Clinical Focus


  • Vascular and Endovascular Surgery
  • Residency

Academic Appointments


Professional Education


  • MD, Yale School of Medicine, Doctor of Medicine (2020)
  • MHS, Yale School of Medicine, Translational Research (2020)
  • MS, Yale Graduate School of Arts and Sciences, Molecular Biology (2015)
  • BS, Yale College, Molecular, Cellular and Developmental Biology (2015)

All Publications


  • Endovascular retrieval of an entrapped balloon in a tibial artery. Journal of vascular surgery cases and innovative techniques Fereydooni, A., Chandra, V., George, E. L. 2024; 10 (3): 101459

    Abstract

    Balloon entrapment is a rare complication of angioplasty in calcified or recalcitrant lesions. A 65-year-old man with chronic limb-threatening ischemia underwent balloon angioplasty of his heavily calcified tibial arteries with a low-profile, tapered, compliant balloon. The balloon became entrapped within the posterior tibial artery and required multiple endovascular maneuvers to deflate and separate the balloon from the calcified arterial wall. This case report describes several adjunctive techniques for retrieval of an entrapped balloon in small, calcified arteries before consideration of surgical removal. These techniques allow for minimally invasive retrieval and continuation of endovascular treatment thereafter.

    View details for DOI 10.1016/j.jvscit.2024.101459

    View details for PubMedID 38591015

    View details for PubMedCentralID PMC10999707

  • Management of thoracic outlet syndrome in patients with hemodialysis access. Seminars in vascular surgery Fereydooni, A., Sgroi, M. D. 2024; 37 (1): 50-56

    Abstract

    Patients with threatened arteriovenous access are often found to have central venous stenoses at the ipsilateral costoclavicular junction, which may be resistant to endovascular intervention. Stenoses in this location may not resolve unless surgical decompression of thoracic outlet is performed to relieve the extrinsic compression on the subclavian vein. The authors reviewed the management of dialysis patients with central venous lesions at the thoracic outlet, as well as the role of surgical decompression with first-rib resection or claviculectomy for salvage of threatened, ipsilateral dialysis access.

    View details for DOI 10.1053/j.semvascsurg.2024.01.004

    View details for PubMedID 38704184

  • Impact of Integrated Vascular Surgery Residency Training Pathway and Professional Development Time on Career Choice and Research Productivity. Journal of surgical education Fereydooni, A., Fisher, A. T., Mullis, D. M., Smith, B. K., Sgroi, M. D. 2023

    Abstract

    The limited availability of academic surgery positions has led to increased competition for these jobs. Integrated vascular surgery residency (IVSR) allows for earlier specialization, with some programs providing professional development time (PDT). We hypothesized that IVSR and PDT lead to academic employment and increased research productivity.This is a retrospective study of vascular surgery fellowship (VSF) and IVSR graduates.Training, number of publications, H-index, NIH funding, and employment history were collected using institutional websites, Doximity, Scopus, PubMed, and NIH Research Portfolio Reporting.After a review of the research protocol, the Association of Program Directors in Vascular Surgery (APDVS) provided a list of vascular surgery fellowship (VSF) and IVSR graduates.After review of the research protocol, the Association of Program Directors in Vascular Surgery (APDVS) provided a list of vascular surgery fellowship (VSF) and IVSR graduates. Training, number of publications, H-index, NIH funding, and employment history were collected using institutional websites, Doximity, Scopus, PubMed, and NIH Research Portfolio Reporting.From 2013-2017, comparison of IVSR (n=131) to VSF (n=603) graduates showed that IVSR graduates were more likely to be women (38.17% vs 28.19%; p = 0.024), be MD graduates (99.24% vs 93.37%; p = 0.008), attended programs in the northeast (41.98% vs 27.5%; p < 0.001), have advanced degrees (13.74% vs 6.97%; p = 0.01) and graduate from larger programs (median 15 vs 14 faculty; p = 0.013). There was no significant difference in number of publications per trainee by the end of training (median 4 vs 3; P=0.61) or annual trend in average number of publications. After training, there was no significant difference in the type of practice, academic affiliation, practice region, publication number, H-index, NIH funding, level of academic appointment, or leadership positions. From 2013-2019, a comparison of IVSR graduates with (n=32) and without PDT (n=190) demonstrated that those with PDT were more likely to be women (53.13% vs 34.74%; p = 0.038), have advanced degrees (28.12% vs 8.95%; p = 0.002), be at larger programs (median 14 vs 9 faculty; p < 0.001), train at a top 10 NIH funded program (65.62% vs 21.58%; p < 0.001) and publish more by the end of IVSR (median 9 vs 3; p < 0.001). Graduates with PDT were more likely to have academic employment and affiliation, a higher yearly publication rate, and greater H-index.IVSR and VSF graduates have comparable academic employment and research productivity. However, PDT during IVSR correlates with an eventual academic career and greater research productivity. This study supports the importance of PDT in developing academic vascular surgeons. It remains necessary to continue both IVSR and VSF training paradigms as healthcare needs of the population are met through both academic and non-academic surgeons.

    View details for DOI 10.1016/j.jsurg.2023.10.009

    View details for PubMedID 38105151

  • Serration Angioplasty Is Associated With Less Recoil in Infrapopliteal Arteries Compared With Plain Balloon Angioplasty. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists Fereydooni, A., Chandra, V., Schneider, P. A., Giasolli, R., Lichtenberg, M., Stahlhoff, S. 2023: 15266028231215284

    Abstract

    Recoil following balloon angioplasty of tibial arteries is a known mechanism of lumen loss and widely considered to be a contributing factor in early failure or later restenosis. The Serranator balloon has been designed to provide a controlled lumen gain while minimizing vessel injury. The objective of this study was to assess the ability to define and measure postangioplasty recoil in infrapopliteal arteries and to compare recoil after serration angioplasty and plain balloon angioplasty (POBA).This multicenter, sequential comparative study included patients with lesions of infrapopliteal arteries up. Patients were enrolled sequentially and underwent alternating POBA or serration angioplasty with Serranator. The study captured angiographic imaging at pre, immediately post, and 15-minute after angioplasty. Vessel recoil, final diameter stenosis, and dissection were compared using core laboratory analysis.This study enrolled 36 patients who underwent treatment of 39 infrapopliteal lesions. There was no significant difference between Serranator (n=20) and POBA (n=19) with respect to baseline demographics and lesion characteristics. Arterial recoil (>10%) occurred in 25% of Serranator-treated lesions versus 64% in POBA-treated lesions (p=0.02. Clinically relevant recoil (>30%) was present after serration angioplasty in 10% of patients and after POBA in 53% (p=0.01). There was no significant difference in technical success (100% for both), dissection rate between Serranator (5%) and POBA (5.2%).Recoil occurs after infrapopliteal angioplasty with serration angioplasty produces substantially less arterial recoil compared with POBA. Additional studies are needed to assess whether reduced arterial recoil translates into superior long-term clinical outcomes.Prior studies have demonstrated over 90% recoil in patients after balloon angioplasty (POBA) of the infrapopliteal vessels, which significantly impacts the durability and impact of endovascular interventions in this clinical space. This study compared recoil after infrapopliteal angioplasty with serration angioplasty and POBA. Serration angioplasty produces substantially less arterial recoil compared with POBA. Additional studies are needed to assess whether reduced arterial recoil translates into superior long-term clinical outcomes.

    View details for DOI 10.1177/15266028231215284

    View details for PubMedID 38059463

  • Advanced Endovascular Techniques for Limb Salvage. The Surgical clinics of North America Fereydooni, A., Chandra, V. 2023; 103 (4): 779-799

    Abstract

    As the number of patients affected by peripheral arterial disease continues to increase, new technical approaches and devices have been developed to provide effective and durable treatment options that will lead to improved outcomes. While the mainstay of endovascular intervention remains mostly balloon-based, several innovative techniques and technologies are in development that may provide new solutions. This review highlights recent endovascular advancements in the management of chronic limb-threatening ischemia and additional adjunctive devices that are needed to improve lesion patency, reduce the need for reintervention, and lead to better patient-centered functional outcomes.

    View details for DOI 10.1016/j.suc.2023.05.002

    View details for PubMedID 37455037

  • Individual and program-related predictors of academic vascular surgery practice. Annals of vascular surgery Fisher, A. T., Fereydooni, A., Mullis, D. M., Smith, B. K., Sgroi, M. D. 2023

    Abstract

    Several studies have explored factors affecting academic employment in surgical subspecialties; however, vascular surgery has not yet been investigated. We examined which elements of surgical training predict future academic productivity and studied characteristics of NIH-funded vascular surgery attendings.With approval from the APDVS, the database of recent vascular surgery fellowship (VSF) and integrated vascular surgery residency (IVSR) graduates was obtained, and public resources (Doximity, Scopus, PubMed, NIH, etc.) were queried for research output during and after training, completion of dedicated research years, individual and program NIH funding, current practice setting and academic rank. Adjusted multivariate regression analyses were conducted for postgraduate academic productivity.From 2013-2017, there were 734 graduates. 603 completed VSF and 131 IVSR; 220 (29%) were female. Academic employment was predicted by MD degree, advanced degree, training at a top NIH-funded program, number publications by end of training, and H-index. Dedicated research time before or during vascular training, advanced degree, or graduating from a top NIH-funded program were predictors of publishing >1 paper/year. Number of publications by end of training and years in practice were predictive of H-index ≥5. VSF vs. IVSR pathway did not have an impact on future academic employment, annual publication rate as an attending, or H-index. Characterization of NIH-funded attendings showed that they often completed dedicated research time (72%) and trained at a top NIH-funded program (79%). Mean publications by graduation among this group was 15.82±11.3, and they averaged 4.31±4.2 publications/year as attendings.Research output during training, advanced degrees, and training at a top NIH funded program predict an academic vascular surgery career. VSF and IVSR constitute equally valid paths to productive academic careers.

