoxicity when tested with cultured HCC cells and uniform drug distribution throughout the ablation zone when percutaneously injected into liver tumors in the rabbit liver tumor model. Because this ionic liquid preparation is simple to use, is efficacious, and has a low cost, we propose that this new LRT may bridge more patients to liver transplantation.
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http://dx.doi.org/10.1126/scitranslmed.abe3889DOI Listing
February 2021

Nanocomposite Hydrogel with Tantalum Microparticles for Rapid Endovascular Hemostasis.

Adv Sci (Weinh) 2020 Jan 30;8(1):2003327. Epub 2020 Nov 30.

Minimally Invasive Therapeutics Laboratory Department of Vascular and Interventional Radiology Mayo Clinic Phoenix AZ 85054 USA.

Endovascular embolization to treat vascular hemorrhage involves pushing coil-shaped metal wires into the artery repeatedly until they are densely packed to slow the blood flow and clot. However, coil embolization is associated with high rebleeding rates, unpredictable economics and, most importantly, they rely on the patient's ability to make a clot. These issues are exacerbated when the patient is anticoagulated or coagulopathic. A novel bioengineered tantalum-loaded nanocomposite hydrogel for gel embolic material (Ta-GEM) that can be rapidly delivered using clinical catheters for instant hemostasis regardless of the coagulopathic state is reported. Ta-GEM formulation is visible by most of the clinically available imaging modalities including ultrasound, computed tomography, magnetic resonance imaging, and fluoroscopy without significant artifact. In addition, Ta-GEM can be retrieved, allowing temporary vascular occlusion, and it can be used to rescue cases of failed coil embolization. Ta-GEM occlusion of first-order arteries such as the renal artery and iliac artery in a swine model is found to be safe and durable; by 28 days, 75% of the injected Ta-GEM in the arterial lumen is replaced by dense connective tissue. Altogether, this study demonstrates that Ta-GEM has many advantages over the current technologies and has potential applications in clinical practice.
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http://dx.doi.org/10.1002/advs.202003327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788497PMC
January 2020

Blood-Derived Biomaterial for Catheter-Directed Arterial Embolization.

Adv Mater 2020 Dec 11;32(52):e2005603. Epub 2020 Nov 11.

Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA.

Vascular embolization is a life-saving minimally invasive catheter-based procedure performed to treat bleeding vessels. Through these catheters, numerous metallic coils are often pushed into the bleeding artery to stop the blood flow. While there are numerous drawbacks to coil embolization, physician expertise, availability of these coils, and their costs further limit their use. Here, a novel blood-derived embolic material (BEM) with regenerative properties, that can achieve instant and durable intra-arterial hemostasis regardless of coagulopathy, is developed. In a large animal model of vascular embolization, it is shown that the BEM can be prepared at the point-of-care within 26 min using fresh blood, it can be easily delivered using clinical catheters to embolize renal and iliac arteries, and it can achieve rapid hemostasis in acutely injured vessels. In swine arteries, the BEM increases cellular proliferation, angiogenesis, and connective tissue deposition, suggesting vessel healing and durable vessel occlusion. The BEM has significant advantages over embolic materials used today, making it a promising new tool for embolization.
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http://dx.doi.org/10.1002/adma.202005603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769968PMC
December 2020

Bioactive-Tissue-Derived Nanocomposite Hydrogel for Permanent Arterial Embolization and Enhanced Vascular Healing.

Adv Mater 2020 Aug 23;32(33):e2002611. Epub 2020 Jun 23.

Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA.

Transcatheter embolization is a minimally invasive procedure that uses embolic agents to intentionally block diseased or injured blood vessels for therapeutic purposes. Embolic agents in clinical practice are limited by recanalization, risk of non-target embolization, failure in coagulopathic patients, high cost, and toxicity. Here, a decellularized cardiac extracellular matrix (ECM)-based nanocomposite hydrogel is developed to provide superior mechanical stability, catheter injectability, retrievability, antibacterial properties, and biological activity to prevent recanalization. The embolic efficacy of the shear-thinning ECM-based hydrogel is shown in a porcine survival model of embolization in the iliac artery and the renal artery. The ECM-based hydrogel promotes arterial vessel wall remodeling and a fibroinflammatory response while undergoing significant biodegradation such that only 25% of the embolic material remains at 14 days. With its unprecedented proregenerative, antibacterial properties coupled with favorable mechanical properties, and its superior performance in anticoagulated blood, the ECM-based hydrogel has the potential to be a next-generation biofunctional embolic agent that can successfully treat a wide range of vascular diseases.
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http://dx.doi.org/10.1002/adma.202002611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491606PMC
August 2020

Current concepts in portal vein thrombosis: etiology, clinical presentation and management.

