Anand Athavale, MD

All Publications

• Comprehensive Approach to Management of Lipedema CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE Athavale, A., Fukaya, E., Aday, A. W. 2025; 27 (1)

  View details for DOI 10.1007/s11936-025-01126-x

  View details for Web of Science ID 001589464700002

• Peripheral Artery Disease: Molecular Mechanisms and Novel Therapies. Arteriosclerosis, thrombosis, and vascular biology Athavale, A., Fukaya, E., Leeper, N. J. 2024; 44 (6): 1165-1170

  View details for DOI 10.1161/ATVBAHA.124.320195

  View details for PubMedID 38776386

• Early observations on large language models for venous disease Athavale, A., Fukaya, E., Baier, J. SAGE PUBLICATIONS LTD. 2023: 510

  View details for Web of Science ID 001083593400040

• A Systematic Review on Ablation Techniques for Larger Saphenous Veins in Patients with Symptomatic Superficial Venous Disease. Journal of vascular surgery. Venous and lymphatic disorders Athavale, A., Monahan, D., Fukaya, E. 2023

  Abstract

  To summarize the existing evidence for the treatment of saphenous veins >10 mm in diameter, determine whether there were vein size limits for treatment modalities and if there are specific technical considerations for treatment of large veins.We searched the literature for reports of treatment methods and outcomes for patients with large-diameter saphenous veins treated with various ablation methods between 1993 and 2023. These studies were evaluated for the size of the vein determined as "large diameter," type of ablation method, study type, outcomes, adverse events, and any technical considerations noted. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The COVIDENCE software was used for full-text screening and data extraction. Three reviewers reviewed the data, and the content expert served as the tiebreaker.Seventy-one records were identified, of which, twenty-four studies were deemed appropriate for extraction. Most of the studies identified reported outcomes of endovenous thermal ablation (EVTA) modalities. There were fewer studies on non-thermal non-tumescent techniques (NTNT) and these studies reported an overall lower occlusion rate compared to EVTA techniques.Large head-to-head trials or randomized controlled that compare all the modalities over a long follow-up duration are yet to be performed. In the existing literature, there is considerable heterogeneity in terms of the study size, design, definition of large veins, site of vein measurement and follow-up periods making it challenging to make fair comparisons and draw firm conclusions. Currently available evidence supports the use of endothermal ablation techniques for the treatment of veins > 10 mm in diameter as they have a more favorable efficacy and safety profile and have a larger body of evidence available compared to NTNT techniques or surgery.

  View details for DOI 10.1016/j.jvsv.2023.08.020

  View details for PubMedID 37703943

• The potential of chatbots in chronic venous disease patient management. JVS-vascular insights Athavale, A., Baier, J., Ross, E., Fukaya, E. 2023; 1

  Abstract

  Health care providers and recipients have been using artificial intelligence and its subfields, such as natural language processing and machine learning technologies, in the form of search engines to obtain medical information for some time now. Although a search engine returns a ranked list of webpages in response to a query and allows the user to obtain information from those links directly, ChatGPT has elevated the interface between humans with artificial intelligence by attempting to provide relevant information in a human-like textual conversation. This technology is being adopted rapidly and has enormous potential to impact various aspects of health care, including patient education, research, scientific writing, pre-visit/post-visit queries, documentation assistance, and more. The objective of this study is to assess whether chatbots could assist with answering patient questions and electronic health record inbox management.We devised two questionnaires: (1) administrative and non-complex medical questions (based on actual inbox questions); and (2) complex medical questions on the topic of chronic venous disease. We graded the performance of publicly available chatbots regarding their potential to assist with electronic health record inbox management. The study was graded by an internist and a vascular medicine specialist independently.On administrative and non-complex medical questions, ChatGPT 4.0 performed better than ChatGPT 3.5. ChatGPT 4.0 received a grade of 1 on all the questions: 20 of 20 (100%). ChatGPT 3.5 received a grade of 1 on 14 of 20 questions (70%), grade 2 on 4 of 16 questions (20%), grade 3 on 0 questions (0%), and grade 4 on 2/20 questions (10%). On complex medical questions, ChatGPT 4.0 performed the best. ChatGPT 4.0 received a grade of 1 on 15 of 20 questions (75%), grade 2 on 2 of 20 questions (10%), grade 3 on 2 of 20 questions (10%), and grade 4 on 1 of 20 questions (5%). ChatGPT 3.5 received a grade of 1 on 9 of 20 questions (45%), grade 2 on 4 of 20 questions (20%), grade 3 on 4 of 20 questions (20%), and grade 4 on 3 of 20 questions (15%). Clinical Camel received a grade of 1 on 0 of 20 questions (0%), grade 2 on 5 of 20 questions (25%), grade 3 on 5 of 20 questions (25%), and grade 4 on 10 of 20 questions (50%).Based on our interactions with ChatGPT regarding the topic of chronic venous disease, it is plausible that in the future, this technology may be used to assist with electronic health record inbox management and offload medical staff. However, for this technology to receive regulatory approval to be used for that purpose, it will require extensive supervised training by subject experts, have guardrails to prevent "hallucinations" and maintain confidentiality, and prove that it can perform at a level comparable to (if not better than) humans. (JVS-Vascular Insights 2023;1:100019.).