    View details for DOI 10.1016/j.avsg.2023.06.037

    View details for PubMedID 37454896

  • Neurogenic Thoracic Outlet Syndrome in Division 1 Collegiate Athletes: Presentation, Diagnosis, and Treatment. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Olson, E. M., Dyrek, P., Harris, T., Fereydooni, A., Lee, J. T., Kussman, A., Roh, E. 2023

    Abstract

    Athletes who engage in repetitive upper-extremity exercise are susceptible to neurogenic thoracic outlet syndrome (nTOS). We sought to identify typical presenting symptoms and common findings on diagnostic workup, in addition to evaluating rates of return to play following various treatment interventions.Retrospective chart review.Single institution.Medical records of Division 1 athletes containing the diagnosis of nTOS between the years 2000 and 2020 were identified. Athletes with arterial or venous thoracic outlet syndrome were excluded.Demographics, sport, participation status, clinical presentation, physical examination findings, diagnostic workup, and treatments provided.Rate of return to play (RTP) to collegiate athletics.Twenty-three female and 13 male athletes were diagnosed and treated for nTOS. Digit plethysmography showed diminished or obliterated waveforms with provocative maneuvers in 23 of 25 athletes. Forty-two percent were able to continue competing despite symptoms. Of the athletes who were initially unable to compete, 12% returned to full competition after physical therapy alone, 42% of those remaining were able to RTP after botulinum toxin injection, and an additional 42% of the remaining athletes RTP after thoracic outlet decompression surgery.Many athletes diagnosed with nTOS will be able to continue competing despite symptoms. Digit plethysmography is a sensitive diagnostic tool for nTOS to document anatomical compression at the thoracic inlet. Botulinum toxin injection had a significant positive effect on symptoms and a high rate of RTP (42%), allowing numerous athletes to avoid surgery and its prolonged recovery and associated risks.This study demonstrates that botulinum toxin injection had a high rate of return to full competition in elite athletes without the risks and recovery needed for surgical intervention, suggesting that this may be a good intervention especially among elite athletes who only experience symptoms with sport-related activities.

    View details for DOI 10.1097/JSM.0000000000001162

    View details for PubMedID 37207307

  • Racial, ethnic, and socioeconomic inequities in amputation risk for patients with peripheral artery disease and diabetes. Seminars in vascular surgery Fereydooni, A., Patel, J., Dossabhoy, S. S., George, E. L., Arya, S. 2023; 36 (1): 9-18

    Abstract

    Peripheral artery disease and diabetes are highly prevalent diseases and the leading cause of limb loss. Despite advances in medical and surgical techniques, there are stark differences in delivery and outcomes of lower extremity amputation among populations when stratified by race, ethnicity, and socioeconomic status. We reviewed studies from the last 2 decades (1999-2022) to provide a comprehensive assessment of the current impact of disparities on the risk for, and management of, lower extremity amputation and offer action items that can optimize health outcomes.

    View details for DOI 10.1053/j.semvascsurg.2023.01.005

    View details for PubMedID 36958903

  • Impact of Integrated Vascular Surgery Residency Training Pathway and Professional Development Time on Career Choice and Research Productivity Fereydooni, A., Fisher, A. T., Mullis, D. M., Smith, B. K., Sgroi, M. D. MOSBY-ELSEVIER. 2023: E37-E38
  • Impact of Scalene Muscle Botulinum Toxin Injection With and Without Surgery in Neurogenic Thoracic Outlet Syndrome. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Fereydooni, A., Ho, V. T., Olson, E. M., Dyrek, P., Harris, T., Kussman, A., Roh, E., Lee, J. T. 2022

    Abstract

    Scalene blocks are part of both the diagnostic and treatment algorithm for patients presenting with symptoms of neurogenic thoracic outlet syndrome (nTOS). However, there is a paucity of data on the utility of scalene botulinum toxin injection (BTI) before surgical decompression. We sought to determine the impact of BTI with and without surgery at a multidisciplinary referral center.Retrospective cohort study.Single institution tertiary academic center, 2011 to 2020.Seventy-seven consecutive patients.Scalene muscle BTI for nTOS with or without surgical decompression.Pain relief and Quick Disability of the Arm, Shoulder and Hand (QDASH) score.Seventy-seven patients, with a mean age of 31.4 years, had BTI for symptoms of nTOS. All patients underwent pretreatment physical therapy through the Edgelow protocol for a mean duration of 3.4 months. However, 72.7% had dynamic vascular compression on duplex ultrasound with provocative maneuvers and 85.7% had a positive physical examination finding. After BTI, 77.9% reported subjective relief, confirmed by an improved QDASH disability score. Thirty-one patients (40.3%) then went on to have further persistent symptoms and proceeded with first rib resection. After BTI + Surgery, 96.8% reported symptomatic relief and had a median QDASH score improvement of 21 (range: 10-40), with all reaching minimal clinically important differences in the QDASH score after combination therapy.In this reported series of chemodenervation in patients with nTOS, BTI is helpful in alleviating symptoms before definitive surgical decompression. BTI followed by first rib resection provides additional symptom improvement over BTI alone.

    View details for DOI 10.1097/JSM.0000000000001094

    View details for PubMedID 36367782

  • Preliminary Clinical Validation Results of a Deep Learning Approach for Ankle Brachial Index Prediction in Noncompressible Tibial Vessels Fereydooni, A., Rao, A., Chaudhari, A., Battenfield, K., Aalami, O. MOSBY-ELSEVIER. 2022: E85
  • Multidisciplinary extremity preservation program improves quality of life for patients with advanced limb threat. Annals of vascular surgery Fereydooni, A., Yawary, F., Sen, S., Chou, L., Murphy, M., Dalman, R. L., Stern, J. R., Chandra, V. 2022

    Abstract

    The need for multidisciplinary care of patients with advanced limb threat is well established. We examined patient reported outcomes and health-related quality of life (HR-QoL) for those who completed a multidisciplinary extremity preservation program (EPP) at our institution.Patients with advanced limb threat, who had previously failed standard management at a tertiary-care center, were referred to EPP for evaluation by a multidisciplinary panel of vascular, plastic, orthopedic and podiatric surgeons, along with infectious disease, prosthetics, orthotics, imaging, palliative care, social work and wound nursing specialists. HR-QoL was quantified before and after EPP participation with the RAND-36 questionnaire. The validated RAND-36 assesses physical function, role limitations caused by physical and emotional health problems, social functioning, emotional well-being, energy, pain and general health perceptions.From 2018 to 2020, 185 patients were referred to EPP. After review by the multidisciplinary panel, 120 were accepted into the program, 63 of whom completed their course of care; 9 were one-time consultations. The median number of EPP in-person care visits was 23 (13-54) per participant; 87.3% of patients received one or more surgical procedure, including operative debridement (73%), revascularization (44%), soft tissue reconstruction or transplantation (46%), as well as hyperbaric oxygen therapy (11%) during their course of treatment. 85.7% of patients achieved complete wound healing, 41.5% occurring within 6 months. Ultimately, 14.3% required a major amputation. Graduates noted improvement in all categories of the HR-QoL upon completion, including those undergoing major amputation. On adjusted multivariate regression analysis, patients with immunocompromised status were more likely to show greater improvement in their social function (OR: 10.1; P<0.044) and emotional role limitation (OR:8.1; P=0.042), while patients with larger wound volume at presentation were more likely to have greater improvement in their general health (OR: 1.1; P<0.049). Conversely, patients with a smoking history had less improvement in energy level (OR:0.4; P=0.044) and patients with dialysis-dependence had less improvement in social function (OR:0.2; P=0.034).Coordinated, multidisciplinary extremity preservation program improves HR-QoL of patients with complex limb threat, including those who are immunocompromised with impaired social function and emotional role limitations. Further study is warranted to better characterize the generalizability of this approach, including considerations of cost-effectiveness, wound recidivism, and limiting the number of in-person visits required to achieve complete healing.

    View details for DOI 10.1016/j.avsg.2022.05.047

    View details for PubMedID 35803456

  • Anatomic factors contributing to external iliac artery endofibrosis in high performance athletes. Annals of vascular surgery Fisher, A. T., Tran, K., Dossabhoy, S. S., Sorondo, S., Fereydooni, A., Lee, J. T. 2022

    Abstract

    External iliac artery endofibrosis (EIAE) classically presents in cyclists with intimal thickening of the affected arteries. We investigated possible anatomical predisposing factors including psoas muscle hypertrophy, arterial tortuosity, inguinal ligament compression, and arterial kinking via case-control comparison of symptomatic and contralateral limbs.All patients with unilateral EIAE treated surgically at our institution were reviewed. Each patient's symptomatic side was compared with their contralateral side using paired t-tests. Psoas hypertrophy was quantified by transverse cross-sectional area (CSA) at L4, L5, and S1 vertebral levels, and inguinal ligament compression was measured as anterior-posterior distance between inguinal ligament and underlying bone. Tortuosity index for diseased segments and arterial kinking were measured on TeraRecon.Of 33 patients operated on for EIAE from 2004-2021, 27 with available imaging presented with unilateral disease, more commonly left-sided (63%). Most (96%) had external iliac involvement and 26% had ≥2 segments affected: 19% common iliac artery, 15% common femoral artery. The symptomatic limb had greater mean L5 psoas CSA (1450 mm2 vs. 1396 mm2, mean difference 54 mm2, P=0.039). There were no significant differences in L4 or S1 psoas hypertrophy, tortuosity, inguinal ligament compression, or arterial kinking. 63% underwent patch angioplasty and 85% underwent additional inguinal ligament release. 84% reported postoperative satisfaction, which was associated with greater difference in psoas hypertrophy at L4 (p=0.022).Psoas muscle hypertrophy is most pronounced at L5 and is associated with symptomatic EIAE. Preferential hypertrophy of the affected side correlates with improved outcomes, suggesting psoas muscle hypertrophy as a marker of disease severity.