Abdom Radiol (NY) 2019 10;44(10):3453-3462

Department of Interventional Radiology, Mayo Clinic Arizona, Phoenix, USA.

Objective: The aim of this article is to focus on etiology, risk factors, clinical presentation and classification systems of acute and chronic PVT as well as focusing on current diagnostic and therapeutic options for the management of acute and chronic PVT.

Results: PVT represents a serious clinical concern in cirrhotic patients and in those with specific local or systemic risk factors. The rate and extent of thrombus formation can significantly impact patient presentation and the resulting clinical outcomes. The presentation of acute PVT can range from abdominal pain to intestinal ischemia/infarction and even death, while chronic PVT can remain clinically silent. A number of imaging modalities including US, CT and MRI can be used to confirm the diagnosis. In addition to addressing underlying risk factors, AC therapy forms a cornerstone of treatment and has demonstrated efficacy in both acute and chronic settings. Proper caution should be used when initiating AC therapy in cirrhotic patients given their underlying coagulopathic status with attention now being paid to NOACs and LMWH. For patients with bowel ischemia, extensive thrombosis, contraindications or poor response to AC, or for those with co-morbidities that preclude AC, minimally invasive endovascular techniques offer alternative treatment options.

Conclusion: Familiarity with the etiology, clinical presentation and classification of PVT optimize early detection and incorporate effective therapeutic options, the management of these complex patients should be undertaken by a multidisciplinary team. Minimally invasive catheter-based therapies and endovascular portosystemic shunt creation demonstrated efficacy in the treatment of AC-resistant patients and for patients with extensive or complicated disease.
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http://dx.doi.org/10.1007/s00261-019-02174-1DOI Listing
October 2019

Advances in Biomaterials and Technologies for Vascular Embolization.

Adv Mater 2019 Aug 6;31(33):e1901071. Epub 2019 Jun 6.

Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA.

Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.
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http://dx.doi.org/10.1002/adma.201901071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014563PMC
August 2019

Systemically Administered Hemostatic Nanoparticles for Identification and Treatment of Internal Bleeding.

ACS Biomater Sci Eng 2019 May 2;5(5):2563-2576. Epub 2019 May 2.

Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.

Internal bleeding is an injury that can be difficult to localize and effectively treat without invasive surgeries. Injectable polymeric nanoparticles have been developed that can reduce clotting times and blood loss, but they have yet to incorporate sufficient diagnostic capabilities to assist in identifying bleeding sources. Herein, polymeric nanoparticles were developed to simultaneously treat internal bleeding while incorporating tracers for visualization of the nanoparticles by standard clinical imaging modalities. Addition of 1,1'-dioctadecyl-3,3,3',3'-tetramethylindodicarbocyanine perchlorate (DiD; a fluorescent dye), biotin functionality, and gold nanoparticles to hemostatic polymeric nanoparticles resulted in nanoparticles amenable to imaging with near-infrared (NIR) imaging, immunohistochemistry, and X-ray computed tomography (CT), respectively. Following a lethal liver resection injury, visualization of accumulated nanoparticles by multiple imaging methods was achieved in rodents, with the highest accumulation observed at the liver injury site, resulting in improved survival rates. Tracer addition to therapeutic nanoparticles allows for an expansion of their applicability, during stabilization by first responders to diagnosis and identification of unknown internal bleeding sites by clinicians using standard clinical imaging modalities.
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http://dx.doi.org/10.1021/acsbiomaterials.9b00054DOI Listing
May 2019

Needle-shaped ultrathin piezoelectric microsystem for guided tissue targeting via mechanical sensing.