  View details for DOI 10.1016/j.jvsvi.2023.100019

  View details for PubMedID 37701430

  View details for PubMedCentralID PMC10497234

• A Diagnostic Quandary of Escherichia Coli Pneumonia: A Case Report and Literature Review. Cureus Ganipisetti, V. M., Dudiki, N., Athavale, A. 2023; 15 (5): e39668

  Abstract

  Escherichia coli community-acquired pneumonia (CAP) is an under-recognized condition associated with higher mortality compared to the other well-studied causes of pneumonia. E. coli pneumonia is frequently associated with bacteremia. Despite the absence of abdominal or urinary symptoms, the infection may originate from an occult gastrointestinal (GI) source since it is a common commensal bacteria of the GI tract. Conditions related to extraintestinal pathogenic E. coli (ExPEC) are gaining attention, and there has been a trend toward the rise of pneumonia secondary to gram-negative bacteria. This presents a diagnostic stewardship dilemma in a patient with sepsis, E. coli bacteremia, and apparent pneumonia - to assume and treat for E. coli CAP or to look for a GI/genitourinary source which may, in turn, lead to incidental findings and further studies. We report a case of E. coli CAP in a 62-year-old patient and our approach regarding the treatment and imaging course.

  View details for DOI 10.7759/cureus.39668

  View details for PubMedID 37265881

  View details for PubMedCentralID PMC10231897

• Cyanoacrylate Glue Reactions: A Systematic Review, Cases, and Proposed Mechanisms. Journal of vascular surgery. Venous and lymphatic disorders Athavale, A., Thao, M., Sassaki, V. S., Lewis, M., Chandra, V., Fukaya, E. 2023

  Abstract

  OBJECTIVE: Cyanoacrylate Glue Closure (CAC) was first used in humans ten years ago to treat venous reflux of the axial veins. Studies have since shown its clinical efficacy in vein closure. However, there is much need to elucidate further, the types of specific adverse reactions that cyanoacrylate glue can cause, and to perform patient selection better and minimize these events. In this study, we systematically reviewed the literature to identify the types of reported reactions. In addition, we explored the pathophysiology contributing to these and proposed the mechanistic pathway with a showcase of actual cases.METHODS: We searched the literature for reports of reactions following cyanoacrylate glue use in patients with venous diseases between 2012 and 2022. The search was performed using Medical Subject Headings (MeSH) terms. The terms included cyanoacrylate, venous insufficiency, chronic venous disorder, varicose veins, vein varicosities, venous ulcer, venous wound, CEAP, vein, adverse events, phlebitis, hypersensitivity, foreign body granuloma, giant cell, endovenous glue induced thrombosis (EGIT), and allergy. The search was limited to the literature published in English. These studies were evaluated for the type of product used, and the reactions noted. A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, was performed. The COVIDENCE software was used for full-text screening and data extraction. Two reviewers reviewed the data, and the content expert served as the tiebreaker.RESULTS: One hundred and two records were identified, of which, thirty-seven records reported on cyanoacrylate use other than in the context of chronic venous diseases and were excluded. Fifty-five reports were determined appropriate for data extraction. The adverse reactions to cyanoacrylate glue were phlebitis, hypersensitivity, foreign body granuloma, and endovenous glue induced thrombosis (EGIT).CONCLUSIONS: Although cyanoacrylate glue closure for venous reflux is generally a safe and clinically effective treatment choice for symptomatic chronic venous disease patients with axial reflux, some adverse events may be specific to the properties of the cyanoacrylate product. We proposed mechanisms for how such reactions can occur based on histological changes, published reports, and case examples; however, further exploration is necessary to confirm these theories.

  View details for DOI 10.1016/j.jvsv.2023.03.018

  View details for PubMedID 37054883

• Therapeutic Drug Monitoring of Isavuconazole: Lessons Learnt from a Real-life Setting in a Tertiary Care Center in India. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine Prayag, P. S., Soman, R. N., Panchakshari, S. P., Ajapuje, P. S., Mahale, N. P., Dhupad, S., Patwardhan, S. A., Naik, S. S., Narawade, S., Athavale, A., Saseedharan, S., Melinkeri, S., Prayag, A. P. 2023; 27 (4): 260-264