    View details for DOI 10.1016/j.avsg.2022.05.011

    View details for PubMedID 35654289

  • Embolic protection devices are not associated with improved outcomes of atherectomy for lower extremity revascularization. Annals of vascular surgery Fereydooni, A., Bai, H., Baril, D., Chandra, V., Ochoa Chaar, C. I. 2022

    Abstract

    OBJECTIVE: Atherectomy is associated with a risk of distal embolization, but the role of embolic protection devices (EPD) during atherectomy is not well-defined. This study examines the utilization and impact of EPD on the outcomes of atherectomy during peripheral vascular interventions (PVI).METHODS: The annual trend in utilization of EPD during atherectomy in the Vascular Quality Initiative PVI files (2010-2018) was derived. Patients with concomitant open surgery, acute limb ischemia, emergent-status, concomitant thrombolysis, missing indication, missing EPD use, missing long-term follow up data were excluded. The characteristics of patients undergoing atherectomy with and without EPD were compared. Propensity matching based on age, gender, race, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), end-stage renal disease (ESRD), prior PVI, indication, urgent-status, TransAtlantic interSociety Consensus (TASC) classification and anatomical location of lesion was performed. The perioperative and 1-year outcomes of the matched groups were compared.RESULTS: EPD was used in 23.3% of atherectomy procedures (N=5,013 / 21,500). The utilization of EPD with atherectomy increased from 8.8% to 22.7% (P=0.003) during the study period. Patients undergoing atherectomy without EPD were more likely to have ESRD (7.8% vs 5.2%; P<0.001), tissue loss (31% vs 23.1; P<0.001), tibial intervention (39.6% vs 23.3%; P<0.001), higher number of arteries treated (1.78 ±0.92 vs 1.68±0.93; P=0.001), and longer length of lesion (21.15±21.14 vs 19±20.27cm; P=0.004). Conversely, patients undergoing atherectomy with EPD were more likely to be white (81.1% vs 74%; P<0.001), have a history of smoking (80.6% vs 74.5%; P<0.001), COPD (24.8% vs 21.6%; P<0.037), CAD (38.5% vs 33.2%; P=0.002), prior PCI (24.3% vs 19.9%, P=0.005), prior CABG (32.3% vs 24.9%; P<0.001), prior PVI (49.2% vs 45.1%; P=0.023). After propensity matching, there were 1,007 patients in each group with no significant difference in baseline characteristics. There was no significant difference in short-term outcomes including rate of distal embolization, technical success, dissection, perforation, discharge to home, and 30-day mortality. The use of EPD was, however, associated with longer fluoroscopy time. At 1-year, there was also no difference in primary patency, ipsilateral minor or major amputation, ABI improvement, reintervention or mortality rate between patients who underwent atherectomy with and without EPD.CONCLUSION: EPD has been increasingly utilized in conjunction with atherectomy especially in patients with claudication and femoropopliteal disease. However, the use of EPD during atherectomy does not seem to impact the outcomes. Further research is needed to justify the additional cost and fluoroscopy time associated with the use of EPD during atherectomy.

    View details for DOI 10.1016/j.avsg.2022.04.045

    View details for PubMedID 35589031

  • Visceral Reconstruction to Facilitate Cancer Management: Celiac, Mesenteric, Splenic, Hepatic, and Renal Artery Disease Management Operative Techniques in Surgery Fereydooni, A., Harris, E. J. Wolters Kluwer. 2022; 2nd
  • Impact of Scalene Muscle Botulinum Toxin Injection with and without Surgery in Neurogenic Thoracic Outlet Syndrome Fereydooni, A., Ho, V. T., Olson, E., Dyrek, P., Harris, T., Kussman, A., Roh, E. Y., Lee, J. T. MOSBY-ELSEVIER. 2021: E410
  • AutoABI: Feasibility of a Smartphone-Enabled ABI and Waveform Phasicity Prediction Model Using Machine Learning for Rapid Point-of-Care Limb Perfusion Assessment Rao, A., Battenfield, K. G., Fereydooni, A., Aalami, O. MOSBY-ELSEVIER. 2021: E182
  • Multidisciplinary Extremity Preservation Program Improves Quality of Life for Patients With Advanced Limb Threat Fereydooni, A., Yawary, F., Sen, S., Chou, L., Dalman, R. L., Murphy, M., Stern, J. R., Chandra, V. MOSBY-ELSEVIER. 2021: E41-E43
  • Embolic Protection Devices Are Not Associated With Improved Outcomes of Atherectomy for Lower Extremity Revascularization Fereydooni, A., Bai, H., Baril, D., Chandra, V., Chaar, C. MOSBY-ELSEVIER. 2021: E38-E39
  • Predictors Of Relief Following Botulinum Injection For Thoracic Outlet Syndrome Olson, E., Dyrek, P., Fereydooni, A., Harris, T., Lee, J. T., Kussman, A., Roh, E. Y. LIPPINCOTT WILLIAMS & WILKINS. 2021: 377
  • Predicting Return To Play In NCAA Division 1 Athletes With Neurogenic Thoracic Outlet Syndrome Dyrek, P., Olson, E., Fereydooni, A., Harris, T., Kussman, A., Roh, E., Lee, J. T., Segovia, N. LIPPINCOTT WILLIAMS & WILKINS. 2021: 390
  • Contemporary treatment of May-Thurner Syndrome. The Journal of cardiovascular surgery Fereydooni, A., Stern, J. R. 2021

    Abstract

    Compression of the left common iliac vein by the overlying right common iliac artery is a benign anatomic abnormality in most individuals. However, in patients with significant vein compression, outflow obstruction and chronic intraluminal venous damage may lead to May-Thurner Syndrome. This syndrome commonly manifests as unilateral left leg swelling or acute iliofemoral deep venous thrombosis. In addition to clinical findings, diagnosis is made with ultrasound, computed tomography venography, or magnetic resonance venography. The extent of compression of the iliac vein is best determined by venography with intravascular ultrasound. Symptoms and hemodynamic significance of the compression guides the ideal treatment approach. Iliocaval stenting has become the standard treatment for this condition and has promising patency rates and clinical outcomes. This review paper provides an overview of pathophysiology, and utility and limitations of the existing diagnostic modalities and treatment options in the management of May-Thurner Syndrome.

    View details for DOI 10.23736/S0021-9509.21.11889-0

    View details for PubMedID 33870678

  • Interview Experience, Postinterview Communication, and Gender-Based Differences in the Integrated Vascular Surgery Residency Match Fereydooni, A., Ramirez, J. L., Morrow, K. L., Sorondo, S., Lee, J. T., Coleman, D. M., Chandra, V. MOSBY-ELSEVIER. 2021: E46
  • Trends in Utilization and Outcomes of Orbital, Laser, and Excisional Atherectomy for Lower Extremity Revascularization. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists Bai, H., Fereydooni, A., Zhang, Y., Tonnessen, B. H., Guzman, R. J., Chaar, C. I. 2021: 15266028211050329

    Abstract

    The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes.All patients undergoing atherectomy in the 2010-2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared.Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18-5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09-0.95]).Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds.

    View details for DOI 10.1177/15266028211050329

    View details for PubMedID 34643142

  • Identifying enhancement-based staging markers on baseline MRI in patients with colorectal cancer liver metastases undergoing intra-arterial tumor therapy. European radiology Ghani, M. A., Fereydooni, A., Chen, E., Letzen, B., Laage-Gaupp, F., Nezami, N., Deng, Y., Gan, G., Thakur, V., Lin, M., Papademetris, X., Schernthaner, R. E., Huber, S., Chapiro, J., Hong, K., Georgiades, C. 2021

    Abstract

    To determine if three-dimensional whole liver and baseline tumor enhancement features on MRI can serve as staging biomarkers and help predict survival of patients with colorectal cancer liver metastases (CRCLM) more accurately than one-dimensional and non-enhancement-based features.This retrospective study included 88 patients with CRCLM, treated with transarterial chemoembolization or Y90 transarterial radioembolization between 2001 and 2014. Semi-automated segmentations of up to three dominant lesions were performed on pre-treatment MRI to calculate total tumor volume (TTV) and total liver volumes (TLV). Quantitative 3D analysis was performed to calculate enhancing tumor volume (ETV), enhancing tumor burden (ETB, calculated as ETV/TLV), enhancing liver volume (ELV), and enhancing liver burden (ELB, calculated as ELV/TLV). Overall and enhancing tumor diameters were also measured. A modified Kaplan-Meier method was used to determine appropriate cutoff values for each metric. The predictive value of each parameter was assessed by Kaplan-Meier survival curves and univariable and multivariable cox proportional hazard models.All methods except whole liver (ELB, ELV) and one-dimensional/non-enhancement-based methods were independent predictors of survival. Multivariable analysis showed a HR of 2.1 (95% CI 1.3-3.4, p = 0.004) for enhancing tumor diameter, HR 1.7 (95% CI 1.1-2.8, p = 0.04) for TTV, HR 2.3 (95% CI 1.4-3.9, p < 0.001) for ETV, and HR 2.4 (95% CI 1.4-4.0, p = 0.001) for ETB.Tumor enhancement of CRCLM on baseline MRI is strongly associated with patient survival after intra-arterial therapy, suggesting that enhancing tumor volume and enhancing tumor burden are better prognostic indicators than non-enhancement-based and one-dimensional-based markers.• Tumor enhancement of colorectal cancer liver metastases on MRI prior to treatment with intra-arterial therapies is strongly associated with patient survival. • Three-dimensional, enhancement-based imaging biomarkers such as enhancing tumor volume and enhancing tumor burden may serve as the basis of a novel prognostic staging system for patients with liver-dominant colorectal cancer metastases.