Nat Biomed Eng 2018 03 26;2(3):165-172. Epub 2018 Feb 26.

Simpson Querrey Center and Feinberg School of Medicine, Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA.

Needles for percutaneous biopsies of tumour tissue can be guided by ultrasound or computed tomography. However, despite best imaging practices and operator experience, high rates of inadequate tissue sampling, especially for small lesions, are common. Here, we introduce a needle-shaped ultrathin piezoelectric microsystem that can be injected or mounted directly onto conventional biopsy needles and used to distinguish abnormal tissue during the capture of biopsy samples, through quantitative real-time measurements of variations in tissue modulus. Using well-characterized synthetic soft materials, explanted tissues and animal models, we establish experimentally and theoretically the fundamental operating principles of the microsystem, as well as key considerations in materials choices and device designs. Through systematic tests on human livers with cancerous lesions, we demonstrate that the piezoelectric microsystem provides quantitative agreement with magnetic resonance elastography, the clinical gold standard for the measurement of tissue modulus. The piezoelectric microsystem provides a foundation for the design of tools for the rapid, modulus-based characterization of tissues.
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http://dx.doi.org/10.1038/s41551-018-0201-6DOI Listing
March 2018

History and Evolution of Yttrium-90 Radioembolization for Hepatocellular Carcinoma.

J Clin Med 2019 Jan 7;8(1). Epub 2019 Jan 7.

Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ 85054, USA.

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and affects millions worldwide. Due to the lack of effective systemic therapies for HCC, researchers have been investigating the use of locoregional tumor control with Yttrium-90 (Y90) radioembolization since the 1960s. Following the development of glass and resin Y90 microspheres in the early 1990s, Y90 radioembolization has been shown to be a safe and efficacious treatment for patients with HCC across Barcelona Clinic Liver Cancer (BCLC) stages. By demonstrating durable local control, good long term outcomes, and equivalent if not superior tumor responses and tolerability when compared to alternative therapies including transarterial chemoembolization (TACE) and sorafenib, Y90 radioembolization is being increasingly used in HCC treatment. More recently, investigations into variations in Y90 radioembolization technique including radiation segmentectomy and radiation lobectomy have further expanded its clinical utility. Here, we discuss the history and evolution of Y90 use in HCC. We outline key clinical trials that have established the safety and efficacy of Y90 radioembolization, and also summarize trials comparing its efficacy to existing HCC treatments. We conclude by reviewing the techniques of radiation segmentectomy and lobectomy, and by discussing dosimetry.
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http://dx.doi.org/10.3390/jcm8010055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352151PMC
January 2019

Radiogenomics and Radiomics in Liver Cancers.

Diagnostics (Basel) 2018 Dec 27;9(1). Epub 2018 Dec 27.

Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.

Radiogenomics is a computational discipline that identifies correlations between cross-sectional imaging features and tissue-based molecular data. These imaging phenotypic correlations can then potentially be used to longitudinally and non-invasively predict a tumor's molecular profile. A different, but related field termed radiomics examines the extraction of quantitative data from imaging data and the subsequent combination of these data with clinical information in an attempt to provide prognostic information and guide clinical decision making. Together, these fields represent the evolution of biomedical imaging from a descriptive, qualitative specialty to a predictive, quantitative discipline. It is anticipated that radiomics and radiogenomics will not only identify pathologic processes, but also unveil their underlying pathophysiological mechanisms through clinical imaging alone. Here, we review recent studies on radiogenomics and radiomics in liver cancers, including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastases to the liver.
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http://dx.doi.org/10.3390/diagnostics9010004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468592PMC
December 2018

Irreversible Electroporation in Liver Cancers and Whole Organ Engineering.

J Clin Med 2018 Dec 25;8(1). Epub 2018 Dec 25.

Department of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ 85054, USA.

