1
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Farsad K, Novelli PM, Laing C, Gandhi RT, Cynamon J, López CS, Stempinski ES, Strasser R, Agah R. Double-Balloon Catheter-Mediated Transarterial Chemotherapy Delivery in a Swine Model: A Mechanism Recruiting the Vasa Vasorum for Localized Therapies. J Vasc Interv Radiol 2024:S1051-0443(24)00238-0. [PMID: 38508449 DOI: 10.1016/j.jvir.2024.03.016] [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: 09/08/2023] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE Treatment of hypovascular tumors, such as pancreatic adenocarcinoma, is challenging owing to inefficient drug delivery. This report examines the potential mechanism of localized drug delivery via transarterial microperfusion (TAMP) using a proprietary adjustable double-balloon occlusion catheter in a porcine model. MATERIALS AND METHODS Adult Yorkshire swine (N = 21) were used in the Institutional Animal Care & Use Committee-approved protocols. The RC-120 catheter (RenovoRx, Los Altos, California) was positioned into visceral, femoral, and pulmonary arteries with infusion of methylene blue dye, gemcitabine, or gold nanoparticles. Transmural delivery was compared under double-balloon occlusion with and without side-branch exclusion, single-balloon occlusion, and intravenous delivery. Intra-arterial pressure and vascular histologic changes were assessed. RESULTS Infusion with double-balloon occlusion and side-branch exclusion provided increased intra-arterial pressure in the isolated segment and enhanced perivascular infusate penetration with minimal vascular injury. Infusates were predominantly found in the vasa vasorum by electron microscopy. CONCLUSIONS TAMP enhanced transmural passage mediated by localized increase in arterial pressure via vasa vasorum.
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Affiliation(s)
- Khashayar Farsad
- Department of Interventional Radiology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Paula M Novelli
- Department of Radiology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | - Ripal T Gandhi
- Interventional Radiology Division, Miami Cancer Institute and Miami Cardiac & Vascular Institute, Miami, Florida
| | - Jacob Cynamon
- Division of Vascular and Interventional Radiology, Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Claudia S López
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon; Multiscale Microscopy Core, Oregon Health & Science University, Portland, Oregon
| | - Erin S Stempinski
- Multiscale Microscopy Core, Oregon Health & Science University, Portland, Oregon
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2
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Rochon PJ, Reghunathan A, Kapoor BS, Kalva SP, Fidelman N, Majdalany BS, Abujudeh H, Caplin DM, Eldrup-Jorgensen J, Farsad K, Guimaraes MS, Gupta A, Higgins M, Kendi AT, Khilnani NM, Patel PJ, Dill KE, Hohenwalter EJ. ACR Appropriateness Criteria® Lower Extremity Chronic Venous Disease. J Am Coll Radiol 2023; 20:S481-S500. [PMID: 38040466 DOI: 10.1016/j.jacr.2023.08.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Lower extremity venous insufficiency is a chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis or extrinsic venous obstruction. Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million males and 22 million females 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly. Various diagnostic and treatment strategies are in place for lower extremity chronic venous disease and are discussed in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Arun Reghunathan
- Research Author, University of Colorado Denver, Denver, Colorado
| | | | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicholas Fidelman
- Panel Vice-Chair, University of California, San Francisco, San Francisco, California
| | - Bill S Majdalany
- Panel Vice-Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Hani Abujudeh
- Detroit Medical Center, Tenet Healthcare and Envision Radiology Physician Services, Detroit, Michigan
| | - Drew M Caplin
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | | | | | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Neil M Khilnani
- Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, New York; American Vein and Lymphatic Society
| | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| | - Eric J Hohenwalter
- Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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3
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Li N, Al-Hakim R, Lewis S, Ferracane J, Rugonyi S, Campos L, Farsad K, Kaufman J. Coaxial Placement of Balloon-Expandable and Self-Expanding Stents: Impact on Crush Resistance and Luminal Recovery in a Benchtop Model. J Vasc Interv Radiol 2023; 34:1958-1962.e1. [PMID: 37451538 DOI: 10.1016/j.jvir.2023.07.003] [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: 04/05/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
During endovascular interventions, coaxial deployment of stents may be required to preserve luminal gain. This study characterized in vitro the effect on crush resistance and postcompression recovery when 316L stainless steel balloon-expandable (BE) and laser-cut nitinol self-expanding (SE) venous stents were deployed coaxially. Various stent configurations were parallel-plate compressed from a fully expanded state to 50% diameter reduction (Criterion, Model 42; MTS, Eden Prairie, Minnesota) in a 37 °C ± 1 water bath. Coaxial deployments of SE stent inside BE stent and BE stent inside SE stent demonstrated higher crush resistances compared with each stent individually or their mathematical summation (analysis of variance P < .0001; pairwise comparison P < .01). The configuration of SE stent inside BE stent showed higher postcompression luminal recovery at 48.7% compared with that of BE stent inside SE stent at 27.5% (P = .0001). Coaxial deployment of SE stent inside BE stent may improve crush resistance and luminal recovery after compression in the appropriate clinical context.