    View details for DOI 10.1007/s00330-021-08058-7

    View details for PubMedID 34061209

  • Superselective intranidal delivery of platinum-based high-density packing coils for treatment of arteriovenous malformations. Journal of vascular surgery cases and innovative techniques Bellamkonda, K. S., Fereydooni, A. n., Trott, K. n., Lee, Y. n., Mehra, S. n., Nassiri, N. n. 2021; 7 (2): 230-234

    Abstract

    Arteriovenous malformations (AVMs) classically feature an intervening nidus of poorly differentiated endothelium. The pillar of modern AVM treatment is intranidal delivery and deposition of various liquid embolic agents such as n-butyl cyanoacrylate, ethylene vinyl alcohol copolymer, and ethanol. These agents are cumbersome to prepare, deliver, and deploy and have been associated with complications related to limited delivery control, nonretrievability, frequent microcatheter exchanges, and nontarget embolization. Coils and other proximal occlusive agents have not been traditionally recommended as sole embolic agents for AVM treatment given the inherent lack of adequate AVM nidus penetration with previous coil technologies. In the present report, we have described a series of three patients with AVMs in whom newer generation, platinum-based, packing coils were used safely and effectively as the primary agent for superselective nidal penetration and embolization.

    View details for DOI 10.1016/j.jvscit.2021.01.005

    View details for PubMedID 33997560

    View details for PubMedCentralID PMC8095044

  • Improving the Outcomes of Vein Grafts: A View from the Molecular Level Current Vascular Surgery, Chicago Fereydooni, A., Dardik, A. Wildenradt Design Associates. 2021: 377-400
  • Factors Influencing Medical Student Choices in the Integrated Vascular Surgery Match: Implications for Future Post-pandemic Residency Matches. Journal of vascular surgery Fereydooni, A., Ramirez, J. L., Morrow, K. L., Chandra, V., Coleman, D. M., Lee, J. T. 2021

    Abstract

    Integrated Vascular Surgery Residency (IVSR) is among the most competitive specialties, but little is known about the applicant perspective. The COVID-19 outbreak impacted the 2021 IVSR match due to travel restrictions. We sought to better understand pre-pandemic applicant recruitment strategies, logistics of away rotations, and the residency interview process to identify areas for improvement in the application process.An anonymous survey was sent to matched students in 2020, inquiring about motivations for pursuing VS, logistic of away rotations and interviews, and factors influencing students' rank lists.Seventy of the 73 matched students completed the survey (95.9% response rate). The median age was 27 (25-41), 32.9% were female, 91.4% were US medical students, and 77.1% were from institutions with a VS training program. Factors most strongly influencing the decision to choose VS as a career were interest in open vascular procedures, endovascular procedures, perceived job satisfaction, emerging technologies, and influence of a mentor. The prospect of the job market, future salary, and competitiveness of the application process had the least impact. Of the matched students, 82.9% completed an away rotation (median 2; range 1-4), with 51.7% of students paying a total cost of more than $2500. Fifty percent of students matched either at their home institution or where they had performed an away rotation. Students reported application submissions to a median of 50 programs (range 1-70) and interviewed at 17 (range 1-28), with 40% of students paying a total of more than $4000 for interview costs. The most significant factors affecting students' rank lists included: program culture, open aortic surgical volume, geography, and complex endovascular procedure volume. Tours of facilities, resident salary, and male/female distribution had the least importance.Successfully matched applicants in 2020 prioritized operative case volume and program collegiality when ranking programs. Despite their high cost, away rotations played an important role in the Match, suggesting that time spent at potential institutions allowed ideal assessment of factors for students. The high average number of away rotations and in-person interviews performed in 2019-2020 was limited for the 2021 Match due to COVID-19 restrictions. Programs will have to continue developing creative alternatives or additions to away rotations and the application processes to assure continued success in future post-pandemic Match cycles.

    View details for DOI 10.1016/j.jvs.2021.05.014

    View details for PubMedID 34023431

  • Interview Experience, Post-interview Communication and Gender-based Differences in the Integrated Vascular Surgery Residency Match. Journal of vascular surgery Fereydooni, A., Ramirez, J. L., Morrow, K. L., Sorondo, S., Lee, J. T., Coleman, D. M., Chandra, V. 2021

    Abstract

    Integrated vascular surgery residency (IVSR) applicant perspective about the Match process has been rarely studied, yet has important implications on trainee recruitment. We sought to better understand the nature of the interview process, and post-interview communication and its impact on students' ranking choices.A voluntary and anonymous survey was sent to students who matched to IVSR in 2020, inquiring about interviews, post-interview communications and factors influencing students' rank-lists.70 of the 73 matched students completed the survey (96% response rate; 23 female and 47 male). Applicants reported they were asked questions about other programs of interest (81.4%), top choice programs (65.7%), marital-status (32.9%), family-planning (7.1%) and religion (1.4%) during interviews. Female applicants were more frequently asked questions about family-planning (17.4% vs 2.1%; P<.01) and marital-status (52.5% vs 23.4%; P <.01) compared to male applicants. After interviews, 92.9% of applicants notified their top choice program of their ranking preference. 61.4% of applicants received post-interview communication with regards to ranking from at least one program, initiated by program directors in 81.3% of instances. Among these applicants, 58.1% reported that the post-interview communication had an impact on their rank-list and 46.5% matched at a program by which they were contacted. 5.7% of applicants were asked by a program to reveal their ranking of the program and 11.4% were promised by a program to be ranked first if the applicant reciprocally ranked them first. Female and male applicants weighed program culture, operative volume, mentorship and prestige equally in making their rank-list. Male applicants weighed the sub-internship experience more significantly; however, female applicants weighed the sub-internship experience, personal relationships in certain cities, dedicated professional development years and large female representation in the program more heavily (P<.02).This study provides insight into the interview experience and impactful factors for the vascular surgery match. Both female and male applicants were asked a high number of questions about personal matters unrelated to medical school performance. Female applicants, however, experienced a higher proportion of these instances, particularly regarding family-planning. These findings demonstrate the factors that are important to applicants in the match process and raises awareness of potential challenges in the interview and recruitment process.

    View details for DOI 10.1016/j.jvs.2021.05.060

    View details for PubMedID 34197947

  • Comparison of Atherectomy to Balloon Angioplasty and Stenting for Isolated Femoropopliteal Revascularization. Annals of vascular surgery Bai, H. n., Fereydooni, A. n., Zhuo, H. n., Zhang, Y. n., Tonnessen, B. n., Guzman, R. J., Ochoa Chaar, C. I. 2020

    Abstract

    The use of atherectomy for lower extremity revascularization is increasing despite concerning reports about its long-term safety and effectiveness. This study compares the outcomes of atherectomy to percutaneous transluminal angioplasty (PTA) and stenting for treatment of isolated femoropopliteal disease.All patients undergoing endovascular treatment of isolated femoropopliteal lesions in the Vascular Quality Initiative (2009-2018) were identified. Patients with concomitant open surgery, acute limb ischemia, or iliac or tibial intervention were excluded. Patients were divided into 3 treatment groups: atherectomy with or without PTA, PTA alone and stenting alone. Propensity matching was performed based on age, gender, race, ambulatory-status, diabetes, smoking, hypertension, coronary artery disease, chronic obstructive pulmonary disease, congestive heart failure, dialysis, prior inflow bypass and intervention, prior major ipsilateral amputation, indication, length of treated lesion, American Society of Anesthesiologists class, and TASC II classification. The perioperative and one-year outcomes of the matched groups were compared.A total of 10,007 atherectomy, 22,000 PTA and 27,579 stenting of isolated femoropopliteal disease were identified. After matching, there were 6,372 procedures in atherectomy and PTA groups respectively. Atherectomy was associated with higher likelihood of technical success (98.3% vs 97.5%; P<.001) and shorter length of stay (1.8 ± 8.2 days vs 2.7 ± 15.7 days; P<.001), but had increased rate of distal embolization (2% vs 1.1%; P<.001) compared to PTA. At one year, atherectomy was associated with improved primary patency (84.2% vs 82%; P=.047) and survival rate (91.1% vs 90%; P=.044), but was also associated with a higher reintervention rate (15.7% vs 13.6%; P=0.033) compared to PTA. There was no difference in the rates of major amputation, ambulatory-status improvement or ABI improvement. In the second analysis, after matching, there were 6,877 procedures in the atherectomy and stenting groups respectively. Atherectomy was associated with lower rate of dissection (3.7% vs 8.2% <.001), lower rate of perforation (0.6% vs 1.2%; P<.001) and a shorter length of stay (1.9 ± 8.1 vs 2.9 ± 9.8 days; P<.001) compared to stenting. However, patients treated with atherectomy had a lower rate of technical success (98.3% vs 99.2%; P<.001) and a higher rate of distal embolization (2% vs 1.2%; P<.001) compared to stenting. At one year, atherectomy was associated with a higher rate of major ipsilateral amputation (5.3% vs 4.1%; P=.046) and less improvement in ABI (0.19 ± 0.42 vs 0.25 ± 0.4; P<.001) compared to stenting. There was no difference in rates of primary patency, survival, reintervention, ambulatory-status improvement at one year.Atherectomy does not seem to confer any significant additional clinical benefit compared to balloon angioplasty or stenting. Further research is needed to justify its additional cost over other endovascular modalities.

