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Watchmaker J, Carlon T, Goldman D, Marinelli B, Korff R, Bishay V, Patel R, Nowakowski S, Shilo D, Garcia-Reyes K, Patel R, Fischman A, Lookstein R. Abstract No. 272 Initial single-center experience percutaneous thromboaspiration for patients with acute pulmonary embolism. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sher A, Bishay V, Patel R, Fischman A, Nowakowski S, Kim E, Lookstein R. Abstract No. 308 Lung shunt fraction before radiation segmentectomy of very early to early stage HCC. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Korff R, Bishay V, Garcia-Reyes K, Kim E, Nowakowski S, Patel R, Shilo D, Lookstein R, Fischman A. Abstract No. 614 Bioconvertible IVC filters: safety, efficacy, and bioconversion times in a real-world cohort. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Marinelli B, Goldman D, Sharma H, Leong T, Bishay V, Garcia-Reyes K, Shilo D, Kim E, Nowakowski S, Fischman A, Lookstein R, Patel R. Abstract No. 187 Safety and feasibility of “gun-sight technique” for complex transjugular intrahepatic portosystemic shunt (TIPS) creation: single-center retrospective study of 98 interventions. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cooke PV, Lee J, Branchard O, Israni N, Kim SY, Tadros RO, Lookstein R, Faries PL, Vouyouka AG. Elevated Neutrophil to Lymphocyte Ratio Portends a Higher Risk of Amputation After Lower Extremity Atherectomy for Peripheral Arterial Disease. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Holden A, Haruguchi H, Suemitsu K, Isogai N, Ross J, Hull J, Wang H, Seamans J, Lookstein R. IN.PACT AV Access Randomized Trial: 12-month Clinical Results Demonstrating the Sustained Treatment Effect of Drug-Coated Balloons. J Vasc Interv Radiol 2022; 33:884-894.e7. [PMID: 35469957 DOI: 10.1016/j.jvir.2022.03.606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 03/11/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To present twelve-month outcomes of the IN.PACT AV Access Study, a prospective, single-blinded trial enrolling participants with obstructive de novo or restenotic native upper extremity arteriovenous dialysis fistula lesions treated with drug-coated balloon (DCB) or percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS After successful high-pressure PTA, participants at 29 international sites were randomized 1:1 to treatment with IN.PACT AV DCB (n=170) or standard uncoated PTA (n=160). Outcomes at 12 months include target lesion primary patency (TLPP), defined as freedom from clinically-driven target lesion revascularization or access circuit thrombosis, access circuit primary patency (ACPP), number of reinterventions, and adverse events involving the access circuit. RESULTS At 12 months, TLPP was 63.8% (90/141) in the DCB group compared to 43.6% (61/140) in the PTA group (p<0.001). The total number of reinterventions required to maintain TLPP through 360 days was 93 in the DCB group and 144 in the PTA group, a 35.4% reduction in reinterventions when DCB was used. Access circuit thrombosis was 2.9% (4/138) in the DCB group and 6.2% (8/129) in the PTA group (p=0.19). Time to TLPP was assessed using a multivariable analysis to identify factors associated with loss of patency. Treatment device was the independent predictor with the largest effect, with a hazard ratio of 0.42 (95%CI [0.29, 0.64]; p<0.001). CONCLUSION TLPP was statistically significantly higher in DCB compared to standard PTA at 12 months, demonstrating the sustained and superior effectiveness of this device for the treatment of dysfunctional arteriovenous dialysis fistulas.