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Affiliation(s)
- Ningcheng Li
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon.
| | - Ramsey Al-Hakim
- Division of Interventional Radiology, Department of Radiology, Scripps Green Hospital, San Diego, California
| | - Steven Lewis
- Department of Oral Rehabilitation and Biosciences, Oregon Health & Science University, Portland, Oregon
| | - Jack Ferracane
- Department of Oral Rehabilitation and Biosciences, Oregon Health & Science University, Portland, Oregon
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Leonardo Campos
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Khashayar Farsad
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - John Kaufman
- The Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
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4
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Patel RK, Rahman S, Schwantes IR, Bartlett A, Eil R, Farsad K, Fowler K, Goodyear SM, Hansen L, Kardosh A, Nabavizadeh N, Rocha FG, Tsikitis VL, Wong MH, Mayo SC. Updated Management of Colorectal Cancer Liver Metastases: Scientific Advances Driving Modern Therapeutic Innovations. Cell Mol Gastroenterol Hepatol 2023; 16:881-894. [PMID: 37678799 PMCID: PMC10598050 DOI: 10.1016/j.jcmgh.2023.08.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Colorectal cancer is the second leading cause of cancer-related deaths in the United States and accounts for an estimated 1 million deaths annually worldwide. The liver is the most common site of metastatic spread from colorectal cancer, significantly driving both morbidity and mortality. Although remarkable advances have been made in recent years in the management for patients with colorectal cancer liver metastases, significant challenges remain in early detection, prevention of progression and recurrence, and in the development of more effective therapeutics. In 2017, our group held a multidisciplinary state-of-the-science symposium to discuss the rapidly evolving clinical and scientific advances in the field of colorectal liver metastases, including novel early detection and prognostic liquid biomarkers, identification of high-risk cohorts, advances in tumor-immune therapy, and different regional and systemic therapeutic strategies. Since that time, there have been scientific discoveries translating into therapeutic innovations addressing the current management challenges. These innovations are currently reshaping the treatment paradigms and spurring further scientific discovery. Herein, we present an updated discussion of both the scientific and clinical advances and future directions in the management of colorectal liver metastases, including adoptive T-cell therapies, novel blood-based biomarkers, and the role of the tumor microbiome. In addition, we provide a comprehensive overview detailing the role of modern multidisciplinary clinical approaches used in the management of patients with colorectal liver metastases, including considerations toward specific molecular tumor profiles identified on next generation sequencing, as well as quality of life implications for these innovative treatments.
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Affiliation(s)
- Ranish K Patel
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Shahrose Rahman
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Issac R Schwantes
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Alexandra Bartlett
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon
| | - Robert Eil
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon; The Knight Cancer Institute, OHSU, Portland, Oregon
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, OHSU, Portland, Oregon
| | - Kathryn Fowler
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Shaun M Goodyear
- The Knight Cancer Institute, OHSU, Portland, Oregon; Division of Hematology and Oncology, School of Medicine, OHSU, Portland, Oregon
| | - Lissi Hansen
- The Knight Cancer Institute, OHSU, Portland, Oregon; School of Nursing, OHSU, Portland, Oregon
| | - Adel Kardosh
- The Knight Cancer Institute, OHSU, Portland, Oregon; Division of Hematology and Oncology, School of Medicine, OHSU, Portland, Oregon
| | - Nima Nabavizadeh
- The Knight Cancer Institute, OHSU, Portland, Oregon; Department of Radiation Medicine, OHSU, Portland, Oregon
| | - Flavio G Rocha
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon; The Knight Cancer Institute, OHSU, Portland, Oregon
| | - V Liana Tsikitis
- The Knight Cancer Institute, OHSU, Portland, Oregon; Division of Gastrointestinal Surgery, Department of Surgery, OHSU, Portland, Oregon
| | - Melissa H Wong
- The Knight Cancer Institute, OHSU, Portland, Oregon; Department of Cell, Developmental and Cancer Biology, OHSU, Portland, Oregon
| | - Skye C Mayo
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon; The Knight Cancer Institute, OHSU, Portland, Oregon.
