Bio
Dr. Picel is a fellowship-trained, board-certified interventional radiologist at Stanford Health Care. He is also clinical associate professor in the Department of Radiology, Division of Interventional Radiology at Stanford University School of Medicine.
Dr. Picel specializes in diagnosing and treating disease with minimally invasive, image-guided procedures. His expertise includes treating liver tumors, benign prostatic hyperplasia, osteoarthritis, portal hypertension, chronic venous disease, uterine fibroids, pulmonary embolism, and varicose veins.
Dr. Picel’s research interests include using embolization, a nonsurgical procedure that decreases blood loss, for patients with benign prostatic hyperplasia. He also studies new embolic materials and procedures to treat invasive placenta, chronic venous disease, portal hypertension, pulmonary embolism, and osteoarthritis.
Dr. Picel has published in many peer-reviewed journals, including the Journal of Vascular and Interventional Radiology, RadioGraphics, and the American Journal of Obstetrics & Gynecology. He has won multiple awards as a reviewer for the Journal of Vascular and Interventional Radiology. He also serves on the editorial board of the journal CardioVascular and Interventional Radiology. Dr. Picel has delivered lectures across the county and worldwide on various interventional radiology topics.
Dr. Picel is a member of the Society of Interventional Radiology standards committee and the maintenance of certification committee for the American Board of Radiology and Associate Program Director for the Interventional Radiology Residency.
Clinical Focus
- Vascular and Interventional Radiology
Academic Appointments
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Clinical Associate Professor, Radiology
Administrative Appointments
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IR Residency and Fellowship Program Director, UC San Diego (2018 - 2019)
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Assistant Clinical Professor, UC San Diego (2015 - 2019)
Honors & Awards
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Biodesign Faculty Fellowship, Stanford University School of Medicine
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Certificate of Merit for Educational Presentation, Cardiovascular and Interventional Radiological Society of Europe
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Lifetime Centurion Reviewer, Journal of Vascular and Interventional Radiology
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National Institutes of Health (NIH) Student Summer Research Fellowship, Wake Forest University School of Medicine
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Top Reviewer Award, Journal of Vascular and Interventional Radiology
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RNSA Clinical Trials Methodology Workshop, Radiologic Society of North America (2019)
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Academic Medicine Leadership Training Program, National Center of Leadership in Academic Medicine (2018)
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Award for Excellence in Clinical Care, UC San Diego (2017)
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JVIR Editorial Fellow, Journal of Vascular and Interventional Radiology (2017)
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Academic Faculty Development Program, Association of University Radiologists (2016)
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Award for Excellence in Clinical Care, UC San Diego (2015)
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Chief Resident, UC San Diego Radiology (2014)
Professional Education
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Board Certification: American Board of Radiology, Interventional Radiology and Diagnostic Radiology (2017)
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Fellowship: UCSD Vascular and Interventional Radiology Fellowship (2014) CA
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Residency: UCSD Dept of Radiology (2013) CA
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Residency: UCSD Surgery Residency (2010) CA
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Residency: University of Texas Medical Branch Radiology Residency (2009) TX
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MD, UC San Diego, Radiology Residency and Interventional Radiology fellowship (2014)
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Internship: UCSD Surgery Residency (2008) CA
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MD, Wake Forest University School of Medicine, Medicine (2007)
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Medical Education: Wake Forest University School of Medicine (2007) NC
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BS, University of Georgia, Mathematics, Biology (2002)
Current Research and Scholarly Interests
Prostate artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH).
Prophylactic balloon occlusion catheters and uterine artery embolization to reduce blood loss in patients with invasive placenta.
Geniculate artery embolization for relief of osteoarthritis related knee pain.
Clinical Trials
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Genicular Artery Embolization (GAE) for Osteoarthritic Knee Pain
Recruiting
The objective of this investigation is to evaluate the safety of the geniculate artery embolization (GAE) procedure with HydroPearl® Microspheres in 30 patients with knee pain caused by osteoarthritis with 24 months follow-up. The GAE procedure is an arterial embolization procedure that blocks abnormal blood vessels caused be knee arthritis in order to evaluate the effect on knee pain.
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A Humanitarian Device Exemption Treatment Protocol of TheraSphere For Treatment of Unresectable Hepatocellular Carcinoma
Not Recruiting
To provide Therasphere treatment for patients diagnosed with unresectable liver cancer.
Stanford is currently not accepting patients for this trial. For more information, please contact Amy Macke, 650-723-0728.