Liver cancers contribute significantly to cancer-related mortality worldwide and liver transplants remain the cornerstone of curative treatment for select, early-stage patients. Unfortunately, because of a mismatch between demand and supply of donor organs, liver cancer patients must often wait extended periods of time prior to transplant. A variety of local therapies including surgical resection, transarterial chemoembolization, and thermal ablative methods exist in order to bridge to transplant. In recent years, a number of studies have examined the role of irreversible electroporation (IRE) as a non-thermal local ablative method for liver tumors, particularly for those adjacent to critical structures such as the vasculature, gall bladder, or bile duct. In addition to proving its utility as a local treatment modality, IRE has also demonstrated promise as a technique for donor organ decellularization in the context of whole-organ engineering. Through complete non-thermal removal of living cells, IRE allows for the creation of an acellular extra cellular matrix (ECM) scaffold that could theoretically be recellularized and implanted into a living host. Here, we comprehensively review studies investigating IRE, its role in liver cancer treatment, and its utility in whole organ engineering.
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http://dx.doi.org/10.3390/jcm8010022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352021PMC
December 2018

Quiescent-Interval Single-Shot Magnetic Resonance Angiography.

Diagnostics (Basel) 2018 Dec 18;8(4). Epub 2018 Dec 18.

Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.

Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease with a significant global burden. A number of diagnostic imaging techniques exist, including computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CEMRA), to aid in PAD diagnosis and subsequent treatment planning. Due to concerns of renal toxicity or nephrogenic systemic fibrosis (NSF) for iodinated and gadolinium-based contrasts, respectively, a number of non-enhanced MRA (NEMRA) protocols are being increasingly used in PAD diagnosis. These techniques, including time of flight and phase contrast MRA, have previously demonstrated poor image quality, long acquisition times, and/or susceptibility to artifacts when compared to existing contrast-enhanced techniques. In recent years, Quiescent-Interval Single-Shot (QISS) MRA has been developed to overcome these limitations in NEMRA methods, with promising results. Here, we review the various screening and diagnostic tests currently used for PAD. The various NEMRA protocols are discussed, followed by a comprehensive review of the literature on QISS MRA to date. A particular emphasis is placed on QISS MRA feasibility studies and studies comparing the diagnostic accuracy and image quality of QISS MRA versus other diagnostic imaging techniques in PAD.
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http://dx.doi.org/10.3390/diagnostics8040084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315503PMC
December 2018

Liquid Biopsy in Gastrointestinal Cancers.

Diagnostics (Basel) 2018 Oct 29;8(4). Epub 2018 Oct 29.

Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ 85054, USA.

Liquid biopsy is the sampling of any biological fluid in an effort to enrich and analyze a tumor's genetic material. Peripheral blood remains the most studied liquid biopsy material, with circulating tumor cells (CTC's) and circulating tumor DNA (ctDNA) allowing the examination and longitudinal monitoring of a tumors genetic landscape. With applications in cancer screening, prognostic stratification, therapy selection and disease surveillance, liquid biopsy represents an exciting new paradigm in the field of cancer diagnostics and offers a less invasive and more comprehensive alternative to conventional tissue biopsy. Here, we examine liquid biopsies in gastrointestinal cancers, specifically colorectal, gastric, and pancreatic cancers, with an emphasis on applications in diagnostics, prognostics and therapeutics.
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http://dx.doi.org/10.3390/diagnostics8040075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316210PMC
October 2018

Rejuvenation of aged rat skin with pulsed electric fields.

J Tissue Eng Regen Med 2018 12 22;12(12):2309-2318. Epub 2018 Nov 22.

Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and the Shriners Burns Hospital, Boston, Massachusetts.

The demand for skin rejuvenation procedures has progressively increased in the past decade. Additionally, clinical trials have shown that current therapies might cause downtime and side effects in patients including prolonged erythema, scarring, and dyspigmentation. The goal of this study was to explore the effect of partial irreversible electroporation (pIRE) with pulsed electric fields in aged skin rejuvenation as a novel, non-invasive skin resurfacing technique. In this study, we used an experimental model of aged rats. We showed that treatment with pIRE promoted keratinocyte proliferation and blood flow in aged rat skin. We also found significant evidence indicating that pIRE reformed the dermal extracellular matrix (ECM). Both the collagen protein and fibre density in aged skin increased after pIRE administration. Furthermore, using an image-processing algorithm, we found that the collagen fibre orientation in the histological sections did not change, indicating a lack of scar formation in the treated areas. The results showed that pIRE approach could effectively stimulate keratinocyte proliferation, ECM synthesis, and angiogenesis in an aged rat model.
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http://dx.doi.org/10.1002/term.2763DOI Listing
December 2018

Three-dimensional (3D) printing and its applications for aortic diseases.