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5
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Li N, Huber T, Campos L, Yamada K, Kaufman J, Farsad K, Bochnakova T. Double-Barrel Nitinol Stent Placement for Iliocaval Reconstruction: The Effect of Deployment Sequence and Direction on Final Configuration. J Vasc Interv Radiol 2023; 34:1511-1515.e1. [PMID: 37196821 DOI: 10.1016/j.jvir.2023.05.018] [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: 01/20/2023] [Revised: 04/22/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
Double-barrel stent placement across the iliocaval confluence is commonly used for the treatment of chronic bilateral iliocaval occlusion. The difference in the deployment outcomes of synchronous parallel stent deployment versus asynchronous or antiparallel deployment and the underlying stent interactions are poorly understood. In this study, 3 strategies of double-barrel nitinol self-expanding stent deployment across the iliocaval confluence (synchronous parallel, asynchronous parallel, and synchronous antiparallel) were contrasted in vivo in 3 swine followed by assessment of the explanted stent construct. Synchronous parallel stent deployment achieved a desired double-barrel configuration. The asynchronous parallel and antiparallel deployment strategies both resulted in a crushed stent despite subsequent simultaneous balloon angioplasty. These animal model results suggested that in patients who undergo double-barrel iliocaval reconstruction, synchronous parallel stent deployment may provide the desired stent conformation and increase the chance for clinical success.
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Affiliation(s)
- Ningcheng Li
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Timothy Huber
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Leonardo Campos
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Kentaro Yamada
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - John Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon.
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6
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Yamada K, Takata T, Anoushiravani A, Campos L, Graham T, Kotoku J, Farsad K. Abstract No. 53 Image Quality Improvement for Digital Subtraction Angiography (DSA) around High-Density Obstacles Using Deep Learning: A Bench-Top Study. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.096] [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
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7
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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.
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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
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8
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Ohaegbulam KC, Koethe Y, Fung A, Mayo SC, Grossberg AJ, Chen EY, Sharzehi K, Kardosh A, Farsad K, Rocha FG, Thomas CR, Nabavizadeh N. The multidisciplinary management of cholangiocarcinoma. Cancer 2023; 129:184-214. [PMID: 36382577 DOI: 10.1002/cncr.34541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/14/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
Abstract
Cholangiocarcinoma is a lethal malignancy of the biliary epithelium that can arise anywhere along the biliary tract. Surgical resection confers the greatest likelihood of long-term survivability. However, its insidious onset, difficult diagnostics, and resultant advanced presentation render the majority of patients unresectable, highlighting the importance of early detection with novel biomarkers. Developing liver-directed therapies and emerging targeted therapeutics may offer improved survivability for patients with unresectable or advanced disease. In this article, the authors review the current multidisciplinary standards of care in resectable and unresectable cholangiocarcinoma, with an emphasis on novel biomarkers for early detection and nonsurgical locoregional therapy options.
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Affiliation(s)
- Kim C Ohaegbulam
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Yilun Koethe
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Aaron J Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Emerson Y Chen
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kaveh Sharzehi
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Adel Kardosh
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Flavio G Rocha
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Department of Radiation Oncology, Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
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9
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Demessie AA, Park Y, Singh P, Moses AS, Korzun T, Sabei FY, Albarqi HA, Campos L, Wyatt CR, Farsad K, Dhagat P, Sun C, Taratula OR, Taratula O. An Advanced Thermal Decomposition Method to Produce Magnetic Nanoparticles with Ultrahigh Heating Efficiency for Systemic Magnetic Hyperthermia. Small Methods 2022; 6:e2200916. [PMID: 36319445 PMCID: PMC9772135 DOI: 10.1002/smtd.202200916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/13/2022] [Revised: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Due to the limited heating efficiency of available magnetic nanoparticles, it is difficult to achieve therapeutic temperatures above 44 °C in relatively inaccessible tumors during magnetic hyperthermia following systemic administration of nanoparticles at clinical dosage (≤10 mg kg-1 ). To address this, a method for the preparation of magnetic nanoparticles with ultrahigh heating capacity in the presence of an alternating magnetic field (AMF) is presented. The low nitrogen flow rate of 10 mL min-1 during the thermal decomposition reaction results in cobalt-doped nanoparticles with a magnetite (Fe3 O4 ) core and a maghemite (γ-Fe2 O3 ) shell that exhibit the highest intrinsic loss power reported to date of 47.5 nH m2 kg-1 . The heating efficiency of these nanoparticles correlates positively with increasing shell thickness, which can be controlled by the flow rate of nitrogen. Intravenous injection of nanoparticles at a low dose of 4 mg kg-1 elevates intratumoral temperatures to 50 °C in mice-bearing subcutaneous and metastatic cancer grafts during exposure to AMF. This approach can also be applied to the synthesis of other metal-doped nanoparticles with core-shell structures. Consequently, this method can potentially be used for the development of novel nanoparticles with high heating performance, further advancing systemic magnetic hyperthermia for cancer treatment.