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Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms in Prostate Cancer Patients Undergoing Radiation Therapy
Not Recruiting
The purpose of this study is to learn if the prostatic artery embolization procedure can reduce urinary tract symptoms in patients with enlarged prostates and prostate cancer.
Stanford is currently not accepting patients for this trial. For more information, please contact Brittney Williams, 650-736-3688.
All Publications
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Commentary on "Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study".
Cardiovascular and interventional radiology
2024
View details for DOI 10.1007/s00270-024-03885-9
View details for PubMedID 39461906
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Percutaneous Cryoneurolysis for Pain Control After Rib Fractures in Older Adults.
JAMA surgery
2024
View details for DOI 10.1001/jamasurg.2024.2063
View details for PubMedID 39110467
View details for PubMedCentralID PMC11307162
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Commentary on "Safety of prostate artery embolization via transradial access versus transfemoral access".
Journal of vascular and interventional radiology : JVIR
2023
View details for DOI 10.1016/j.jvir.2023.12.005
View details for PubMedID 38103864
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Intra-Operative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement During Cesarean Hysterectomy for Placenta Accreta Spectrum.
Journal of vascular and interventional radiology : JVIR
2023
Abstract
To evaluate efficacy and safety of prophylactic multivessel vessel embolization (MVE) compared to internal iliac artery occlusion balloon (IIABO) placement for patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS).An IRB approved retrospective series was performed of consecutive patients with PAS at a single institution between 2010-2021. MVE was performed in a hybrid operating room after cesarean section prior to hysterectomy. IIABO was performed with balloons placed into the bilateral internal iliac arteries which were inflated during hysterectomy. Median blood loss, transfusion requirements, percentage of cases requiring a transfusion, and adverse events were recorded.A total of 20 patients treated with embolization and 34 patients with balloons were included. Placenta percreta and previa were seen in 60% and 90% of patients, respectively. Median blood loss was 713 mL (interquartile range, 475 - 1000) with MVE compared to 2000 mL (1500- 2425) in the IIABO group (P < .0001). The median total number of units of packed red blood cell transfusions (0 vs 2.5) and the percentage of cases requiring a transfusion (20 vs 65%) were less in the MVE group (P < 0.01). A median of 4 vessels (3-9) were embolized during MVE. No major complications or non-target embolization consequences were observed.Prophylactic multi vessel embolization is a safe procedure which reduces operative blood loss and transfusion requirements compared to IIABO in patients undergoing cesarean hysterectomy for presumed higher degree PAS.
View details for DOI 10.1016/j.jvir.2023.07.024
View details for PubMedID 37527770
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Commentary on "Long-Term Efficacy and Recurrence Prediction of Prostatic Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia" Xu X, et al. CVIR 2022.
Cardiovascular and interventional radiology
2022
View details for DOI 10.1007/s00270-022-03312-x
View details for PubMedID 36348028
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Commentary on "Prostatic Artery Embolization (PAE) Using Polyethylene Glycol Microspheres: Safety and Efficacy in 81 Patients".
Cardiovascular and interventional radiology
2022
View details for DOI 10.1007/s00270-022-03211-1
View details for PubMedID 35853954
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Commentary on "Single-Center Retrospective Comparative Study Evaluating the Benefit of Computed Tomography Angiography Prior to Prostatic Artery Embolization".
Cardiovascular and interventional radiology
2022
View details for DOI 10.1007/s00270-022-03150-x
View details for PubMedID 35534730
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Placenta Accreta Spectrum Treatment with Intraoperative Multivessel Embolization: The PASTIME Protocol.