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Rao MG, Vieira L, Kaplowitz E, Overbey JR, Johnson S, Paul K, Lookstein R, Rebarber A, Fox NS, Stone J. Elective fetal reduction by radiofrequency ablation in monochorionic diamniotic twins decreases adverse outcomes compared to ongoing monochorionic diamniotic twins. Am J Obstet Gynecol MFM 2021; 3:100447. [PMID: 34314851 DOI: 10.1016/j.ajogmf.2021.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multifetal pregnancy reduction is a technique used to reduce the fetal number to mitigate the risks of adverse outcomes associated with multiple gestations. Monochorionic diamniotic twin pregnancies are subject to unique complications, contributing to adverse pregnancy outcomes. Thus, patients have an option to electively reduce 1 fetus to improve outcomes. OBJECTIVE This study aimed to compare outcomes of elective reduction of monochorionic diamniotic twins by radiofrequency ablation to planned ongoing monochorionic diamniotic twins. STUDY DESIGN We performed a retrospective review of 315 monochorionic diamniotic twin gestations that underwent first-trimester ultrasound within 1 institution. Planned electively reduced twins were compared with ongoing monochorionic diamniotic twins. All reductions were performed via radiofrequency ablation of the cord insertion site into the fetal abdomen. The primary outcome was preterm birth at <36 weeks' gestation. Secondary outcomes included gestational age at delivery; preterm birth at less than 37-, 34-, 32-, and 28-weeks' gestation; unintended loss; and adverse perinatal outcomes. RESULTS Among 315 monochorionic diamniotic pregnancies, 14 (4.4%) underwent elective multifetal pregnancy reduction, and 301 (95.6%) were planned ongoing twins. The mean gestational age of radiofrequency ablation in the elective multifetal pregnancy reduction group was 15.1±0.68 weeks. Patients who underwent elective multifetal pregnancy reduction had significantly higher maternal age (P<.01) and were more likely to be Asian (P<.01). Moreover, they were more likely to have undergone in vitro fertilization (P=.03) and chorionic villus sampling (P<.01). There was a significantly higher rate of term deliveries in the elective radiofrequency ablation group compared with ongoing twins (gestational age, 38 weeks [interquartile range, 36.1-39.1] vs 35.9 weeks [interquartile range, 34.0-36.9]; P<.01). Patients with ongoing pregnancies had a trend of increased rate of preterm birth at <36 weeks' gestation (odds ratio, 3.4; 95% confidence interval, 1.0-12.0; P=.06), a significantly increased risk of preterm birth at <37 weeks' gestation (odds ratio, 8.0; 95% confidence interval, 2.4-26.4; P<.01), and no difference at less than 34-, 32-, or 28- weeks' gestation. All patients who underwent elective radiofrequency ablation had successful pregnancies with no pregnancy losses or terminations. Of ongoing gestations, 36 required procedures, including 16 (5.3%) medically indicated radiofrequency ablation, 14 (4.6%) laser ablation, and 6 (1.9%) amnioreductions. Furthermore, 22 patients (7.3%) with planned ongoing twins had total pregnancy loss at <24 weeks' gestation. Notably, 12 patients (4.0%) had unintended loss of 1 fetus before 24 weeks' gestation in the ongoing pregnancy cohort, and 12 patients (4.0%) had unintended loss of both fetuses before 24 weeks' gestation. Moreover, 5 patients (1.7%) in the ongoing pregnancy group had intrauterine fetal demise at >24 weeks' gestation and 10 patients (3.3%) electively terminated both fetuses. There was no significant difference in loss rates between the 2 groups. CONCLUSION In this study of monochorionic diamniotic twins, patients who elected to undergo multifetal pregnancy reduction had significantly lower rates of preterm birth at <37 weeks and a lower trend of preterm birth at <36 weeks' gestation without an increased risk of pregnancy loss. Median gestational age at delivery was significantly higher in the elective multifetal pregnancy reduction group (38 weeks) than in the ongoing pregnancy group (35.9 weeks). Further research is needed to clarify if multifetal pregnancy reduction improves long-term outcomes.
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Rali P, Sacher D, Rivera-Lebron B, Rosovsky R, Elwing JM, Berkowitz J, Mina B, Dalal B, Davis GA, Dudzinski DM, Duval A, Ichinose E, Kabrhel C, Kapoor A, Lio KU, Lookstein R, McDaniel M, Melamed R, Naydenov S, Sokolow S, Rosenfield K, Tapson V, Bossone E, Keeling B, Channick R, Ross CB. Interhospital Transfer of Patients With Acute Pulmonary Embolism (PE): Challenges and Opportunities. Chest 2021; 160:1844-1852. [PMID: 34273391 DOI: 10.1016/j.chest.2021.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 01/07/2023] Open
Abstract
Acute pulmonary embolism (PE) is associated with significant morbidity and mortality. The management paradigm for acute PE has evolved in recent years with wider availability of advanced treatment modalities ranging from catheter-directed reperfusion therapies to mechanical circulatory support. This evolution has coincided with the development and implementation of institutional pulmonary embolism response teams (PERT) nationwide and internationally. Because most institutions are not equipped or staffed for advanced PE care, patients often require transfer to centers with more comprehensive resources, including PERT expertise. One of the unmet needs in current PE care is an organized approach to the process of interhospital transfer (IHT) of critically ill PE patients. In this review, we discuss medical optimization and support of patients before and during transfer, transfer checklists, defined roles of emergency medical services, and the roles and responsibilities of referring and receiving centers involved in the IHT of acute PE patients.