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Affiliation(s)
- Ananiya A Demessie
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Youngrong Park
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Prem Singh
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Abraham S Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Fahad Y Sabei
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan, 88723, Kingdom of Saudi Arabia
| | - Hassan A Albarqi
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran, 55461, Kingdom of Saudi Arabia
| | - Leonardo Campos
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Cory R Wyatt
- Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, OR, 97239, USA
- Advanced Imaging Research Center, Oregon Health & Sciences University, Portland, OR, 97239, USA
| | - Khashayar Farsad
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Pallavi Dhagat
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, OR, 97331, USA
| | - Conroy Sun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Olena R Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
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10
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Pillai AA, Kriss M, Al‐Adra DP, Chadha RM, Cushing MM, Farsad K, Fortune BE, Hess AS, Lewandowski R, Nadim MK, Nydam T, Sharma P, Karvellas CJ, Intagliata N. Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care. Liver Transpl 2022; 28:1651-1663. [PMID: 35253365 PMCID: PMC9790275 DOI: 10.1002/lt.26451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/10/2023]
Abstract
Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies and society guidance address this emerging paradigm and offer recommendations to assist with hemostatic management in patients with liver disease. However, patients undergoing LT are unique and diverse, often with unstable disease that requires specialized approaches. Our aim is to provide a focused review of hemostatic management of the LT patient, distinguish unique aspects of the three main phases of care (before LT, perioperative, and after LT), and identify knowledge gaps and critical areas of future research.
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Affiliation(s)
- Anjana A. Pillai
- Department of MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Michael Kriss
- Department of Internal MedicineUniversity of ColoradoAuroraColoradoUSA
| | - David P. Al‐Adra
- Department of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Ryan M. Chadha
- Department of Anesthesiology and Perioperative MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Melissa M. Cushing
- Department of Pathology and Laboratory MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Khashayar Farsad
- Department of Interventional RadiologyOregon Health & Science UniversityPortlandOregonUSA
| | | | - Aaron S. Hess
- Department of AnesthesiologyUniversity of WisconsinMadisonWisconsinUSA,Department of Pathology & Laboratory MedicineUniversity of WisconsinMadisonWisconsinUSA
| | | | - Mitra K. Nadim
- Department of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Trevor Nydam
- Department of SurgeryUniversity of ColoradoAuroraColoradoUSA
| | - Pratima Sharma
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
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11
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Boike JR, Thornburg BG, Asrani SK, Fallon MB, Fortune BE, Izzy MJ, Verna EC, Abraldes JG, Allegretti AS, Bajaj JS, Biggins SW, Darcy MD, Farr MA, Farsad K, Garcia-Tsao G, Hall SA, Jadlowiec CC, Krowka MJ, Laberge J, Lee EW, Mulligan DC, Nadim MK, Northup PG, Salem R, Shatzel JJ, Shaw CJ, Simonetto DA, Susman J, Kolli KP, VanWagner LB. North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension. Clin Gastroenterol Hepatol 2022; 20:1636-1662.e36. [PMID: 34274511 PMCID: PMC8760361 DOI: 10.1016/j.cgh.2021.07.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
Complications of portal hypertension, including ascites, gastrointestinal bleeding, hepatic hydrothorax, and hepatic encephalopathy, are associated with significant morbidity and mortality. Despite few high-quality randomized controlled trials to guide therapeutic decisions, transjugular intrahepatic portosystemic shunt (TIPS) creation has emerged as a crucial therapeutic option to treat complications of portal hypertension. In North America, the decision to perform TIPS involves gastroenterologists, hepatologists, and interventional radiologists, but TIPS creation is performed by interventional radiologists. This is in contrast to other parts of the world where TIPS creation is performed primarily by hepatologists. Thus, the successful use of TIPS in North America is dependent on a multidisciplinary approach and technical expertise, so as to optimize outcomes. Recently, new procedural techniques, TIPS stent technology, and indications for TIPS have emerged. As a result, practices and outcomes vary greatly across institutions and significant knowledge gaps exist. In this consensus statement, the Advancing Liver Therapeutic Approaches group critically reviews the application of TIPS in the management of portal hypertension. Advancing Liver Therapeutic Approaches convened a multidisciplinary group of North American experts from hepatology, interventional radiology, transplant surgery, nephrology, cardiology, pulmonology, and hematology to critically review existing literature and develop practice-based recommendations for the use of TIPS in patients with any cause of portal hypertension in terms of candidate selection, procedural best practices and, post-TIPS management; and to develop areas of consensus for TIPS indications and the prevention of complications. Finally, future research directions are identified related to TIPS for the management of portal hypertension.