American journal of obstetrics and gynecology
2021
Abstract
BACKGROUND: Multidisciplinary care for placenta accreta spectrum (PAS) improves pregnancy outcomes, but the specific components of such multidisciplinary collaboration varies between institutions. As experience with PAS increases, assessing new surgical techniques and protocols is crucial to help improve maternal outcomes and to advocate for hospital resources.OBJECTIVE: To assess a novel multidisciplinary protocol for the treatment of PAS that involves cesarean delivery, multivessel uterine embolization (MVE), and hysterectomy as a single procedure within a hybrid operative suite.STUDY DESIGN: This was a matched pre-post study of PAS cases managed before (2010-2017) and after implementation of the PASTIME protocol (2018-2021) at a tertiary medical center. Historical cases were previously managed with internal iliac artery balloon placement in select cases, with the decision to inflate the balloons intraoperatively at the discretion of the primary surgeon. PASTIME cases were compared to historical cases in a 1:2 ratio matched on PAS severity and surgical urgency. The primary outcome was transfusion requirement of packed red blood cells (PRBC). Secondary outcomes included: surgical estimated blood loss (EBL), operative and postoperative complications, procedural time, length of stay (LOS), and neonatal outcomes.RESULTS: Fifteen PASTIME cases and 30 matched historical cases were included for analysis. No significant demographic differences were noted between groups. A median [interquartile range] of 0 [0-2] units PRBC were transfused in the PASTIME group compared to 2 [0-4.5] units in the historical group (p = 0.045) with 5 of 15 (33.3%) PASTIME cases requiring blood transfusion as compared to 19/30 (63.3%) in the historical group (p = 0.11). EBL was significantly lower in the PASTIME group with a median [interquartile range] of 750 mL [450-1,050] compared to 1,750 mL [1,050-2,500] in the historical group (p = 0.003). There were no cases of massive transfusion (> 10 red blood cell units in 24 hours) in the PASTIME group, compared to 5/30 (16.7%) in the historical group (p=0.15). There were no intra-operative deaths from hemorrhagic shock using the PASTIME protocol, while this occurred in 2 historical cases. Mean duration of interventional radiology (IR) procedure time was longer in the PASTIME group (67.8 vs 34.1 minutes, p=0.002). Intensive care unit (ICU) and postpartum length of stay were similar, and surgical and post-operative complications were not significantly different between groups. Gestational age and neonatal birth weights were similar, however neonatal length of stay was longer in the PASTIME group (median duration 32 days vs 15 days, p = 0.02) with a trend towards low APGAR scores. Arterial cord blood pH < 7.2, respiratory distress syndrome, and intubation rates were not statistically different.CONCLUSIONS: A multidisciplinary pathway including a single-surgery protocol with multivessel uterine embolization is associated with a decrease in blood transfusion requirements and EBL with no increase in operative complications. The PASTIME protocol provides a definitive surgical method that warrants consideration by other centers specializing in PAS treatment.
View details for DOI 10.1016/j.ajog.2021.07.001
View details for PubMedID 34245679
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Placenta accreta spectrum treatment with intraoperative multivessel embolization to improve surgical outcomes: the PASTIME protocol
MOSBY-ELSEVIER. 2021: S214–S215
View details for Web of Science ID 000621547400325
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CT-guided Reflector Localization of a Previously Positive Axillary Lymph Node after Neoadjuvant Chemotherapy in a Breast Cancer Patient
JOURNAL OF BREAST IMAGING
2020; 2 (6): 633–34
View details for DOI 10.1093/jbi/wbaa049
View details for Web of Science ID 000604372300022
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Outcomes of balloon occlusion in the University of California Morbidly Adherent Placenta Registry.
American journal of obstetrics & gynecology MFM
2020; 2 (1): 100065
Abstract
BACKGROUND: Morbidly adherent placenta, also known as placenta accreta spectrum, is associated with severe maternal morbidity and mortality. Multiple adjunctive procedures have been proposed to improve outcomes, and at many institutions, interventional radiologists will play a role in assisting obstetricians in these cases.OBJECTIVE: The objective of the study was to evaluate the outcomes of women with morbidly adherent placenta who underwent cesarean hysterectomy with aortic balloon occlusion or internal iliac artery balloon occlusion catheters, compared with cesarean hysterectomy with surgical ligation of the iliac arteries, or cesarean hysterectomy without adjunctive procedures.STUDY DESIGN: A retrospective review of women with morbidly adherent placenta treated with cesarean hysterectomy was performed at 5 institutions from May 2014 to April 2018. The balloon occlusion group had either prophylactic aortic or iliac balloons placed prior to cesarean hysterectomy. Comparison groups included those who underwent internal iliac artery ligation prior to hysterectomy or a control group if they underwent cesarean hysterectomy without adjuvant procedures. Evaluated outcomes include estimated blood loss, transfusion requirements, intensive care unit admission, and adverse event rates.RESULTS: There were 171 women with morbidly adherent placenta included in the study. Twenty-eight had balloon placement prior to cesarean hysterectomy, 18 had intraoperative internal iliac artery ligation, and there were 125 control women who underwent cesarean hysterectomy without any adjunctive procedures. Compared with the women who underwent cesarean hysterectomy without adjunctive procedures, women who underwent aortic or iliac artery balloon occlusion prior to hysterectomy had significantly lower estimated blood loss (30.9% decrease, P < .001), transfusion requirements (76.8% decrease, P < .001), intensive care unit admission rates (0% vs 15.2%, P < .001), and intensive care unit stay lengths (0.0 vs 3.1 days, P < .001). Compared with women who underwent surgical ligation of the internal iliac arteries prior to hysterectomy, women who underwent aortic or iliac artery balloon occlusion prior to cesarean hysterectomy had lower estimated blood loss (54.2% decrease, P < .01), transfusion requirements (90.5% decrease, P < .001), operating room times (40.0% decrease, P < .01), intensive care unit admissions rates (0% vs 77.8%, P < .001), intensive care unit stay lengths (0.0 vs 1.4 days, P < .001), and adverse events (3.6% vs 44.4%, P < .01).CONCLUSION: Aortic and iliac artery balloon occlusion are associated with lower estimated blood loss, transfusion requirements, intensive care unit admission rates, and adverse event rates compared with women who underwent internal iliac artery ligation prior to cesarean hysterectomy or women who had no adjunctive interventions prior to cesarean hysterectomy for morbidly adherent placenta.