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Korff R, Titano J, Bishay V, Fischman A, Nowakowski F, Patel R, Kim E, Vouyouka A, Lookstein R. Abstract No. 141 Double-barrel iliocaval reconstruction using novel closed-cell dedicated venous stents. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Goldman D, Sharma H, Finkelstein M, Carlon T, Fischman A, Bishay V, Patel R, Titano J, Nowakowski F, Kim E, Lookstein R. Abstract No. 442 The role of telemedicine in the maintenance of interventional radiology outpatient evaluation and management volume during the COVID-19 global pandemic. J Vasc Interv Radiol 2021. [PMCID: PMC8079615 DOI: 10.1016/j.jvir.2021.03.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sharma H, Maron S, Sher A, Galla N, Titano J, Bishay V, Kim E, Nowakowski F, Patel R, Lookstein R, Rastinehad A, Fischman A. Abstract No. 567 Prostatic artery embolization in patients with prior prostatitis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Maron S, Sharma H, Sher A, Radell J, Titano J, Bishay V, Kim E, Nowakowski F, Patel R, Lookstein R, Rastinehad A, Fischman A. Abstract No. 452 Prostatic artery embolization for inpatient and emergent hematuria: a single-system experience. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Galla N, Voutsinas N, Sher A, Maron S, Titano J, Bishay V, Kim E, Nowakowski F, Patel R, Ranade M, Lookstein R, Fischman A, Rastinehad A. Abstract No. 521 Safety and efficacy of coil embolization of the prostate arteries post-particle embolization for lower urinary tract symptoms. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Radell J, Maron S, Sher A, Bishay V, Kim E, Nowakowski F, Patel R, Lookstein R, Rastinehad A, Fischman A. Abstract No. 39 Prostatic artery embolization in patients with recurrent lower urinary tract symptoms following failed transurethral resection of the prostate. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Farhan S, Kamran H, Vogel B, Garg K, Rao A, Narula N, Jacobowitz G, Tarricone A, Kapur V, Faries P, Marin M, Narula J, Lookstein R, Olin JW, Krishnan P. Considerations for Patients With Peripheral Artery Disease During the COVID-19 Pandemic. Clin Appl Thromb Hemost 2021; 27:1076029620986877. [PMID: 33783244 PMCID: PMC8013533 DOI: 10.1177/1076029620986877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
New York City was one of the epicenters of the COVID-19 pandemic. The management of peripheral artery disease (PAD) during this time has been a major challenge for health care systems and medical personnel. This document is based on the experiences of experts from various medical fields involved in the treatment of patients with PAD practicing in hospitals across New York City during the outbreak. The recommendations are based on certain aspects including the COVID-19 infection status as well as the clinical PAD presentation of the patient. Our case-based algorithm aims at guiding the treatment of patients with PAD during the pandemic in a safe and efficient way.
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Carlon T, Finkelstein M, Maron SZ, Goldman D, Kihira S, Marinelli B, Dayan E, Sullivan N, Hart J, Doshi AH, Delman BN, Lookstein R, Drayer BP. Sources of Revenue Loss and Recovery in Radiology Practices During the Coronavirus Disease 2019 (COVID-19) Pandemic. Acad Radiol 2021; 28:447-456. [PMID: 33495075 PMCID: PMC7813500 DOI: 10.1016/j.acra.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/06/2023]
Abstract
Rationale and Objectives This study seeks to quantify the financial impact of COVID-19 on radiology departments, and to describe the structure of both volume and revenue recovery. Materials and Methods Radiology studies from a large academic health system were retrospectively studied from the first 33 weeks of 2020. Volume and work relative value unit (wRVU) data were aggregated on a weekly basis for three periods: Presurge (weeks 1–9), surge (10–19), and recovery (20–33), and analyzed compared to the pre-COVID baseline stratified by modality, specialty, patient service location, and facility type. Mean and median wRVU per study were used as a surrogate for case complexity. Results During the pandemic surge, case volumes fell 57%, while wRVUs fell by 69% relative to the pre-COVID-19 baseline. Mean wRVU per study was 1.13 in the presurge period, 1.03 during the surge, and 1.19 in the recovery. Categories with the greatest mean complexity declines were radiography (−14.7%), cardiothoracic imaging (−16.2%), and community hospitals overall (−15.9%). Breast imaging (+6.5%), interventional (+5.5%), and outpatient (+12.1%) complexity increased. During the recovery, significant increases in complexity were seen in cardiothoracic (0.46 to 0.49), abdominal (1.80 to 1.91), and neuroradiology (2.46 to 2.56) at stand-alone outpatient centers with similar changes at community hospitals. At academic hospitals, only breast imaging complexity remained elevated (1.32 from 1.17) during the recovery. Conclusion Reliance on volume alone underestimates the financial impact of the COVID-19 pandemic as there was a disproportionate loss in high-RVU studies. However, increased complexity of outpatient cases has stabilized overall losses during the recovery.