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Affiliation(s)
- Justin R. Boike
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bartley G. Thornburg
- Department of Radiology, Division of Vascular and Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Michael B. Fallon
- Department of Medicine, Division of Gastroenterology and Hepatology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | - Brett E. Fortune
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Manhal J. Izzy
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth C. Verna
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Juan G. Abraldes
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, AB, Canada
| | - Andrew S. Allegretti
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Jasmohan S. Bajaj
- Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | - Scott W. Biggins
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Washington Medical Center, Seattle, WA, USA
| | - Michael D. Darcy
- Department of Radiology, Division of Interventional Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Maryjane A. Farr
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Guadalupe Garcia-Tsao
- Department of Digestive Diseases, Yale University, Yale University School of Medicine, and VA-CT Healthcare System, CT, USA
| | - Shelley A. Hall
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Caroline C. Jadlowiec
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Michael J. Krowka
- Department of Pulmonary and Critical Care Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jeanne Laberge
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Edward W. Lee
- Department of Radiology, Division of Interventional Radiology, University of California-Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - David C. Mulligan
- Department of Surgery, Division of Transplantation, Yale University School of Medicine, New Haven, CT, USA
| | - Mitra K. Nadim
- Department of Medicine, Division of Nephrology and Hypertension, University of Southern California, Los Angeles, California, USA
| | - Patrick G. Northup
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Riad Salem
- Department of Radiology, Division of Vascular and Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph J. Shatzel
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Cathryn J. Shaw
- Department of Radiology, Division of Interventional Radiology, Baylor University Medical Center, Dallas, TX, USA
| | - Douglas A. Simonetto
- Department of Physiology, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jonathan Susman
- Department of Radiology, Division of Interventional Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - K. Pallav Kolli
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Address for correspondence: Lisa B. VanWagner MD MSc FAST FAHA, Assistant Professor of Medicine and Preventive Medicine, Divisions of Gastroenterology & Hepatology and Epidemiology, Northwestern University Feinberg School of Medicine, 676 N. St Clair St - Suite 1400, Chicago, Illinois 60611 USA, Phone: 312 695 1632, Fax: 312 695 0036,
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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
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Panick C, Stumbras L, Foster B, Farsad K, Bochnakova T. Abstract No. 136 Abdominal aortic angiogram: a necessary step to look for ovarian artery supply during fibroid embolization? J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.217] [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
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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
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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.
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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
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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.
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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.
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Hissourou M, Farsad K, Enestvedt CK, Fung A, Schlansky B, Naugler WE, Nabavizadeh N. Bridge-to-transplant stereotactic body radiation therapy in patients with hepatocellular carcinoma and advanced cirrhosis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.tps496] [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] [Indexed: 11/20/2022] Open
Abstract
TPS496 Background: Liver cancer is the third most common cause of cancer related death worldwide, and hepatocellular carcinoma (HCC) accounts for 90% of all primary liver cancers, with pre-existing cirrhosis being a very strong risk factor for HCC development. Liver transplantation (LTx) is the best treatment for patients with HCC and advanced cirrhosis as both conditions can be very effectively treated at once. As LTx wait-lists can be many months, liver-directed therapies (LDT), including stereotactic body radiation therapy (SBRT) to one or few lesions are essential as oncologic temporizing measures to bridge patients to LTx and prevent progression outside of LTx criteria. However, due to the fear of further hepatic decompensation, many patients with advanced cirrhosis are excluded from receiving LDT. Rather, recent studies suggest that SBRT be of safe and practical use in this fragile patient population with advanced cirrhosis and HCC, and thereby reduce the rate of transplantation drop-out. This pilot prospective study will assess the feasibility, safety and efficacy of bridge-to-transplantation SBRT for patients with advanced cirrhosis and HCC. Methods: Patients with non-metastatic and unresectable HCC and Child-Pugh (CP)-B8 or worse cirrhosis who are within Milan criteria (one tumor ≤ 5 cm in diameter or no more than 3 tumors each ≤ 3 cm in diameter) and have been listed or recommended to be listed for liver transplantation will be eligible for participation. Eligible participants will undergo SBRT consisting of 40 Gy to be given in 5 fractions every other day to the only or largest lesion, provided that criteria for normal organ constraints are met. In cases where normal organ constraints are not met, the dose will be iteratively de-escalated to two dose levels (35 Gy in 5 fractions, then 30 Gy in 5 fractions). If normal organ constraints are unable to be met at 30 Gy in 5 fractions, the participant will be considered ineligible for SBRT and considered a screen failure. The primary endpoint is the proportion of participants who are transplanted or with localized disease control that meets Milan criteria within a year of SBRT. Secondary endpoints will include localized control rate (mRECIST), incidence of intra- or extra-hepatic progressive disease (mRECIST), overall survival, incidence of liver toxicity per CTCAE v5.0, incidence of non-classical radiation-induced liver disease (defined as CTCAE grade 4 AST/ALT elevation or an increase in CP score of ≥ 2 within 3 months of SBRT) and quality of life scores per QLQ-C30 and FACT-Hep questionnaires. The study is open, aiming to enroll 15 patients with 8 patients enrolled at time of submission. Clinical trial information: NCT03812289.