View details for DOI 10.1016/j.ajogmf.2019.100065
View details for PubMedID 33345981
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Subcapsular hematoma resulting in hepatic ischemia as a complication of necrotizing pancreatitis.
Radiology case reports
2020; 15 (4): 316–20
Abstract
This report presents a case of necrotizing pancreatitis resulting in a large hepatic subcapsular hematoma that led to development of hepatic ischemia and early stages of liver failure. Following surgical decompression, liver function dramatically improved, but large areas of peripheral hepatic infarction had developed. This case demonstrates the risks of a rapidly expanding hepatic subcapsular hematoma, emphasizes the importance of recognizing and aggressively treating active bleeding, and cautions against administering anticoagulation and tissue-plasminogen activator in this clinical scenario.
View details for DOI 10.1016/j.radcr.2019.12.021
View details for PubMedID 31988681
View details for PubMedCentralID PMC6971341
- Prostatic artery anatomy and embolization for benign prostatic hyperplasia Multimodality Vascular Imaging: From Head to Toe 2020
- Physiology of Y90 radioembolization Image-Guided Interventions in Oncology 2020
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Arterial Anatomy for Prostatic Artery Embolization
PROSTATIC ARTERY EMBOLIZATION
2020: 83–92
View details for DOI 10.1007/978-3-030-23471-3_7
View details for Web of Science ID 000553471700008
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Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment.
Radiographics : a review publication of the Radiological Society of North America, Inc
2019: 180195
Abstract
Symptomatic benign prostatic hyperplasia is a common condition in the aging population that results in bothersome lower urinary tract symptoms and decreased quality of life. Patients often are treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is considered the traditional standard of care, but several minimally invasive surgical treatments also are offered. Prostatic artery embolization (PAE) is emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalization. The procedure is offered to patients with moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolization are critical to optimize results. To perform PAE safely and avoid nontarget embolization, interventional radiologists must have a detailed understanding of the pelvic arterial anatomy. Although the prostatic arteries often arise from the internal pudendal arteries, several anatomic variants and pelvic anastomoses are encountered. Prospective cohort studies, small randomized controlled trials, and meta-analyses have shown improved symptoms after treatment, with serious adverse effects occurring rarely. This article reviews the basic principles of PAE that must be understood to develop a thriving PAE practice. These principles include patient evaluation, review of surgical therapies, details of pelvic arterial anatomy, basic principles of embolization, and an overview of published results. Online supplemental material is available for this article.©RSNA, 2019.
View details for DOI 10.1148/rg.2019180195
View details for PubMedID 31348735
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Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection (vol 61, e00954-17, 2017)
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
2018; 62 (12)
View details for PubMedID 30478181
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Endovascular Management of a Large Persistent Sciatic Artery Aneurysm
ELSEVIER SCIENCE INC. 2018: 312.e13–312.e16
Abstract
The persistent sciatic artery (PSA) is a remnant of the fetal circulatory system that is preserved in less than 0.1% of the population. Up to 60% of patients with this vascular anomaly will go on to development of a PSA aneurysm (PSAA), which can produce a variety of symptoms including neuropathy, claudication, and acute limb-threatening ischemia. Historical management is by open operation and interposition grafting, which can be highly morbid. We describe successful management of a large, symptomatic PSAA by endovascular stent grafting with intermediate term follow-up.