Cardiovasc Diagn Ther 2018 Apr;8(Suppl 1):S19-S25

Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Three-dimensional (3D) printing is a process which generates prototypes from virtual objects in computer-aided design (CAD) software. Since 3D printing enables the creation of customized objects, it is a rapidly expanding field in an age of personalized medicine. We discuss the use of 3D printing in surgical planning, training, and creation of devices for the treatment of aortic diseases. 3D printing can provide operators with a hands-on model to interact with complex anatomy, enable prototyping of devices for implantation based upon anatomy, or even provide pre-procedural simulation. Potential exists to expand upon current uses of 3D printing to create personalized implantable devices such as grafts. Future studies should aim to demonstrate the impact of 3D printing on outcomes to make this technology more accessible to patients with complex aortic diseases.
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http://dx.doi.org/10.21037/cdt.2017.10.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949593PMC
April 2018

Social Medicine: Twitter in Healthcare.

J Clin Med 2018 May 28;7(6). Epub 2018 May 28.

Department of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.

Social media enables the public sharing of information. With the recent emphasis on transparency and the open sharing of information between doctors and patients, the intersection of social media and healthcare is of particular interest. Twitter is currently the most popular form of social media used for healthcare communication; here, we examine the use of Twitter in medicine and specifically explore in what capacity using Twitter to share information on treatments and research has the potential to improve care. The sharing of information on Twitter can create a communicative and collaborative atmosphere for patients, physicians, and researchers and even improve quality of care. However, risks involved with using Twitter for healthcare discourse include high rates of misinformation, difficulties in verifying the credibility of sources, overwhelmingly high volumes of information available on Twitter, concerns about professionalism, and the opportunity cost of using physician time. Ultimately, the use of Twitter in healthcare can allow patients, healthcare professionals, and researchers to be more informed, but specific guidelines for appropriate use are necessary.
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http://dx.doi.org/10.3390/jcm7060121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025547PMC
May 2018

The Use of Transarterial Approaches in Peripheral Arteriovenous Malformations (AVMs).

J Clin Med 2018 May 9;7(5). Epub 2018 May 9.

Department of Radiology and Neurological Surgery, Mayo Clinic, Phoenix, AZ 85054, USA.

Arteriovenous malformations (AVMs) are a subset of congenital vascular malformations (CVMs). They comprise abnormal connections between arterial and venous circulation; treatment approaches are dependent on the angioarchitecture of the AVM, specifically the number and arrangement of the feeder arteries and outflow veins. Various imaging modalities can be used to diagnose and plan treatment. Here we will review the use of transarterial approaches to treat AVMs.
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http://dx.doi.org/10.3390/jcm7050109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977148PMC
May 2018

Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome.

J Clin Med 2018 May 8;7(5). Epub 2018 May 8.

Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.

Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment. We aimed to evaluate the specificity of LRV compression to NS symptoms through a retrospective study including 33 NS and 103 control patients. The size of the patent lumen at point of compression and normal portions of the LRV were measured for all patients. Multiple logistic regression analyses (MLR) assessing impact of compression, body mass index (BMI), age, and gender on the likelihood of each symptom with NS were obtained. NS patients presented most commonly with abdominal pain (72.7%), followed by hematuria (57.6%), proteinuria (39.4%), and left flank pain (30.3%). These symptoms were more commonly seen than in the control group at 10.6, 11.7, 6.8, and 1.9%, respectively. The degree of LRV compression for NS was 74.5% and 25.2% for controls ( < 0.0001). Higher compression led to more hematuria ( < 0.0013), abdominal pain ( < 0.006), and more proteinuria ( < 0.002). Furthermore, the average BMI of NS patients was 21.4 and 27.2 for controls ( < 0.001) and a low BMI led to more abdominal pain ( < 0.005). These results demonstrate a strong correlation between the degree of LRV compression on imaging in diagnosing NS.
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http://dx.doi.org/10.3390/jcm7050107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977146PMC
May 2018

Multi-Detector Computed Tomography Imaging Techniques in Arterial Injuries.