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Rao MG, Vieira L, Kaplowitz E, Overbey J, Johnson S, Paul K, Lookstein R, Rebarber A, Fox NS, Stone J. 513 Elective fetal reduction in monochorionic diamniotic(MCDA) twins decreases adverse outcomes compared to ongoing MCDA twins. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Doshi AH, Kihira S, Mahmoudi K, Dayan E, Carlon T, Marinelli B, Goldman D, Finkelstein M, Delman BN, Lookstein R, Sullivan N, Hart J, Drayer BP. Impact of COVID-19 social distancing regulations on outpatient diagnostic imaging volumes and no-show rates. Clin Imaging 2021; 76:65-69. [PMID: 33567344 PMCID: PMC7846884 DOI: 10.1016/j.clinimag.2021.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/09/2021] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted outpatient radiology practices, necessitating change in practice infrastructure and workflow. Objective The purpose of this study was to assess the consequences of social distancing regulations on 1) outpatient imaging volume and 2) no-show rates per imaging modality. Methods Volume and no-show rates of a large, multicenter metropolitan healthcare system outpatient practice were retrospectively stratified by modality including radiography, CT, MRI, ultrasonography, PET, DEXA, and mammography from January 2 to July 21, 2020. Trends were assessed relative to timepoints of significant state and local social distancing regulatory changes. Results The decline in imaging volume and rise in no-show rates was first noted on March 10, 2020 following the declaration of a state of emergency in New York State (NYS). Total outpatient imaging volume declined 85% from baseline over the following 5 days. Decreases varied by modality: 88% for radiography, 75% for CT, 73% for MR, 61% for PET, 80% for ultrasonography, 90% for DEXA, and 85% for mammography. Imaging volume and no-show rate recovery preceded the mask mandate of April 15, 2020, and further trended along with New York City's reopening phases. No-show rates recovered within 2 months of the height of the pandemic, however, outpatient imaging volume has yet to recover to baseline after 3 months. Conclusion The total outpatient imaging volume declined alongside an increase in the no-show rate following the declaration of a state of emergency in NYS. No-show rates recovered within 2 months of the height of the pandemic with imaging volume yet to recover after 3 months. Clinical impact Understanding the impact of social distancing regulations on outpatient imaging volume and no-show rates can potentially aid other outpatient radiology practices and healthcare systems in anticipating upcoming changes as the COVID-19 pandemic evolves.
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Goldman DT, Sharma H, Finkelstein M, Carlon T, Marinelli B, Doshi AH, Delman BN, Lookstein R. The Role of Telemedicine in the Maintenance of IR Outpatient Evaluation and Management Volume During the COVID-19 Global Pandemic. J Vasc Interv Radiol 2020; 32:479-481. [PMID: 33509609 PMCID: PMC7834179 DOI: 10.1016/j.jvir.2020.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/01/2023] Open
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Rosovsky RP, Grodzin C, Channick R, Davis GA, Giri JS, Horowitz J, Kabrhel C, Lookstein R, Merli G, Morris TA, Rivera-Lebron B, Tapson V, Todoran TM, Weinberg AS, Rosenfield K. Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT Consortium. Chest 2020; 158:2590-2601. [PMID: 32861692 PMCID: PMC7450258 DOI: 10.1016/j.chest.2020.08.2064] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022] Open
Abstract
The coexistence of coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE), two life-threatening illnesses, in the same patient presents a unique challenge. Guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of COVID-19 confound both the diagnosis and treatment of PE, and therefore require modification of established algorithms. Important considerations include adjustment of diagnostic modalities, incorporation of the prothrombotic contribution of COVID-19, management of two critical cardiorespiratory illnesses in the same patient, and protecting patients and health-care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERTs), have become more evident in this crisis. The importance of careful follow-up care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in patients with COVID-19.