View details for DOI 10.1016/j.avsg.2018.03.003
View details for Web of Science ID 000443980600041
View details for PubMedID 29772318
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Needle localization of small pulmonary nodules: Lessons learned
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
2018; 155 (5): 2140–47
Abstract
Lung nodules that are small and deep within lung parenchyma, and have semisolid characteristics are often challenging to localize with video-assisted thoracoscopic surgery (VATS). We describe our cumulative experience using needle localization of small nodules before surgical resection. We report procedural tips, operative results, and lessons learned over time.A retrospective review of all needle localization cases between July 1, 2006, and December 30, 2016, at a single institution was performed. A total of 253 patients who underwent needle localization of lung nodules ranging from 0.6 to 1.2 cm before operation were enrolled. Nodules were localized by placing two 20-gauge Hawkins III coaxial needles from different trajectories with tips adjacent to the nodule, injection of 0.3 to 0.6 mL of methylene blue, and deployment of 2 hookwires, under computed tomography guidance. Patients then underwent VATS wedge resection for diagnosis, followed by anatomic resection for lung carcinoma. Procedural and perioperative outcomes were assessed.Needle localization was successful in 245 patients (96.8%). Failures included both wires falling out of lung parenchyma before operation (5 patients), wire migration (2 patients), and bleeding resulting in hematoma requiring transfusion (1 patient). The most common complication of needle localization was asymptomatic pneumothorax (11/253 total patients; 4.3%) and was higher in patients with bullous emphysema (9/35 patients; 25.7%). Of the 8 individuals who had unsuccessful needle localization, 7 had successful wedge resection in the area of methylene blue injection that included the nodule; 1 required segmentectomy for diagnosis. Completion lobectomy (154 VATS, 2 minithoracotomies) or VATS segmentectomy (18 patients) was performed in 174 individuals with a diagnosis of non-small cell carcinoma or carcinoid. The average length of hospital stay was 1.4 days for wedge resection, 1.9 days for VATS segmentectomy, 3.1 days for VATS lobectomy, and 4.9 days for minithoracotomy. Perioperative survival was 100%.Needle localization with hookwire deployment and methylene blue injection is a safe and feasible strategy to localize small, deep lung nodules for wedge resection and diagnosis. Multidisciplinary coordination between the thoracic surgeon and the interventional radiologist is key to the success of this procedure.
View details for DOI 10.1016/j.jtcvs.2018.01.007
View details for Web of Science ID 000430195900067
View details for PubMedID 29455962
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Prophylactic Internal Iliac Artery Occlusion Balloon Placement to Reduce Operative Blood Loss in Patients with Invasive Placenta
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
2018; 29 (2): 219–24
Abstract
To evaluate efficacy and safety of prophylactic internal iliac occlusion balloon placement before cesarean hysterectomy for invasive placenta.A retrospective analysis was performed of patients with invasive placenta treated with and without occlusion balloon placement. Preoperative occlusion balloons were placed in 90 patients; 61 patients were treated without balloon placement (control group). Baseline demographics, including patient age, gestational age at delivery, gravidity, parity, and number of previous cesarean sections, were not significantly different (P > .05). Of the balloon placement group, 56% had placenta percreta compared with 25% in the control group (P < .001), and 83% had placenta previa compared with 66% in the control group (P = .012).Median blood loss was 2 L (range, 1.5-2.5 L) in the balloon placement group versus 2.5 L (range, 2-4 L) in the control group (P = .002). Patients with occlusion balloons were transfused a median of 2 U (range, 0-5 U) of packed red blood cells versus 5 U (range, 2-8 U) in patients in the control group (P = .002). In the balloon placement group, 34% had large volume blood loss > 2,500 mL versus 61% in the control group (P = .001), and 21% required blood transfusion > 6 U versus 44% in the control group (P = .002). Eight complications (9%) were attributed to occlusion balloon placement.Prophylactic internal iliac artery occlusion balloon placement reduces operative blood loss and transfusion requirements in patients undergoing hysterectomy for invasive placenta.
View details for PubMedID 29128157
- Uterine fibroid embolization in a patient with lupus and previous venous thromboembolism Endovascular Today 2018
- Treating postpartum hemorrhage and invasive placenta Endovascular Today 2018
- Endovascular treatment of pelvic congestion syndrom Endovascular Today 2018
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Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
2017; 61 (10)
Abstract
Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including Acinetobacter baumannii We report on a method used to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR A. baumannii infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an A. baumannii isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the A. baumannii infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted.