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Affiliation(s)
| | | | | | - Alice Fung
- Oregon Health & Science University, Portland, OR
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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.
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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.
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Huber TC, Bochnakova T, Koethe Y, Park B, Farsad K. Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies. J Hepatocell Carcinoma 2021; 8:1181-1193. [PMID: 34589446 PMCID: PMC8476177 DOI: 10.2147/jhc.s268300] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.
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Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Brian Park
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
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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.
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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
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Cretcher M, Panick CEP, Boscanin A, Farsad K. Splenic trauma: endovascular treatment approach. Ann Transl Med 2021; 9:1194. [PMID: 34430635 PMCID: PMC8350634 DOI: 10.21037/atm-20-4381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used. Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.
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Affiliation(s)
- Maxwell Cretcher
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Catherine E P Panick
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Alexander Boscanin
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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22
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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
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Ngo T, Spiliotopoulos E, Kolbeck K, Farsad K. Abstract No. 571 Circulating cell-free RNA in plasma enables early detection of acute response to ablation and transarterial therapies for hepatocellular carcinoma. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.381] [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
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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
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Karuppasamy K, Kapoor BS, Fidelman N, Abujudeh H, Bartel TB, Caplin DM, Cash BD, Citron SJ, Farsad K, Gajjar AH, Guimaraes MS, Gupta A, Higgins M, Marin D, Patel PJ, Pietryga JA, Rochon PJ, Stadtlander KS, Suranyi PS, Lorenz JM. ACR Appropriateness Criteria® Radiologic Management of Lower Gastrointestinal Tract Bleeding: 2021 Update. J Am Coll Radiol 2021; 18:S139-S152. [PMID: 33958109 DOI: 10.1016/j.jacr.2021.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient for most patients, followed by elective diagnostic tests. However, if acute lower GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Colonoscopy can identify the site and cause of bleeding and provide effective treatment. CTA is a noninvasive diagnostic tool that is better tolerated by patients, can identify actively bleeding site or a potential bleeding lesion in vast majority of patients. RBC scan can identify intermittent bleeding, and with single-photon emission computed tomography, can more accurately localize it to a small segment of bowel. If patients are hemodynamically unstable, CTA and transcatheter arteriography/embolization can be performed. Colonoscopy can also be considered in these patients if rapid bowel preparation is feasible. Transcatheter arteriography has a low rate of major complications; however, targeted transcatheter embolization is only feasible if extravasation is seen, which is more likely in hemodynamically unstable patients. If bleeding site has been previously localized but the intervention by colonoscopy and transcatheter embolization have failed to achieve hemostasis, surgery may be required. Among patients with obscure (nonlocalized) recurrent bleeding, capsule endoscopy and CT enterography can be considered to identify culprit mucosal lesion(s). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Nicholas Fidelman
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Hani Abujudeh
- Detroit Medical Center, Tenet Healthcare and Envision Radiology Physician Services, Detroit, Michigan
| | | | - Drew M Caplin
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, Chair, Committee on Practice Parameters Interventional Radiology, American College of Radiology, Program Director, Interventional Radiology Residency, Zucker School of Medicine NSLIJ
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas, American Gastroenterological Association
| | | | - Khashayar Farsad
- Oregon Health and Science University, Portland, Oregon, Vice Chair, Department of Interventional Radiology, Oregon Health & Science University
| | - Aakash H Gajjar
- PRiSMA Proctology Surgical Medicine & Associates, Houston, Texas, American College of Surgeons
| | | | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | | | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Paul J Rochon
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | | | - Pal S Suranyi
- Medical University of South Carolina, Charleston, South Carolina
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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
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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.![]()
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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
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Farsad K, Nabavizadeh N, Kardosh A, Jou JH, Naugler WE, Kolbeck KJ. Combined locoregional and systemic therapy for advanced hepatocellular carcinoma: finally, the future is obscure. Ann Transl Med 2020; 8:1700. [PMID: 33490212 PMCID: PMC7812172 DOI: 10.21037/atm-20-4164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Nima Nabavizadeh
- Department of Radiation Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Adel Kardosh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Janice H. Jou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Willscott E. Naugler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kenneth J. Kolbeck
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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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.