  Abstract

  Isavuconazole is an emerging therapeutic option for invasive infections caused by molds, especially aspergillosis and mucormycosis. Isavuconazole has predictable pharmacokinetics and good bioavailability. These attributes have led to some doubts regarding the need for therapeutic drug monitoring (TDM). There are no data from India regarding TDM for isavuconazole.A retrospective analysis of 50 patients who received oral isavuconazole for therapeutic purposes. Plasma isavuconazole levels were measured using a reversed phase high-performance liquid chromatography (HPLC) and UV detector with acetonitrile (ACN) as protein precipitating solvent.Of the 50 cases, 5 (10.0%) patients had subtherapeutic levels, while 45 (90.0%) had therapeutic levels. Higher body weight and solid organ transplantation (SOT) were significantly associated with subtherapeutic levels of isavuconazole (p-value < 0.05 for all). Receipt of a SOT was the only independent and statistically significant factor which was associated with subtherapeutic levels of isavuconazole (p-value < 0.05).Our study reemphasizes the need of TDM for isavuconazole and adds to the growing evidence for the need to obtain drug levels. Factors associated with subtherapeutic levels of isavuconazole need to be assessed in larger studies to help identify those patients who are at risk of having subtherapeutic drug levels.Prayag PS, Soman RN, Panchakshari SP, Ajapuje PS, Mahale NP, Dhupad S, et al. Therapeutic Drug Monitoring of Isavuconazole: Lessons Learnt from a Real-life Setting in a Tertiary Care Center in India. Indian J Crit Care Med 2023;27(4):260-264.

  View details for DOI 10.5005/jp-journals-10071-24443

  View details for PubMedID 37378040

  View details for PubMedCentralID PMC10291642

• Daptomycin-Rifampin-Induced Rhabdomyolysis, Acute Renal Failure, and Hepatic Injury: A Case Report and Literature Review. Cureus Ganipisetti, V. M., Dudiki, N., Athavale, A., Bollimunta, P., Maringanti, B. S. 2023; 15 (3): e36834

  Abstract

  Daptomycin is a canonical antibiotic used very commonly in practice for its bactericidal activity against Gram-positive bacteria, including vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, bone infections, skin and soft tissue infections, meningitis, urinary tract infections, and endocarditis. Although daptomycin in conventional doses is usually well tolerated, it is paramount to be aware of the possible adverse effects. Daptomycin is reported to cause an elevation in creatine kinase levels, although frank rhabdomyolysis is rare. An even more infrequent occurrence is the simultaneous development of acute kidney injury and drug-induced liver injury with rhabdomyolysis. Daptomycin and rifampin combination are used for synergistic bactericidal action against MRSA. Still, data on the efficacy and safety of the combination is limited due to a lack of extensive studies. Herein, we present a clinical case of septic arthritis of a prosthetic knee, which resulted in bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) and subsequently led to infective endocarditis of the aortic valve. The patient was treated with a combination of daptomycin and rifampin, complicated by the development of rhabdomyolysis, acute kidney injury, and drug-induced liver injury. This case highlights the significance of timely recognizing adverse drug effects and identifying risk factors to ensure successful patient outcomes.

  View details for DOI 10.7759/cureus.36834

  View details for PubMedID 37009360

  View details for PubMedCentralID PMC10050791

• Concomitant Vitamin B1 and Vitamin B12 Deficiency Mimicking Thrombotic Thrombocytopenic Purpura. Cureus Ganipisetti, V. M., Bollimunta, P., Tun, N. N., Kanugula, A., Anil, V., Athavale, A., Maringanti, B. S. 2023; 15 (1): e34421

  Abstract

  Vitamin B12 deficiency-induced pseudo-thrombotic thrombocytopenic purpura (pseudo-TTP) is a rare condition. In reported literature, most cases were due to pernicious anemia (confirmed by the presence of anti-parietal cells or anti-intrinsic factor antibodies). Nutritional vitamin B12 deficiency causing pseudo-TTP is a much rarer entity. Differentiating thrombotic thrombocytopenic purpura (TTP) cases from pseudo-TTP (from any cause) should be done as soon as possible since the etiology, treatment, and outcome are different. Hematological findings from pseudo-TTP (when associated with vitamin B12 deficiency) respond to B12 replacement but do not respond to plasmapheresis. Neurological symptoms are one of the criteria for TTP, and altered mentation or psychosis in these cases is presumed secondary to either TTP or vitamin B12 deficiency. However, neurological symptoms are more characteristic of TTP rather than pseudo-TTP. In the rarer subsets of patients concerned with nutritional deficiency and neuropsychiatric symptoms, prompt consideration of concomitant vitamin B1 deficiency and Wernicke encephalopathy is essential. Immediate empiric treatment with high-dose IV thiamine should be started. If unrecognized and left untreated, thiamine deficiency can cause rapid progression to irreversible neurological symptoms, coma, and death, despite hematological improvement with B12 replacement. We report a rare case of concomitant vitamin B12 and vitamin B1 deficiency presenting with confusion, severe hemolytic anemia, acute renal failure, diarrhea, and thrombocytopenia mimicking TTP.

  View details for DOI 10.7759/cureus.34421

  View details for PubMedID 36726764

  View details for PubMedCentralID PMC9887457

• Post-Bariatric Surgery Hypoglycemia StatPearls Athavale, A., Ganipisetti, V. 2023
• Rare adverse event following cyanoacrylate closure of greater saphenous vein Athavale, A., Fukaya, E., Sassaki, V. S. SAGE PUBLICATIONS LTD. 2022: NP7-NP8

  View details for Web of Science ID 000923957000029

• Opportunistic infections in HIV Comprehensive Review of Infectious Diseases Cutrell, J., Athavale, A. 2020