J Clin Med 2018 Apr 24;7(5). Epub 2018 Apr 24.

Department of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.

Cross-sectional imaging has become a critical aspect in the evaluation of arterial injuries. In particular, angiography using computed tomography (CT) is the imaging of choice. A variety of techniques and options are available when evaluating for arterial injuries. Techniques involve contrast bolus, various phases of contrast enhancement, multiplanar reconstruction, volume rendering, and maximum intensity projection. After the images are rendered, a variety of features may be seen that diagnose the injury. This article provides a general overview of the techniques, important findings, and pitfalls in cross sectional imaging of arterial imaging, particularly in relation to computed tomography. In addition, the future directions of computed tomography, including a few techniques in the process of development, is also discussed.
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http://dx.doi.org/10.3390/jcm7050088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977127PMC
April 2018

Quadrilateral Space Syndrome: Diagnosis and Clinical Management.

J Clin Med 2018 Apr 21;7(4). Epub 2018 Apr 21.

Department of Vascular Interventional Surgery, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.

Quadrilateral space syndrome (QSS) is a rare disorder characterized by axillary nerve and posterior humeral circumflex artery (PHCA) compression within the quadrilateral space. Impingement is most frequently due to trauma, fibrous bands, or hypertrophy of one of the muscular borders. Diagnosis can be complicated by the presence of concurrent traumatic injuries, particularly in athletes. Since many other conditions can mimic QSS, it is often a diagnosis of exclusion. Conservative treatment is often first trialed, including physical exercise modification, physical therapy, and therapeutic massage. In patients unrelieved by conservative measures, surgical decompression of the quadrilateral space may be indicated.
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http://dx.doi.org/10.3390/jcm7040086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920460PMC
April 2018

Bioengineered models of thrombosis: methods and techniques.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S329-S335

Division of Vascular & Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA.

Thrombosis is a prevailing vascular disorder that has been historically studied with conventional animal models. Here we review recent advances in methods and techniques that allow for engineering of biomimetic models of thrombosis, usually combined with microfluidic devices, termed thrombosis-on-a-chip systems, to reproduce such vascular pathology outside living organisms. These human cell-based thrombosis-on-a-chip platforms recapitulate the important characteristics of native thrombosis in terms of vascular structures, extracellular matrix properties, cellular composition, and pathophysiology, making them enabling models to study this important class of vascular disorders as well as to develop personalized treatment regimens.
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http://dx.doi.org/10.21037/cdt.2017.08.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778531PMC
December 2017

Paget-Schroetter syndrome: treatment of venous thrombosis and outcomes.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S285-S290

Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Thoracic outlet syndrome (TOS) is a rare clinical entity with many etiologies. Venous thoracic outlet syndrome (VTOS), also called Paget-Schroetter syndrome (PSS), is a primary "effort" thrombosis. Here we will focus on the pathophysiology, anatomy, clinical presentation, treatments, and outcomes of VTOS. Treatment involves anticoagulation, catheter-directed thrombolysis, and surgical decompression. Early diagnosis and treatment can improve symptoms and quality of life.
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http://dx.doi.org/10.21037/cdt.2017.08.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778512PMC
December 2017

Deep vein thrombosis: pathogenesis, diagnosis, and medical management.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S276-S284

Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000-100,000 deaths annually. Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors. Virchow's Triad distills the multitude of risk factors for DVT into three basic elements favoring thrombus formation: venous stasis, vascular injury, and hypercoagulability. Clinical, biochemical, and radiological tests are used to increase the sensitivity and specificity for diagnosing DVT. Anticoagulation therapy is essential for the treatment of DVT. With few exceptions, the standard therapy for DVT has been vitamin K-antagonists (VKAs) such as warfarin with heparin or fractionated heparin bridging. More recently, a number of large-scale clinical trials have validated the use of direct oral anticoagulants (DOACs) in place of warfarin in select cases. In this review, we summarize the pathogenesis, diagnosis, and medical management of DVT, with particular emphasis on anticoagulation therapy and the role of DOACs in the current treatment algorithm.
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http://dx.doi.org/10.21037/cdt.2017.09.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778510PMC
December 2017