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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.)
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Gabr AM, Li N, Schenning RC, Elbarbary A, Anderson JC, Kaufman JA, Farsad K. Diagnostic and Interventional Radiology Case Volume and Education in the Age of Pandemics: Impact Analysis and Potential Future Directions. Acad Radiol 2020; 27:1481-1488. [PMID: 32703647 PMCID: PMC7372272 DOI: 10.1016/j.acra.2020.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the immediate impact of the COVID-19 pandemic on Diagnostic and Interventional Radiology education, and to propose measures to preserve and augment trainee education during future crises. MATERIALS AND METHODS Diagnostic Radiology (DR) studies and Interventional Radiology (IR) procedures at a single tertiary-care teaching institution between 2015 and 2020 were reviewed. DR was divided by section: body, cardiothoracic, musculoskeletal (MSK), neuroradiology, nuclear medicine, pediatrics, and women's imaging. IR was divided by procedural types: arterial, venous, lymphatic, core, neuro, pediatrics, dialysis, cancer embolization or ablation, noncancer embolization, portal hypertension, and miscellaneous. Impact on didactic education was also assessed. ANOVA, t test, and multiple comparison correction were used for analysis. RESULTS DR and IR caseloads decreased significantly in April 2020 compared to April of the prior 5 years (both p < 0.0001). Case volumes were reduced in body (49.2%, p < 0.01), MSK (54.2%, p < 0.05), neuro (39.3%, p < 0.05), and women's imaging (75.5%, p < 0.05) in DR, and in arterial (62.6%, p < 0.01), neuro IR (57.6%, p < 0.01) and core IR (42.6%, p < 0.05) in IR. IR trainee average caseload in April 2020 decreased 51.9% compared to April of the prior 5 years (p < 0.01). Utilization of online learning increased in April. Trainees saw significant increases in overall DR didactics (31.3%, p = 0.02) and no reduction in IR didactics, all online. Twelve major national and international DR and IR meetings were canceled or postponed between March and July. CONCLUSION Decreases in caseload and widespread cancellation of conferences have had significant impact on DR/IR training during COVID-19 restrictions. Remote learning technologies with annotated case recording, boards-style case reviews, procedural simulation and narrated live cases as well as online lectures and virtual journal clubs increased during this time. Whether remote learning can mitigate lost opportunities from in-person interactions remains uncertain. Optimizing these strategies will be important for potential future restricted learning paradigms and can also be extrapolated to augment trainee education during unrestricted times.
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Affiliation(s)
- Ahmed M Gabr
- Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland OR, 97239-3011; Radiology Department, Tanta University, Tanta, Egypt
| | - Ningcheng Li
- Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland OR, 97239-3011
| | - Ryan C Schenning
- Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland OR, 97239-3011
| | - Aly Elbarbary
- Radiology Department, Tanta University, Tanta, Egypt
| | - James C Anderson
- Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland OR, 97239-3011
| | - John A Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland OR, 97239-3011
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland OR, 97239-3011.