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El Shamy O, Munoz-Casablanca N, Coca S, Sharma S, Lookstein R, Uribarri J. Bilateral Renal Artery Thrombosis in a Patient With COVID-19. Kidney Med 2020; 3:116-119. [PMID: 33200122 PMCID: PMC7654329 DOI: 10.1016/j.xkme.2020.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Reports of the incidence of acute kidney injury in patients with coronavirus disease 2019 (COVID-19) have varied greatly from 0.5% to as high as 39%, with onset generally within 7 days from time of admission. The nature of the kidney insult is acute tubular necrosis, immune cell infiltration, or rhabdomyolysis, as demonstrated in autopsy reports. Moreover, infection with COVID-19 has been associated with coagulation abnormalities, as well as complement-mediated generalized thrombotic microvascular injury. These patients have been found to have high D-dimer, fibrin degradation product, and fibrinogen values, an elevated international normalized ratio, normal partial thromboplastin time, and normal platelet count values. Renal artery thrombosis is a rare condition, the most common cause of which is atrial fibrillation. However, bilateral completely occlusive renal artery thrombosis is even rarer. We present a case of a patient with COVID-19 on systemic anticoagulation therapy who presented with a serum creatinine level of 6.04 mg/dL requiring the initiation of kidney replacement therapy and was found to have bilateral renal artery thrombosis.
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Marinelli B, Cedillo M, Pasik SD, Charles D, Murthy S, Patel RS, Fischman A, Ranade M, Bishay V, Nowakowski S, Sung M, Marron T, Lookstein R, Schwartz M, Kim E. Safety and Efficacy of Locoregional Treatment during Immunotherapy with Nivolumab for Hepatocellular Carcinoma: A Retrospective Study of 41 Interventions in 29 Patients. J Vasc Interv Radiol 2020; 31:1729-1738.e1. [PMID: 33012649 DOI: 10.1016/j.jvir.2020.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To assess the safety of locoregional treatment (LRT) combined with nivolumab for intermediate and advanced hepatocellular carcinoma (HCC). MATERIALS AND METHODS A single-center retrospective review included 29 patients undergoing 41 LRTs-transarterial chemoembolization or yttrium-90 transarterial radioembolization-60 days before or concurrently with nivolumab. Demographic, clinical, and laboratory values and adverse events were reviewed before and after nivolumab initiation and after each LRT. Treatment response and time to progression were assessed using Modified Response Evaluation Criteria in Solid Tumors. Clinical events, including nivolumab termination, death, and time of last follow-up, were assessed. RESULTS Over a median nivolumab course of 8.1 months (range, 1.0-30) with a median of 14.2 2-week cycles (range, 1-53), predominantly Child-Pugh A (22/29) patients-12 Barcelona Clinic Liver Cancer (BCLC) B and 17 BCLC C-underwent 20 transarterial chemoembolization and 21 transarterial radioembolization LRTs at a median of 67 days (range, 48-609) after nivolumab initiation. Ten patients underwent multiple LRTs. During a median follow-up of 11.5 months (range, 1.8-35.1), no grade III/IV adverse events attributable to nivolumab were observed. There were five instances of grade III/IV hypoalbuminemia or hyperbilirubinemia within 3 months after LRT. There were no nivolumab-related deaths, and 30-day mortality after LRT was 0%. CONCLUSIONS LRTs performed concurrently with nivolumab immunotherapy demonstrate an acceptable safety profile in patients with intermediate and advanced HCC.
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Sher A, Posham R, Vouyouka A, Patel R, Lookstein R, Faries PL, Fischman A, Tadros R. Safety and feasibility of transradial infrainguinal peripheral arterial disease interventions. J Vasc Surg 2020; 72:1237-1246.e1. [DOI: 10.1016/j.jvs.2020.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/06/2020] [Indexed: 01/07/2023]
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El Shamy O, Patel N, Abdelbaset MH, Chenet L, Tokita J, Lookstein R, Lee DS, Cohen NA, Sharma S, Uribarri J. Acute Start Peritoneal Dialysis during the COVID-19 Pandemic: Outcomes and Experiences. J Am Soc Nephrol 2020; 31:1680-1682. [PMID: 32546597 PMCID: PMC7460897 DOI: 10.1681/asn.2020050599] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S. Corrigendum to "Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischaemia" [Eur J Vasc Endovasc Surg 58 (1S) (2019) 1-109>]. Eur J Vasc Endovasc Surg 2020; 60:158-159. [PMID: 32622518 DOI: 10.1016/j.ejvs.2020.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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