Hemostasis and nanotechnology.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S267-S275

Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Hemorrhage accounts for significant morbidity and mortality. Various techniques have been employed to augment hemostasis from simple tourniquets to self-assembling nanoparticles. A growing understanding of the natural clotting cascade has allowed agents to become more targeted for potential use in different clinical scenarios. This review discusses current and developing hemostatic techniques, including matrix agents, external agents, biologically inspired agents, and synthetic and cell-derived nanoparticles.
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http://dx.doi.org/10.21037/cdt.2017.08.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778530PMC
December 2017

Anti-fouling strategies for central venous catheters.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S246-S257

Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Central venous catheters (CVCs) are ubiquitous in the healthcare industry and carry two common complications, catheter related infections and occlusion, particularly by thrombus. Catheter-related bloodstream infections (CRBSI) are an important cause of nosocomial infections that increase patient morbidity, mortality, and hospital cost. Innovative design strategies for intravenous catheters can help reduce these preventable infections. Antimicrobial coatings can play a major role in preventing disease. These coatings can be divided into two major categories: drug eluting and non-drug eluting. Much of these catheter designs are targeted at preventing the formation of microbial biofilms that make treatment of CRBSI nearly impossible without removal of the intravenous device. Exciting developments in catheter impregnation with antibiotics as well as nanoscale surface design promise innovative changes in the way that physicians manage intravenous catheters. Occlusion of a catheter renders the catheter unusable and is often treated by tissue plasminogen activator administration or replacement of the line. Prevention of this complication requires a thorough understanding of the mechanisms of platelet aggregation, signaling and cross-linking. This article will look at the advances in biomaterial design specifically drug eluting, non-drug eluting, lubricious coatings and micropatterning as well as some of the characteristics of each as they relate to CVCs.
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http://dx.doi.org/10.21037/cdt.2017.09.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778515PMC
December 2017

Elastography techniques in the evaluation of deep vein thrombosis.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S238-S245

Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Deep venous thrombosis (DVT) is a significant medical problem with an incidence of 1 in 1,000 adults and greatly reduces quality of life through post-thrombotic syndrome. Treatment choice for DVT can be influenced by the age of the clot. While new endovascular catheter techniques treat venous clots to potentially prevent post-thrombotic syndrome, they require improved imaging techniques to accurately determine clot age. This review investigates experimental and clinical evidence of elastography techniques for aging DVT. Strain elastography and shear wave elastography are the most common techniques to age thrombus. These elastography techniques can distinguish between acute and chronic clots by characterizing tissue stiffness. When clot age cannot be determined with ultrasound duplex analysis, elastography may offer a helpful adjunct. However, further investigation is required to validate accuracy and reproducibility for clinical implementation of this novel technique.
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http://dx.doi.org/10.21037/cdt.2017.10.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778513PMC
December 2017

Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S228-S237

Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Deep vein thrombosis (DVT) is a major health problem worldwide. The risk of pulmonary embolism following DVT is well established, but the long-term vascular sequelae of DVT are often underappreciated, costly to manage, and can have extremely detrimental effects on quality of life. Treatment of DVT classically involves oral anticoagulation, which reduces the risk of pulmonary embolism but does not remove the clot. Anticoagulation therefore does little to prevent the venous damage and scarring that occurs following DVT, leaving the patient at risk for permanent venous insufficiency and development of post-thrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) is a minimally invasive endovascular treatment that is used as an adjunct to anticoagulation. CDT lowers the risk of PTS by reducing clot burden and protecting against valvular damage. A catheter is advanced directly to the site of thrombosis under fluoroscopy followed by a slow, prolonged infusion of a relatively low dose of thrombolytic agent. CDT restores venous patency faster than anticoagulation, which hastens the relief of acute symptoms. Adjunctive CDT modalities have become increasingly popular among interventional radiologists, allowing for additional mechanical thrombectomy or ultrasound-enhanced thrombolysis at the time of catheter placement. These pharmacomechanical CDT (PCDT) techniques have the potential to reduce treatment time and associated healthcare costs. Numerous observational and retrospective studies have consistently shown a benefit of CDT plus anticoagulation over anticoagulation alone for prevention of PTS. Patients with long life expectancy and acute thrombosis involving the iliac and proximal femoral veins (iliofemoral DVT) have the greatest benefit from CDT, which may decrease the risk of PTS and/or decrease the severity of PTS symptoms if they do occur. Randomized controlled trials remain limited but generally support the observational data. CDT also plays an important role in those with acute limb-threatening venous occlusion or severe symptoms from DVT. Although adverse outcomes are rare, a potential devastating outcome is intracranial bleeding. While the available literature suggests the risk of serious morbidity from bleeding is quite rare, the absolute risk of bleeding is not clear and will require outcomes data from randomized trials. Future studies should also examine the cost-effectiveness of CDT for PTS prevention, particularly with respect to quality-adjusted life years, and compare the effectiveness of available PCDT devices.
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http://dx.doi.org/10.21037/cdt.2017.09.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778526PMC
December 2017