    View details for DOI 10.1016/j.avsg.2020.05.019

    View details for PubMedID 32512112

  • Using the epidemiology of critical limb ischemia to estimate the number of patients amenable to endovascular therapy. Vascular medicine (London, England) Fereydooni, A. n., Gorecka, J. n., Dardik, A. n. 2020; 25 (1): 78–87

    Abstract

    Critical limb ischemia represents the advanced stage of peripheral artery disease, a health problem with increasing prevalence. Critical limb ischemia is associated with significant mortality, limb loss, pain, and diminished health-related quality of life. Public awareness and early diagnosis are necessary for an effective treatment with early risk factor modification, smoking cessation, and exercise therapy. Herein, we present an overview of the epidemiology as well as the clinical stages of the disease, and estimate that there are 6.5 million patients with critical limb ischemia in the US, Europe, and Japan based on global population-based studies. At least 75% of these patients, accounting for approximately 4.8 million patients, are amenable to endovascular therapy.

    View details for DOI 10.1177/1358863X19878271

    View details for PubMedID 31621531

  • Endovascular Revascularization Incorporating Infrapopliteal Coronary Drug-Eluting Stents Improves Clinical Outcomes in Patients with Critical Limb Ischemia and Tissue Loss. Annals of vascular surgery Huntress, L. A., Fereydooni, A. n., Dardik, A. n., Nassiri, N. n. 2020; 63: 234–40

    Abstract

    Critical limb ischemia (CLI) involving infrapopliteal arterial atherosclerosis and tissue loss remains a formidable clinical scenario with significant morbidity and mortality. Despite level IA evidence, tibial revascularization with coronary drug-eluting stents (DES) remains a seldom-used technique in the United States due, in part, to lack of a Food and Drug Administration-approved indication and dedicated stent technology for infrapopliteal application. Furthermore, follow-up data beyond 1 year remain scarce, and further evidence for improvement in clinical outcomes using this technique is needed. Herein, we present our multi-institutional experience with endovascular revascularization of patients with CLI and tissue loss using coronary DES for infrapopliteal lesions of appropriate dimensions and the Wound, Ischemia, and foot Infection (WIfI) score as supportive evidence for improvement in clinical outcomes.In this retrospective study, 40 sequential tibial revascularization procedures performed in 32 patients with CLI were reviewed. Outcomes including changes in WIfI scores, patency rates, freedom from major amputation, target lesion recurrence, and all-cause mortality were analyzed. Average follow-up duration was 19.3 months (interquartile range: 7-27.1 months).Freedom from major amputation was 88.6%. One-year primary patency was 90.3%. Mean ankle-brachial indices increased after revascularization (0.57 ± 0.26 to 0.97 ± 0.26; P = 0.03). All components of the WIfI score significantly improved after revascularization (W: 1.9 to 1.1, P = 0.03; I: 2.0 to 0.6, P = 0.001; and fI: 1.5 to 0.8, P = 0.01). WIfI risk of major amputation score before revascularization was 3.58 ± 0.75 (high risk), which was reduced to 2.04 ± 1.31 (low risk; P < 0.001). One-year survival rate was 90.6%.Coronary DES continue to demonstrate promising primary patency and limb salvage rates in appropriately selected patients undergoing multilevel endovascular revascularization for CLI and tissue loss. In addition to its value as a predictor for major amputation and revascularization benefit, the WIfI score can also serve as a multicomponent tool for objective assessment of outcomes after revascularization.

    View details for DOI 10.1016/j.avsg.2019.07.011

    View details for PubMedID 31563654

  • Use of neuraxial anesthesia for hybrid lower extremity revascularization is associated with reduced perioperative morbidity. Journal of vascular surgery Fereydooni, A. n., O'Meara, T. n., Popescu, W. M., Dardik, A. n., Ochoa Chaar, C. I. 2020; 71 (4): 1296–1304.e7

    Abstract

    Recent advances in endovascular technology have allowed complex peripheral arterial disease (PAD) to be treated with less invasive hybrid procedures under neuraxial anesthesia. This study investigates the perioperative outcomes of hybrid lower extremity revascularization (LER) performed under neuraxial anesthesia (NAA) vs general anesthesia (GA). We hypothesize that the use of NAA is associated with improved outcomes.The 2005-2017 American College of Surgeons National Surgical Quality Improvement Program dataset was used to identify patients who underwent hybrid LER for PAD. Based on the primary anesthetic technique, patients were divided into two groups: GA and NAA, which included spinal or epidural anesthesia. Baseline characteristics of the two groups were compared. A group of patients treated under GA were matched (2:1) to patients in the NAA group based on gender, age, race, functional status, transfer status, chronic obstructive pulmonary disease, wound infection, American Society of Anesthesiologists classification, emergent surgery, preoperative sepsis, indication, and type of hybrid procedure. Patient characteristics and 30-day outcomes were compared.Of 9430 patients who underwent hybrid LER, only 452 (4.8%) received NAA. Patients who received NAA were older (mean age, 68 ± 8.4 vs 72.3 ± 9.2; P = .004) and were more likely to be white (70.9% vs 85.6%; P < .0001), have dependent functional status (7.6% vs 13.1%; P < .0001), chronic obstructive pulmonary disease (24.3% vs 17.5%; P = .001), and a diagnosis of wound infection (15% vs 23.5%; P < .0001). After propensity matching, 904 patients in the GA group were compared with 452 patients in the NAA group with no difference in baseline characteristics. NAA was associated with reduced rate of more than 48 hours' ventilator requirement (2.4% vs 0.2%; P = .0014), bleeding requiring transfusion (17.5% vs 8%; P < .0001), and overall morbidity (29.3% vs 19%; P < .0001), as well as shorter length of hospital stay (6.8 ± 9.3 vs 5.3 ± 6.1 days; P = .0026) and total operating time (237.8 ± 109 vs 202.4 ± 113 minutes; P < .0001) compared with GA.NAA is an infrequently used anesthesia technique during hybrid LER and is primarily used for older patients with chronic obstructive pulmonary disease. NAA is associated with decreased perioperative morbidity and length of hospital stay compared with GA and may be considered in this sicker patient population.

    View details for DOI 10.1016/j.jvs.2019.07.072

    View details for PubMedID 31708304

  • Utilization and Outcomes of Local Anesthesia and Peripheral Nerve Block for Hybrid Lower Extremity Revascularization. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists Fereydooni, A. n., O'Meara, T. n., Popescu, W. M., Dardik, A. n., Ochoa Chaar, C. I. 2020; 27 (1): 94–101

    Abstract

    Purpose: To investigate the utilization of local anesthesia or peripheral nerve block with monitored anesthesia care (LPMAC) and its impact on the perioperative outcomes of hybrid lower extremity revascularization (LER) compared with general anesthesia (GA). Materials and Methods: A search of the ACS-NSQIP database between 2005 and 2017 identified 9430 patients who underwent hybrid LER for peripheral artery disease. Excluding 449 ineligible cases left 8981 hybrid LER patients for analysis. The patients were dichotomized based on the anesthetic technique: 8631 (96.1%) GA and 350 (3.9%) LPMAC. The GA patients were matched 3:1 based on propensity scores to patients in the LPMAC group based on gender, age, race, functional status, transfer status, chronic obstructive pulmonary disease (COPD), dialysis status, American Society of Anesthesiologists (ASA) class, emergent surgery, preoperative sepsis, indication, and type of open and endovascular procedure. Outcomes including complications, mortality, procedure time, and hospital length of stay were compared between the matched groups (801 GA vs 267 LPMAC). Results: Comparing the unmatched groups, those treated under LPMAC were older (72.7±9 vs 68±8.4 years, p<0.001) and had higher rates of COPD (24.3% vs 17%, p=0.001), dialysis dependence (8.1% vs 4.2%, p=0.002), preoperative sepsis (6.6% vs 4.2%, p=0.029), and ASA class ≥IV (29.1% vs 24.1%, p=0.036) than in the unmatched GA cohort. In the matched comparison, LPMAC was associated with lower overall morbidity (25.5% vs 32.3%, p=0.042) and shorter operating time (202.7±98 vs 217.7±102 minutes, p=0.034) compared with GA. The rate of myocardial infarction was lower (1.1% vs 2.4%) and ventilator use for >48 hours was less frequent (0.4% vs 2.6%) for LPMAC patients, though statistical significance was not reached. There was no difference in mortality or hospital length of stay. Conclusion: LPMAC is an infrequent anesthetic technique for hybrid LER and is primarily used for patients with a high burden of comorbidities. LPMAC is associated with reduced overall morbidity and operating time. Further studies are needed to identify which patients undergoing hybrid LER benefit most from LPMAC.

    View details for DOI 10.1177/1526602819887382

    View details for PubMedID 31746264

  • Transcarotid Artery Revascularization With Flow Reversal-Reply. JAMA surgery Fereydooni, A. n., Gorecka, J. n., Dardik, A. n. 2020

    View details for DOI 10.1001/jamasurg.2019.5445

    View details for PubMedID 32022828

  • Lipiodol as an Imaging Biomarker of Tumor Response After Conventional Transarterial Chemoembolization: Prospective Clinical Validation in Patients with Primary and Secondary Liver Cancer. Translational oncology Miszczuk, M. A., Chapiro, J. n., Geschwind, J. H., Thakur, V. n., Nezami, N. n., Laage-Gaupp, F. n., Kulon, M. n., van Breugel, J. M., Fereydooni, A. n., Lin, M. n., Savic, L. J., Tegel, B. n., Wahlin, T. n., Funai, E. n., Schlachter, T. n. 2020; 13 (3): 100742

    View details for DOI 10.1016/j.tranon.2020.01.003

    View details for PubMedID 32092672

    View details for PubMedCentralID PMC7036424

  • Induced pluripotent stem cell-derived smooth muscle cells increase angiogenesis and accelerate diabetic wound healing. Regenerative medicine Gorecka, J. n., Gao, X. n., Fereydooni, A. n., Dash, B. C., Luo, J. n., Lee, S. R., Taniguchi, R. n., Hsia, H. C., Qyang, Y. n., Dardik, A. n. 2020

    Abstract

    Aim: To assess the potential of human induced pluripotent stem cell-derived smooth muscle cells (hiPSC-SMC) to accelerate diabetic wound healing. Methods: hiPSC-SMC were embedded in 3D collagen scaffolds and cultured in vitro for 72 h; scaffolds were then applied to diabetic, nude mouse, splinted back wounds to assess in vivo healing. Cultured medium after scaffold incubation was collected and analyzed for expression of pro-angiogenic cytokines. Results: hiPSC-SMC secrete increased concentration of pro-angiogenic cytokines, compared with murine adipose derived stem cells. Delivery of hiPSC-SMC-containing collagen scaffolds accelerates diabetic wound healing and is associated with an increased number of total and M2 type macrophages. Conclusion: hiPSC-SMC promote angiogenesis and accelerate diabetic wound healing, making them a promising new candidate for treatment of diabetic wounds.