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Farsad K, Narasimhan E, Russell L, Kaufman JA. Transjugular Intrahepatic Portosystemic Shunt Creation Using a Radiofrequency Wire: Prospective Clinical Safety and Feasibility Trial in Cirrhosis. J Vasc Interv Radiol 2020; 31:1401-1407. [PMID: 32792278 DOI: 10.1016/j.jvir.2020.05.025] [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: 03/18/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the safety and feasibility of using a radiofrequency (RF) wire for portosystemic shunt creation. MATERIALS AND METHODS Ten patients undergoing elective creation of a transjugular intrahepatic portosystemic shunt (TIPS) or a direct intrahepatic portosystemic shunt (DIPS) were prospectively enrolled. Primary outcomes were the safety and feasibility of RF wire used for the creation of TIPS and DIPS. Median age was 66.5 ± 6.1 years. Causes of liver disease included alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), hepatitis C virus (n = 1), primary biliary cirrhosis (n = 1), autoimmune hepatitis (n = 1). The median score for model for end-stage liver disease was 11 ± 4.3. The Rosch-Uchida TIPS set was used with intravascular ultrasonography guidance in all cases. A 0.035-inch RF wire was used in lieu of the trocar needle through the 5-F TIPS set catheter to create a track between the hepatic vein and the portal vein. All shunts were created using stent grafts. RESULTS Technical success rate was 100%. In 7 of 10 patients, portal vein access was achieved with a single pass. A DIPS was created in 2 patients based on anatomic favorability. Median fluoroscopy time was 13.3 ± 3.8 min, and median total procedure time was 102 ± 19 min. The wire passed through parenchyma without subjective deflection. There was 1 case of extracapsular puncture with no clinical consequence. The RF wire was too stiff to curve into the main portal vein, requiring wire exchange in all but 1 case. Mean portosystemic gradient decreased from 13.9 ± 3.3 to 5.9 ± 2.1 mm Hg. No immediate complications were encountered. Shunt patency was 100% at 30 days. CONCLUSIONS Creation of TIPS and DIPS using an RF wire was safe and feasible, enabling creation of an intrahepatic track without subjective deflection in cirrhotic patients.
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Affiliation(s)
- Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
| | - Evan Narasimhan
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Lori Russell
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - John A Kaufman
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
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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.
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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.
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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."
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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.
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Farsad K, Kapoor BS, Fidelman N, Cain TR, Caplin DM, Eldrup-Jorgensen J, Gupta A, Higgins M, Hohenwalter EJ, Lee MH, McBride JJ, Minocha J, Rochon PJ, Sutphin PD, Lorenz JM. ACR Appropriateness Criteria® Radiologic Management of Iliofemoral Venous Thrombosis. J Am Coll Radiol 2020; 17:S255-S264. [PMID: 32370969 DOI: 10.1016/j.jacr.2020.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Iliofemoral venous thrombosis carries a high risk for pulmonary embolism, recurrent deep vein thrombosis, and post-thrombotic syndrome complicating 30% to 71% of those affected. The clinical scenarios in which iliofemoral venous thrombosis is managed may be diverse, presenting a challenge to identify optimum therapy tailored to each situation. Goals for management include preventing morbidity from venous occlusive disease, and morbidity and mortality from pulmonary embolism. Anticoagulation remains the standard of care for iliofemoral venous thrombosis, although a role for more aggressive therapies with catheter-based interventions or surgery exists in select circumstances. Results from recent prospective trials have improved patient selection guidelines for more aggressive therapies, and have also demonstrated a lack of efficacy for certain conservative therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Portland, Oregon.
| | | | - Nicholas Fidelman
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Thomas R Cain
- Desert Regional Medical Center, Palm Springs, California
| | - Drew M Caplin
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | | | | | - Margaret H Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Jeet Minocha
- University of California San Diego, San Diego, California
| | - Paul J Rochon
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
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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.
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
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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.
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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
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Kumagai K, Horikawa M, Yamada K, Uchida BT, Farsad K. Transtail Artery Access in Rats: A New Technique for Repeatable Selective Angiography. J Vasc Interv Radiol 2019; 31:678-681.e4. [PMID: 31706884 DOI: 10.1016/j.jvir.2019.07.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022] Open
Abstract
Transtail artery approach successfully enables selective arterial catheterization and angiography in the rat. This technique is effective and repeatable. In addition to its utility in imaging, it may also have a wide range of applications in transcatheter therapy and experimental cerebral stroke models.
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Affiliation(s)
- Kosuke Kumagai
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR; Department of Neurosurgery, National Defense Medical College, Tokorozawa, Japan.
| | - Masahiro Horikawa
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR
| | - Kentaro Yamada
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR
| | - Barry T Uchida
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR
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Affiliation(s)
- Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland
| | | | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
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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.
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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.
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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.
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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.
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Hedge JC, Foulke E, Farsad K. Intravascular US Guidance for Direct Intrahepatic Portosystemic Shunt Creation in the Setting of Polycystic Liver Disease. J Vasc Interv Radiol 2019; 29:1476-1477. [PMID: 30266228 DOI: 10.1016/j.jvir.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- J Cody Hedge
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97221
| | - Evan Foulke
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97221
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97221
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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.
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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
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Yamada K, Horikawa M, Uchida B, Farsad K. Abstract No. 453 In vitro characteristics of imipenem–cilastatin (IPM-CS) particles as embolic agents for geniculate artery embolization: morphology and stability in solution. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.534] [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: 11/29/2022] Open
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