View details for PubMedID 28807909
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Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
2016; 27 (8): 1148–53
Abstract
To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS).Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded.The two groups were well matched by sex, age, etiology of liver disease, Child-Pugh class, Model for End-Stage Liver Disease scores, and indication for TIPS (P range = .19-.94). Fewer intrahepatic needle passes were required in intravascular US-guided TIPS creation compared with conventional TIPS (2 passes vs 6 passes, P < .01). Less iodinated contrast material was used in intravascular US cases (57 mL vs 140 mL, P < .01). Radiation exposure, as measured by cumulative dose, dose area product, and fluoroscopy time, was reduced with intravascular US (174 mGy vs 981 mGy, P < .01; 3,793 μGy * m(2) vs 21,414 μGy * m(2), P < .01; 19 min vs 34 min, P < .01). Procedure time was shortened with intravascular US (86 min vs 125 min, P < .01).Intravascular US guidance resulted in fewer intrahepatic needle passes, decreased contrast medium usage, decreased radiation dosage, and shortened procedure time in TIPS creation.
View details for PubMedID 27052948
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Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations
CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
2016; 39 (8): 1170–76
Abstract
The purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs).A retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %).Embolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization.TAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.
View details for PubMedID 27021069
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May-Thurner Syndrome and Horseshoe Kidney
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
2016; 27 (3): 369
View details for DOI 10.1016/j.jvir.2015.11.049
View details for Web of Science ID 000372855700009
View details for PubMedID 26916939
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Foreign Body Ingestion Resulting in Hydronephrosis
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
2015; 26 (5): 679
View details for DOI 10.1016/j.jvir.2014.11.022
View details for Web of Science ID 000354504000008
View details for PubMedID 25636668
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Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm with Arteriovenous Fistula and Duplication of the Inferior Vena Cava
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
2014; 25 (12): 1901–2
View details for DOI 10.1016/j.jvir.2014.08.017
View details for Web of Science ID 000345676700010
View details for PubMedID 25457139
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Essentials of Endovascular Abdominal Aortic Aneurysm Repair Imaging: Preprocedural Assessment
AMERICAN JOURNAL OF ROENTGENOLOGY
2014; 203 (4): W347–W357
Abstract
To understand the abdominal aortic aneurysm imaging characteristics that must be accurately described for endovascular aortic aneurysm repair treatment planning, including evaluation of the landing zones, aneurysm morphology, and vascular access..A comprehensive understanding of preprocedural imaging is necessary to produce detailed and clinically useful imaging reports and assist the interventionalist in planning endovascular abdominal aortic aneurysm repair.
View details for PubMedID 25247964
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Essentials of Endovascular Abdominal Aortic Aneurysm Repair Imaging: Postprocedure Surveillance and Complications
AMERICAN JOURNAL OF ROENTGENOLOGY
2014; 203 (4): W358–W372
Abstract
Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure.A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.
View details for PubMedID 25247965
- Pericarditis, Superior vena cava syndrome, Congestive heart failure, Aortic stenosis, and Mitral stenosis Clinical Decision Support: Imaging 2012
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An aberrant internal carotid artery discovered during evaluation of obstructive sleep apnea: A report of 2 cases with consideration of a possible association
ENT-EAR NOSE & THROAT JOURNAL
2011; 90 (1): 29–31
Abstract
Obstructive sleep apnea (OSA) is often associated with reduced pharyngeal muscle tone and an anatomically narrowed pharyngeal airspace. We describe 2 cases of aberrant internal carotid arteries that were diagnosed during evaluations of patients with suspected OSA. It is possible that these anatomic anomalies contributed to airspace narrowing in these patients. These 2 cases represent an interesting presentation of sleep apnea, and they provide a reminder of the importance of clinically recognizing carotid artery aberrations in order to avoid arterial damage during routine oropharyngeal procedures.
View details for PubMedID 21229508
- Polyarteritis Nodosa Diagnostic Imaging: Cardiovascular 2008
- Renal Artery Aneurysm Diagnostic Imaging: Cardiovascular 2008
- High-Flow Priapism Diagnostic Imaging: Cardiovascular 2008
- Fibromuscular Dysplasia Extremity Diagnostic Imaging: Cardiovascular 2008
- Ergotism Diagnostic Imaging: Cardiovascular 2008