    View details for DOI 10.2217/rme-2019-0086

    View details for PubMedID 32228292

  • Technical and Ethical Challenges in the Care of an Independent Nonagenarian with Critical Limb Ischemia. Archives of Clinical and Medical Case Reports Fereydooni, A., Dahl, N., Ochoa Chaar, C. I. 2020; 4 (1): 130-137

    View details for DOI 10.26502/acmcr.96550178

  • Altered hemodynamics during arteriovenous fistula remodeling leads to reduced fistula patency in female mice Journal of Vascular Surgery. Vascular Science Kudze, T., Ono, S., Fereydooni, A., Gonzalez, L., Isaji, T., Hu, H., Yatsula, B., Taniguchi, R., Koizumi, J., Nishibe, T., Dardik, A. 2020: 42-56
  • Evaluation and management of the lateral marginal vein in Klippel-Trénaunay and other PIK3CA-related overgrowth syndromes. Journal of vascular surgery. Venous and lymphatic disorders Fereydooni, A. n., Nassiri, N. n. 2020

    Abstract

    The lateral marginal vein is an anomalous clinical entity found in association with Klippel-Trénaunay and other PIK3CA-related overgrowth syndromes. Although it is reported to affect <20% of patients with Klippel-Trénaunay syndrome, this venous anomaly has been associated with significant morbidity and mortality attributable to venous hypertension and potentially lethal thromboembolic events. Limited literature exists on the diagnosis and management of this rare anomaly, with most of the reports focusing on retrospective clinical experience at a few centers of excellence. Despite these limitations, a systematic approach to diagnosis and treatment of this anomaly is warranted and expounded on herein. When plausible, clinical recommendations based on best available literature are made.

    View details for DOI 10.1016/j.jvsv.2019.12.003

    View details for PubMedID 32089498

  • Rapid increase in hybrid surgery for the treatment of peripheral artery disease in the Vascular Quality Initiative database. Journal of vascular surgery Fereydooni, A. n., Zhou, B. n., Xu, Y. n., Deng, Y. n., Dardik, A. n., Ochoa Chaar, C. I. 2020

    Abstract

    Advances in technology have increased the use of endovascular therapy for lower extremity revascularization (LER), but the impact on hybrid surgery has not been studied. This study aims to (1) investigate the contemporary national trends in frequency of hybrid LER and (2) compare the outcomes of open bypass (BYP) and hybrid surgery for isolated femoropopliteal revascularization.Using the national Vascular Quality Initiative database from 2010 to 2017, all patients receiving bypass or hybrid LER for PAD were identified. A trend of all hybrid LER compared with open LER was obtained. Next, only patients who underwent hybrid or open isolated femoropopliteal LER were identified. Patients treated with hybrid surgery underwent femoral endarterectomy and antegrade endovascular intervention of the femoropopliteal vessels (HYB), whereas patients treated with BYP underwent femoral endarterectomy and femoropopliteal bypass. These two groups of patients were matched based on age, gender, race, indication, ambulatory status, emergency status, diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, and hemodialysis. Patient characteristics and the perioperative and 1-year outcomes of the two groups were compared.The overall rate of hybrid LER procedures increased from 6.1% in 2010 to 32% in 2017 (P = .03). Hybrid LER was significantly more commonly used in patients with claudication (47%) and BYP surgery was used in patients with tissue loss (38.5%; P = .019). There were 456 HYB and 2665 BYP for isolated femoropopliteal revascularization. After propensity matching, the cohort comprised 425 patients in each group. HYB was associated with lower rate of myocardial infarction (1.9% vs 5.7%; P = .005) and renal complications (2.1% vs 6.7%; P = .003), length of stay (4.7 vs 6.1 days; P = .001), and higher rate of discharge to home (90.8% vs 81.4%; P < .001) compared with BYP. There was no significant difference in 30-day mortality (HYB 1.5% vs BYP, 2.5%; P = .44). The 1-year outcomes comparison suggested that patients in the BYP group had a higher likelihood of improvement in ambulatory status compared with patients in HYB group (16.7% vs 7.7%; P = .044). However, Kaplan-Meier analysis showed no difference in overall survival (P = .13) or amputation-free survival (P = .057) between the two groups. There was no statistical difference in graft patency, limb loss, or secondary interventions.Hybrid LER for PAD has been increasingly used and accounts for up to one-third of open LER in the Vascular Quality Initiative. Hybrid femoropopliteal revascularization improves perioperative outcomes compared with femoropopliteal bypass. However, the 1-year outcomes between the two procedures are comparable, suggesting that hybrid femoropopliteal revascularization should be favored in high-risk patients because of its perioperative advantages.

    View details for DOI 10.1016/j.jvs.2019.11.041

    View details for PubMedID 32067877

  • Mechanochemical and surgical ablation of an anomalous upper extremity marginal vein in CLOVES syndrome identifies PIK3CA as the culprit gene mutation Journal of vascular surgery cases and innovative techniques Lim, Y., Fereydooni, A., Brahmandam, A., Dardik, A., Choate, K., Nassiri, N. 2020; 6 (3): 438-442
  • Distinct subsets of T-cells and macrophages impact venous remodeling during arteriovenous fistula maturation Journal of Vascular Surgery. Vascular Science Matsubara, Y., Kiwan, G., Fereydooni, A., Langford, J., Dardik, A. 2020; 1 (1)
  • Stem Cell Delivery Techniques for Stroke and Peripheral Artery Disease Stem Cell Therapy for Vascular Diseases Lee, S., Fereydooni, A., Dardik, A. Springer Nature. 2020: 69–103
  • A national post-Match webinar panel improves knowledge and preparedness of medical students interested in vascular surgery training. Journal of vascular surgery Fereydooni, A., Ramirez, J. L., Dossabhoy, S. S., Brahmandam, A., Dardik, A., Ochoa Chaar, C. I. 2019

    Abstract

    BACKGROUND: The current shortage of vascular surgeons is projected to worsen. Compared with other surgical residency programs, integrated vascular surgery residency (IVSR) offers fewer training positions and attracts fewer applicants. As a result, only a few medical students from each school match into the specialty, and conventional resources like Match panels are not available to students interested in vascular surgery. We hypothesize that a national post-Match panel webinar will improve medical students' knowledge of the IVSR application process.METHODS: A panel of four recently matched medical students shared their experiences on their successful Match into an IVSR through a 65-minute-long national webinar. Data were collected from students who attended the webinar through anonymous online surveys before and after the panel discussion. The participants' self-reported understanding of the IVSR was assessed using a 5-point Likert scale for 11 questions. Objective knowledge of the IVSR Match process was assessed using five data-based questions. All prewebinar and postwebinar responses were paired and compared using bivariate analysis.RESULTS: A total of 76 participants completed both the prewebinar and postwebinar surveys. The majority of respondents were first-year medical students (51.3%) and attended medical school in the Northeast (38.2%). Among these respondents, 57.6% indicated that their home institution had an IVSR program, 44.7% had an active vascular surgery interest group (VSIG), 14.5% had previously attended a vascular surgery conference, and 28.9% were very likely to apply into an IVSR. After the webinar, more students correctly identified the number of currently existing IVSR training positions (76.3% vs 89.5%; P= .002), duration of IVSR (56.6% vs 85.5%; P< .001), and median Step 1 score (50% vs 84.2%; P< .001) and minimum number of applications (38.2% vs 65.8%; P< .001) recommended for a successful Match into IVSR. Students who had a VSIG at their home institution were found to have a better baseline knowledge of the IVSR based on their higher aggregate scores on the data-based questions (3.4± 1 vs 1.9± 1.2; P< .001) compared with those without one.CONCLUSIONS: A national webinar run by recently matched students can effectively improve medical students' understanding of the IVSR application process. Students with a VSIG at their institutions have a better baseline knowledge of IVSR. In addition to expanding the VSIG, instituting an annual national postmatch webinar may help students become better prepared applicants and improve the overall application pool.

