Andrew C. Picel, MD, is a board-certified interventional radiologist who specializes in diagnosing and treating disease with minimally invasive image guided procedures. These imaging techniques include X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound.

Dr. Picel was one of the first physicians in the region to test a minimally invasive therapy to treat severe lower urinary tract symptoms related to benign prostate hyperplasia (BPH), called prostate artery embolization (PAE). This now FDA-approved treatment does not have the sexual side effects of transurethral resection of the prostate (TURP), the standard treatment for men who have not responded to medications and lifestyle modifications. He currently works closely with urologists to evaluate and treat patients with BPH.

Dr. Picel provides treatment for individuals with circulatory system diseases, such as peripheral arterial and venous disease. He performs numerous procedures for the treatment of venous insufficiency and varicose veins. These procedures commonly include endovenous ablation and sclerotherapy. Clinically, Dr. Picel also has a special interest in interventional oncology and performs TACE and TARE to treat patients with hepatocellular carcinoma (HCC). He also performs uterine fibroid embolization and occlusion balloon placement for invasive placenta.

An assistant professor in the Department of Radiology at Stanford University, Dr. Picel trains interventional radiology fellows and residents. His research interests focus on prostate artery embolization and pelvic embolization for invasive placenta.

Outside of work, Dr. Picel enjoys sailing, spending time with family, and traveling.

Clinical Focus

  • Vascular and Interventional Radiology

Academic Appointments

  • Clinical Associate Professor, Radiology

Administrative Appointments

  • IR Residency and Fellowship Program Director, UC San Diego (2018 - 2019)
  • Assistant Clinical Professor, UC San Diego (2015 - 2019)

Honors & Awards

  • RNSA Clinical Trials Methodology Workshop, Radiologic Society of North America (2019)
  • Academic Medicine Leadership Training Program, National Center of Leadership in Academic Medicine (2018)
  • Award for Excellence in Clinical Care, UC San Diego (2017)
  • JVIR Editorial Fellow, Journal of Vascular and Interventional Radiology (2017)
  • Academic Faculty Development Program, Association of University Radiologists (2016)
  • Award for Excellence in Clinical Care, UC San Diego (2015)
  • Chief Resident, UC San Diego Radiology (2014)

Professional Education

  • Residency: UCSD Dept of Radiology (2013) CA
  • Board Certification: American Board of Radiology, Interventional Radiology and Diagnostic Radiology (2017)
  • Fellowship: UCSD Vascular and Interventional Radiology Fellowship (2014) CA
  • Residency: UCSD Surgery Residency (2010) CA
  • Residency: University of Texas Medical Branch Radiology Residency (2009) TX
  • MD, UC San Diego, Radiology Residency and Interventional Radiology fellowship (2014)
  • Internship: UCSD Surgery Residency (2008) CA
  • MD, Wake Forest University School of Medicine, Medicine (2007)
  • Medical Education: Wake Forest University School of Medicine (2007) NC
  • 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

  • Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms in Prostate Cancer Patients Undergoing Radiation Therapy 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.

    View full details

  • 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.

    View full details

  • Genicular Artery Embolization (GAE) for Osteoarthritic Knee Pain Not 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.

    Stanford is currently not accepting patients for this trial. For more information, please contact Andrew C Picel, MD, 650-736-6109.

    View full details

All Publications

  • Commentary on "Safety of prostate artery embolization via transradial access versus transfemoral access". Journal of vascular and interventional radiology : JVIR McNamara, K. L., Picel, A. C. 2023

    View details for DOI 10.1016/j.jvir.2023.12.005

    View details for PubMedID 38103864

  • 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 Berman, Z. T., Boone, C. E., Melber, D. J., Ballas, J., Parikh, R., Ramos, G., Kelly, T., McHale, M., Picel, A. C., Roberts, A. C. 2023


    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

  • 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 McNamara, K., Picel, A. C. 2022

    View details for DOI 10.1007/s00270-022-03312-x

    View details for PubMedID 36348028

  • Commentary on "Prostatic Artery Embolization (PAE) Using Polyethylene Glycol Microspheres: Safety and Efficacy in 81 Patients". Cardiovascular and interventional radiology Zhan, C., Picel, A. C. 2022

    View details for DOI 10.1007/s00270-022-03211-1

    View details for PubMedID 35853954

  • Commentary on "Single-Center Retrospective Comparative Study Evaluating the Benefit of Computed Tomography Angiography Prior to Prostatic Artery Embolization". Cardiovascular and interventional radiology Zhan, C., Picel, A. C. 2022

    View details for DOI 10.1007/s00270-022-03150-x

    View details for PubMedID 35534730

  • Placenta Accreta Spectrum Treatment with Intraoperative Multivessel Embolization: The PASTIME Protocol. American journal of obstetrics and gynecology Melber, D. J., Berman, Z. T., Jacobs, M. B., Picel, A. C., Conturie, C. L., Zhang-Rutledge, K., Binder, P. S., Eskander, R. N., Roberts, A. C., Mchale, M. T., Ramos, G. A., Ballas, J., Kelly, T. F. 2021