Transplant artery thrombosis and outcomes.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S219-S227

Division of Vascular and Interventional Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA.

Post-transplantation allograft arterial thrombosis is a well-recognized complication associated with solid organ transplantation. Much of the literature is centered on liver and kidney transplantation, which will therefore serve as the principle basis for this review, with a brief discussion on pancreas transplantation and associated arterial complications. The number of solid organ transplants has been steadily increasing over the past decade in parallel with growing demand for organs and expansion of the transplantation criteria for both donors and recipients. This increase has been accompanied by a number of innovative medical advances and surgical techniques, as well as improved imaging that has allowed for thoughtful exploration of vascular anatomic variants and the possibilities for transplant with which they are associated. It has also been accompanied by a growing field of behavioral research, as potential recipients must weigh the risk of accepting certain organs based on perceived outcomes that may differ according to the quality of the underlying organ. Improvements in imaging technology have brought greater sensitivity to detecting arterial complications in post-operative surveillance examinations and have allowed for further development of tailored endovascular and surgical interventions for transplant-associated vascular complications. This review will focus on post-transplantation solid organ allograft artery thrombosis, including discussion of risk factors, diagnostic imaging, natural history, and therapeutic options.
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http://dx.doi.org/10.21037/cdt.2017.10.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778523PMC
December 2017

Statins as a preventative therapy for venous thromboembolism.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S207-S218

Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

The anti-inflammatory effects of statins have likely not been used to their fullest extent, particularly in reducing venous thromboembolic events. Current therapy for thrombotic events hinges on anticoagulation via heparin, warfarin or new oral anticoagulants. Interventional procedures with thrombectomy may also play a critical role. Unfortunately, thrombotic events can occur and recur despite meticulous anticoagulation therapy. Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), two complicated and prevalent diseases that can cause chronic disease states such as post-thrombotic syndrome (PTS). In 2009 the JUPITER trial demonstrated that rosuvastatin may be effective when dealing with vascular inflammation by providing an anti-inflammatory effect. Multiple subsequent studies have looked at this association with some promising findings. The mechanism of action for statins is not entirely understood but there has been a variety of proposals and subsequent testing of inflammatory biomarkers. Additional prospective trials are needed to confirm the possible benefit of VTE reduction through an anti-inflammatory effect, but if this can be shown then statins may become a safe adjunctive therapy for VTE prevention.
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http://dx.doi.org/10.21037/cdt.2017.09.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778529PMC
December 2017

Animal models of venous thrombosis.

Cardiovasc Diagn Ther 2017 Dec;7(Suppl 3):S197-S206

Department of Radiology, Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA.

Venous thrombosis (VT) is a prevalent clinical condition with significant adverse sequela or mortality. Anticoagulation and pharmacologic or pharmacomechanical thrombolytic therapies are the mainstays of VT treatment. An understanding of thrombosis biology will allow for more effective VT-tailored diagnosis and therapy. models of thrombosis provide indispensable tools to study the pathogenesis of thrombus formation and to evaluate novel therapeutic or preventive adjuncts for VT management or prevention. In this article, we review the most prominent models of VT created in rodents and swine species and outline how each model can serve as a useful tool to promote our understanding of VT pathogenesis and to examine novel therapies.
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http://dx.doi.org/10.21037/cdt.2017.08.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778525PMC
December 2017