    View details for DOI 10.1016/j.jvs.2019.08.282

    View details for PubMedID 31843302

  • Induced Pluripotent Stem Cell Derived Smooth Muscle Cells Are Superior to Mesenchymal Stem Cells at Accelerating Diabetic Wound Healing Gorecka, J. R., Fereydooni, A., Luo, J., Dash, B., Isaji, T., Gonzalez, L., Lee, S., Qyang, Y., Hsia, H., Dardik, A. ELSEVIER SCIENCE INC. 2019: S331
  • Inhibition of the Akt1-mTORC1 Axis Alters Venous Remodeling to Improve Arteriovenous Fistula Patency Fereydooni, A., Guo, X., Gorecka, J., Isaji, T., Ono, S., Taniguchi, R., Nassiri, N., Dardik, A. MOSBY-ELSEVIER. 2019: E43–E44
  • Neuraxial Anesthesia for Hybrid Lower Extremity Revascularization Is Associated With Reduced Perioperative Morbidity Fereydooni, A., O'Meara, T., Popescu, W., Dardik, A., Chaar, C. MOSBY-ELSEVIER. 2019: E48–E50
  • Inhibition of the Akt1-mTORC1 Axis Alters Venous Remodeling to Improve Arteriovenous Fistula Patency SCIENTIFIC REPORTS Guo, X., Fereydooni, A., Isaji, T., Gorecka, J., Liu, S., Hu, H., Ono, S., Alozie, M., Lee, S., Taniguchi, R., Yatsula, B., Nassiri, N., Zhang, L., Dardik, A. 2019; 9: 11046

    Abstract

    Arteriovenous fistulae (AVF) are the most common access created for hemodialysis, but up to 60% do not sustain dialysis within a year, suggesting a need to improve AVF maturation and patency. In a mouse AVF model, Akt1 regulates fistula wall thickness and diameter. We hypothesized that inhibition of the Akt1-mTORC1 axis alters venous remodeling to improve AVF patency. Daily intraperitoneal injections of rapamycin reduced AVF wall thickness with no change in diameter. Rapamycin decreased smooth muscle cell (SMC) and macrophage proliferation; rapamycin also reduced both M1 and M2 type macrophages. AVF in mice treated with rapamycin had reduced Akt1 and mTORC1 but not mTORC2 phosphorylation. Depletion of macrophages with clodronate-containing liposomes was also associated with reduced AVF wall thickness and both M1- and M2-type macrophages; however, AVF patency was reduced. Rapamycin was associated with improved long-term patency, enhanced early AVF remodeling and sustained reduction of SMC proliferation. These results suggest that rapamycin improves AVF patency by reducing early inflammation and wall thickening while attenuating the Akt1-mTORC1 signaling pathway in SMC and macrophages. Macrophages are associated with AVF wall thickening and M2-type macrophages may play a mechanistic role in AVF maturation. Rapamycin is a potential translational strategy to improve AVF patency.

    View details for DOI 10.1038/s41598-019-47542-5

    View details for Web of Science ID 000477858900022

    View details for PubMedID 31363142

    View details for PubMedCentralID PMC6667481

  • Rapid Increase in Hybrid Surgery for the Treatment of Peripheral Artery Disease in the Vascular Quality Initiative Database Fereydooni, A., Zhou, B., Deng, Y., Dardik, A., Chaar, C. MOSBY-ELSEVIER. 2019: E225–E227
  • Rapamycin Alters Venous Remodeling to Improve Arteriovenous Fistula Patency Fereydooni, A., Guo, X., Isaji, T., Gorecka, J., Ono, S., Nassiri, N., Zhang, L., Dardik, A. MOSBY-ELSEVIER. 2019: E265
  • Molecular Targets for Improving Arteriovenous Fistula Maturation and Patency. Vascular investigation and therapy Gorecka, J. n., Fereydooni, A. n., Gonzalez, L. n., Lee, S. R., Liu, S. n., Ono, S. n., Xu, J. n., Liu, J. n., Taniguchi, R. n., Matsubara, Y. n., Gao, X. n., Gao, M. n., Langford, J. n., Yatsula, B. n., Dardik, A. n. 2019; 2 (2): 33–41

    Abstract

    The increasing prevalence of chronic and end-stage renal disease creates an increased need for reliable vascular access, and although arteriovenous fistulae (AVF) are the preferred mode of hemodialysis access, 60% fail to mature and only 50% remain patent at one year. Fistulae mature by diameter expansion and wall thickening; this outward remodeling of the venous wall in the fistula environment relies on a delicate balance of extracellular matrix (ECM) remodeling, inflammation, growth factor secretion, and cell adhesion molecule upregulation in the venous wall. AVF failure occurs via two distinct mechanisms with early failure secondary to lack of outward remodeling, that is insufficient diameter expansion or wall thickening, whereas late failure occurs with excessive wall thickening due to neointimal hyperplasia (NIH) and insufficient diameter expansion in a previously functional fistula. In recent years, the molecular basis of AVF maturation and failure are becoming understood in order to develop potential therapeutic targets to aide maturation and prevent access loss. Erythropoietin-producing hepatocellular carcinoma (Eph) receptors, along with their ligands, ephrins, determine vascular identity and are critical for vascular remodeling in the embryo. Manipulation of Eph receptor signaling in adults, as well as downstream pathways, is a potential treatment strategy to improve the rates of AVF maturation and patency. This review examines our current understanding of molecular changes occurring following fistula creation, factors predictive of fistula success, and potential areas of intervention to decrease AVF failure.

    View details for DOI 10.4103/VIT.VIT_9_19

    View details for PubMedID 31608322

    View details for PubMedCentralID PMC6788624

  • Uterine Fibroid Embolization. Leiomyoma Izreig, S., Fereydooni, A., Nassiri, N. 2019

    View details for DOI 10.5772/intechopen.86937

  • Endovascular Aortic Aneurysm Repair in Patients with Aortoiliac Occlusive Disease. Vascular Access Surgery - Tips and Tricks Mangum, K. D., Fereydooni, A., Nassiri, N. IntechOpen. 2019

    View details for DOI 10.5772/intechopen.83848

  • Reduced patency in left-sided arteriovenous grafts in a porcine model. Journal of vascular surgery Liu, S. n., Wang, T. n., Wang, J. n., Isaji, T. n., Ono, S. n., Fereydooni, A. n., Taniguchi, R. n., Matsubara, Y. n., Niklason, L. E., Dardik, A. n. 2019

    Abstract

    The porcine arteriovenous graft model is commonly used to study hemodialysis vascular access failure, with most studies using a bilateral, paired-site approach in either the neck or femoral vessels. In humans, left- and right-sided central veins have different anatomy and diameters, and left-sided central vein catheters have worse outcomes. We assessed the effect of laterality on arteriovenous prosthetic graft patency and hypothesized that left-sided carotid-jugular arteriovenous prosthetic grafts have reduced patency in the porcine model.Arteriovenous polytetrafluoroethylene grafts were placed ipsilaterally or bilaterally in 10 Yorkshire male pigs from the common carotid artery to the internal jugular vein. Ultrasound measurements of blood flow velocities and diameters were assessed before graft placement. Animals were sacrificed at 1 week, 2 weeks, or 3 weeks. Patency was determined clinically; grafts and perianastomotic vessels were excised and analyzed with histology and immunostaining.At baseline, left- and right-sided veins and arteries had similar blood flow velocities. Although internal jugular veins had similar diameters at baseline, left-sided carotid arteries had 11% smaller outer diameters (P = .0354). There were 10 left-sided and 8 right-sided polytetrafluoroethylene grafts placed; only 4 of 10 (40%) grafts were patent on the left compared with 7 of 8 (88%) grafts patent on the right (P = .04). Left-sided grafts had increased macrophages at the arterial anastomosis (P = .0007). Left-sided perianastomotic arteries had thicker walls (0.74 vs 0.60 mm; P = .0211) with increased intima-media area (1.14 vs 0.77 mm2; P = .0169) as well as a trend toward 38% smaller luminal diameter (1.6 vs 2.5 mm; P = .0668) and 20% smaller outer diameter (3.0 vs 3.7 mm; P = .0861). Left- and right-sided perianastomotic veins were similar histologically, but left-sided veins had decreased expression of phosphorylated endothelial nitric oxide synthase (P = .0032) and increased numbers of α-actin-positive smooth muscle cells (P = .0022).Left-sided arteriovenous grafts are associated with reduced short-term patency compared with right-sided grafts in the Yorkshire pig preclinical model of arteriovenous prosthetic grafts. Laterality must be considered in planning and interpreting surgical preclinical models.

    View details for DOI 10.1016/j.jvs.2019.06.221

    View details for PubMedID 31699515

  • Coil embolization of bilateral internal mammary artery aneurysms in the setting of a heterozygous missense variant of unknown significance in COL5A1 and fibromuscular dysplasia. Journal of vascular surgery cases and innovative techniques Chen, J. F., Papanikolaou, D. n., Fereydooni, A. n., Mojibian, H. n., Dardik, A. n., Nassiri, N. n. 2019; 5 (4): 410–14

    Abstract

    Internal mammary artery aneurysms are rare but serious clinical entities. Rupture results in hemothorax and can be life threatening. Most reported cases are pseudoaneurysms secondary to iatrogenic or traumatic causes. Noniatrogenic, nontraumatic, true internal mammary artery aneurysms have most commonly been associated with vasculitides or connective tissue disorders; rare cases have been deemed idiopathic. We describe a rare case of bilateral internal mammary artery aneurysms-successfully treated with coil embolization-in the setting of heterozygosity for a missense variant of unknown significance in the COL5A1 gene and multifocal fibrodysplastic changes on angiography.