    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

  • Placenta accreta spectrum treatment with intraoperative multivessel embolization to improve surgical outcomes: the PASTIME protocol Melber, D., Berman, Z., Jacobs, M., Picel, A., Conturie, C. L., Zhang-Rutledge, K., Parast, M., Binder, P., Eskander, R., Roberts, A., McHale, M., Ramos, G. A., Ballas, J., Kelly, T. MOSBY-ELSEVIER. 2021: S214–S215
  • CT-guided Reflector Localization of a Previously Positive Axillary Lymph Node after Neoadjuvant Chemotherapy in a Breast Cancer Patient JOURNAL OF BREAST IMAGING Kozlov, A. N., Picel, A. 2020; 2 (6): 633–34
  • Outcomes of balloon occlusion in the University of California Morbidly Adherent Placenta Registry. American journal of obstetrics & gynecology MFM Lee, A. Y., Ballah, D., Moreno, I., Dong, P. R., Cochran, R., Picel, A., Lee, E. W., Moriarty, J., Padgett, M., Nelson, K., Kohi, M. P. 2020; 2 (1): 100065


    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

  • Subcapsular hematoma resulting in hepatic ischemia as a complication of necrotizing pancreatitis. Radiology case reports Duncan, D. P., Briese, A. K., Niemiec, S. n., White, R. n., Picel, A. C., Hahn, M. E. 2020; 15 (4): 316–20


    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

  • Arterial Anatomy for Prostatic Artery Embolization PROSTATIC ARTERY EMBOLIZATION Hoque, M. M., Cabatingan, K., Mittal, S., Picel, A., Isaacson, A. J., Isaacson, A. J., Bagla, S., Raynor, M. C., Yu, H. 2020: 83–92
  • 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 Picel, A. C., Hsieh, T. C., Shapiro, R. M., Vezeridis, A. M., Isaacson, A. J. 2019: 180195


    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

  • 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 Schooley, R. T., Biswas, B., Gill, J. J., Hernandez-Morales, A., Lancaster, J., Lessor, L., Barr, J. J., Reed, S. L., Rohwer, F., Benler, S., Segall, A. M., Taplitz, R., Smith, D. M., Kerr, K., Kumaraswamy, M., Nizet, V., Lin, L., McCauley, M. D., Strathdee, S. A., Benson, C. A., Pope, R. K., Leroux, B. M., Picel, A. C., Mateczun, A. J., Cilwa, K. E., Regeimbal, J. M., Estrella, L. A., Wolfe, D. M., Henry, M. S., Quinones, J., Salka, S., Bishop-Lilly, K. A., Young, R., Hamilton, T. 2018; 62 (12)

    View details for PubMedID 30478181

  • Endovascular Management of a Large Persistent Sciatic Artery Aneurysm Inui, T. S., Picel, A. C., Barleben, A., Lane, J. S. ELSEVIER SCIENCE INC. 2018: 312.e13–312.e16


    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

  • Needle localization of small pulmonary nodules: Lessons learned JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Thistlethwaite, P. A., Gower, J. R., Hernandez, M., Zhang, Y., Picel, A. C., Roberts, A. C. 2018; 155 (5): 2140–47


    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

  • Prophylactic Internal Iliac Artery Occlusion Balloon Placement to Reduce Operative Blood Loss in Patients with Invasive Placenta JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Picel, A. C., Wolford, B., Cochran, R. L., Ramos, G. A., Roberts, A. C. 2018; 29 (2): 219–24


    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

  • Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection ANTIMICROBIAL AGENTS AND CHEMOTHERAPY Schooley, R. T., Biswas, B., Gill, J. J., Hernandez-Morales, A., Lancaster, J., Lessor, L., Barr, J. J., Reed, S. L., Rohwer, F., Benler, S., Segall, A. M., Taplitz, R., Smith, D. M., Kerr, K., Kumaraswamy, M., Nizet, V., Lin, L., McCauley, M. D., Strathdee, S. A., Benson, C. A., Pope, R. K., Leroux, B. M., Picel, A. C., Mateczun, A. J., Cilwa, K. E., Regeimbal, J. M., Estrella, L. A., Wolfe, D. M., Henry, M. S., Quinones, J., Salka, S., Bishop-Lilly, K. A., Young, R., Hamilton, T. 2017; 61 (10)


    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

  • 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 Kao, S. D., Morshedi, M. M., Narsinh, K. H., Kinney, T. B., Minocha, J., Picel, A. C., Newton, I., Rose, S. C., Roberts, A. C., Kuo, A., Aryafar, H. 2016; 27 (8): 1148–53


    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

  • Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY Picel, A. C., Koo, S. J., Roberts, A. C. 2016; 39 (8): 1170–76


    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

  • May-Thurner Syndrome and Horseshoe Kidney JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Nwoke, F., Picel, A. C. 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

  • Foreign Body Ingestion Resulting in Hydronephrosis JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Ramaswamy, R. S., Picel, A. C. 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

  • Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm with Arteriovenous Fistula and Duplication of the Inferior Vena Cava JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Picel, A. C., Lane, J. S. 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

  • Essentials of Endovascular Abdominal Aortic Aneurysm Repair Imaging: Preprocedural Assessment AMERICAN JOURNAL OF ROENTGENOLOGY Picel, A. C., Kansal, N. 2014; 203 (4): W347–W357


    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

  • Essentials of Endovascular Abdominal Aortic Aneurysm Repair Imaging: Postprocedure Surveillance and Complications AMERICAN JOURNAL OF ROENTGENOLOGY Picel, A. C., Kansal, N. 2014; 203 (4): W358–W372


    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

  • 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 Picel, A. C., Davidson, T. M. 2011; 90 (1): 29–31


    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