    View details for DOI 10.1016/j.jvscit.2019.07.002

    View details for PubMedID 31660461

    View details for PubMedCentralID PMC6806644

  • Carotid Endarterectomy and Carotid Artery Stenting for Patients With Crescendo Transient Ischemic Attacks: A Systematic Review. JAMA surgery Fereydooni, A. n., Gorecka, J. n., Xu, J. n., Schindler, J. n., Dardik, A. n. 2019

    Abstract

    Thromboembolic stroke attributable to an ipsilateral carotid artery plaque is a leading cause of disability in the United States and a major source of morbidity. Randomized clinical trials have demonstrated the efficacy of carotid endarterectomy and carotid stenting at minimizing stroke risk in patients with minor stroke and transient ischemic attack. However, there is no consensus on guidelines for medical management and the timing of revascularization in patients with multiple recurrent episodes of transient ischemic attack over hours or days, an acute neurological event known as crescendo transient ischemic attack.To review the management of and timing of intervention in patients presenting with crescendo transient ischemic attack.This systematic review included all English-language articles published from January 1, 1985, to January 1, 2019, available from PubMed (MEDLINE) and Google Scholar. Articles were excluded if they did not include analysis of patients with symptoms, did not report the timing of intervention after crescendo transient ischemic attack, or mixed analysis of patients with stroke in evolution with patients with crescendo transient ischemic attack. The quality of the evidence was assessed with the modified rating from the Oxford Centre for Evidence-based Medicine.Patients with crescendo transient ischemic attack were found to have a higher risk of stroke or death after carotid endarterectomy compared with patients with a single transient ischemic attack or stable stroke. With medical therapy alone, a considerable number of patients with crescendo transient ischemic attack experience a completed stroke within several months and have a poor prognosis without intervention. Urgent carotid endarterectomy, typically performed within 48 hours of initial presentation, is beneficial in carefully selected patients. There have been several reports of operative treatment within the first 24 hours of presentation; however, review of these reports does not show any additional benefit from emergency treatment. Carotid artery stenting is reserved only for selected patients with prohibitive surgical risk for endarterectomy. The literature does not clearly support any additional benefit of intravenous heparin therapy over mono or dual antiplatelet therapy prior to carotid endarterectomy.Crescendo transient ischemic attack is best managed with optimal medical management as well as urgent carotid endarterectomy within 2 days of presentation. Surgical endarterectomy appears to be preferred because of the increased embolic potential of bifurcation plaque, whereas stenting is an option for patients with contraindications for surgery. With ongoing advances in cerebrovascular imaging and medical treatment of stroke, there is a need for better evidence to determine the optimal timing and preoperative medical management of patients with crescendo transient ischemic attack.

    View details for DOI 10.1001/jamasurg.2019.2952

    View details for PubMedID 31483458

  • Raising the bar for appropriateness in the care of patients with peripheral artery disease. Journal of vascular surgery cases and innovative techniques Ochoa Chaar, C. I., Fereydooni, A. n., Lawrence, P. F., Dardik, A. n. 2019; 5 (3): 345–49

    Abstract

    Advances in endovascular therapy have exponentially increased the number of procedures performed for peripheral artery disease, but public concerns of overuse have placed the vascular community under scrutiny. The appropriateness of care has thus become a focus of discussion within several professional societies, but literature on the topic is limited. This report presents two cases of patients with peripheral artery disease, one patient who did not need revascularization and underwent an intervention and the other who required additional intervention that was not recognized owing to an incomplete diagnostic workup.

    View details for DOI 10.1016/j.jvscit.2019.03.009

    View details for PubMedID 31334415

    View details for PubMedCentralID PMC6614600

  • On-table modification of self-expanding covered stents for hybrid aortobifemoral revascularization. Journal of vascular surgery cases and innovative techniques Fereydooni, A. n., Deyholos, C. n., Nezami, N. n., Dardik, A. n., Nassiri, N. n. 2019; 5 (2): 179–82

    Abstract

    Femoral endarterectomy with iliac stenting is a safe and effective minimally invasive alternative to aortobifemoral bypass. However, TransAtlantic Inter-Society Consensus D lesions with contiguous iliofemoral occlusion are challenging cases for hybrid repair. Herein, we present a unique approach for iliofemoral revascularization by on-table modification of self-expanding covered stents.

    View details for DOI 10.1016/j.jvscit.2018.12.013

    View details for PubMedID 31193649

    View details for PubMedCentralID PMC6536774

  • Bifurcated unibody aortic endografts can overcome unfavorable aortoiliac anatomy for deployment of bilateral iliac branch endoprostheses. Journal of vascular surgery cases and innovative techniques Fereydooni, A. n., Deyholos, C. n., Botta, R. n., Nezami, N. n., Dardik, A. n., Nassiri, N. n. 2019; 5 (2): 174–78

    Abstract

    In conjunction with traditional modular bifurcated aortic endografts, bilateral iliac branch endoprostheses have been safely and effectively used for treatment of bilateral iliac artery aneurysms. However, anatomic constraints, such as inadequate renal artery to iliac bifurcation lengths and unfavorable aortic anatomy, can preclude deployment in certain configurations and limit use in many patients. We present an innovative technique to overcome such anatomic constraints and to extend the reach of iliac branch endoprosthesis technology in patients with iliac artery aneurysms.

    View details for DOI 10.1016/j.jvscit.2019.01.004

    View details for PubMedID 31193591

    View details for PubMedCentralID PMC6536773

  • National trends of hybrid lower extremity revascularization in the ACS-NSQIP database. Vascular Fereydooni, A. n., Zhou, B. n., Jorshery, S. D., Deng, Y. n., Dardik, A. n., Chaar, C. I. 2019; 27 (6): 653–62

    View details for DOI 10.1177/1708538119852019

    View details for PubMedID 31126228

  • Regulation of axon growth by myosin II-dependent mechanocatalysis of cofilin activity. The Journal of cell biology Zhang, X. F., Ajeti, V. n., Tsai, N. n., Fereydooni, A. n., Burns, W. n., Murrell, M. n., De La Cruz, E. M., Forscher, P. n. 2019; 218 (7): 2329–49

    Abstract

    Serotonin (5-HT) is known to increase the rate of growth cone advance via cofilin-dependent increases in retrograde actin network flow and nonmuscle myosin II activity. We report that myosin II activity is regulated by PKC during 5-HT responses and that PKC activity is necessary for increases in traction force normally associated with these growth responses. 5-HT simultaneously induces cofilin-dependent decreases in actin network density and PKC-dependent increases in point contact density. These reciprocal effects facilitate increases in traction force production in domains exhibiting decreased actin network density. Interestingly, when PKC activity was up-regulated, 5-HT treatments resulted in myosin II hyperactivation accompanied by catastrophic cofilin-dependent decreases in actin filament density, sudden decreases in traction force, and neurite retraction. These results reveal a synergistic relationship between cofilin and myosin II that is spatiotemporally regulated in the growth cone via mechanocatalytic effects to modulate neurite growth.

    View details for DOI 10.1083/jcb.201810054

    View details for PubMedID 31123185

    View details for PubMedCentralID PMC6605792

  • Anomalous course of the left common iliac vein anterior to the right common iliac artery with resultant May-Thurner syndrome. Journal of vascular surgery. Venous and lymphatic disorders Fereydooni, A. n., Deyholos, C. n., Nezami, N. n., Feler, J. R., Mojibian, H. n., Nassiri, N. n. 2019; 7 (3): 450–51

    View details for DOI 10.1016/j.jvsv.2019.01.059

    View details for PubMedID 31000065

  • Molecular changes associated with vascular malformations. Journal of vascular surgery Fereydooni, A. n., Dardik, A. n., Nassiri, N. n. 2019; 70 (1): 314–26.e1

    Abstract

    Vascular anomalies are typically classified into two major categories, vascular tumors and vascular malformations. Most vascular malformations are caused sporadically by somatic mosaic gene mutations, and genetic analyses have advanced our understanding of the biomolecular mechanisms involved in their pathogenesis. Culprit gene mutations typically involve two major signaling pathways; the RAS/MAPK/ERK pathway is typically involved in fast-flow arteriovenous malformations, whereas the PI3K/AKT/mTOR pathway is typically mutated in slow-flow venous and lymphatic malformations. These findings suggest new therapeutic approaches to vascular malformations, focusing on targeting the etiologic mutated pathways. This review summarizes the currently available literature reflecting the updated International Society for Study of Vascular Anomalies classification system with emphasis on potential therapeutic targets that will provide vascular surgeons with an updated perspective on the etiologic basis of vascular malformations, allowing improved multidisciplinary collaboration.

    View details for DOI 10.1016/j.jvs.2018.12.033

    View details for PubMedID 30922748

  • The potential and limitations of induced pluripotent stem cells to achieve wound healing. Stem cell research & therapy Gorecka, J. n., Kostiuk, V. n., Fereydooni, A. n., Gonzalez, L. n., Luo, J. n., Dash, B. n., Isaji, T. n., Ono, S. n., Liu, S. n., Lee, S. R., Xu, J. n., Liu, J. n., Taniguchi, R. n., Yastula, B. n., Hsia, H. C., Qyang, Y. n., Dardik, A. n. 2019; 10 (1): 87

    Abstract

    Wound healing is the physiologic response to a disruption in normal skin architecture and requires both spatial and temporal coordination of multiple cell types and cytokines. This complex process is prone to dysregulation secondary to local and systemic factors such as ischemia and diabetes that frequently lead to chronic wounds. Chronic wounds such as diabetic foot ulcers are epidemic with great cost to the healthcare system as they heal poorly and recur frequently, creating an urgent need for new and advanced therapies. Stem cell therapy is emerging as a potential treatment for chronic wounds, and adult-derived stem cells are currently employed in several commercially available products; however, stem cell therapy is limited by the need for invasive harvesting techniques, immunogenicity, and limited cell survival in vivo. Induced pluripotent stem cells (iPSC) are an exciting cell type with enhanced therapeutic and translational potential. iPSC are derived from adult cells by in vitro induction of pluripotency, obviating the ethical dilemmas surrounding the use of embryonic stem cells; they are harvested non-invasively and can be transplanted autologously, reducing immune rejection; and iPSC are the only cell type capable of being differentiated into all of the cell types in healthy skin. This review focuses on the use of iPSC in animal models of wound healing including limb ischemia, as well as their limitations and methods aimed at improving iPSC safety profile in an effort to hasten translation to human studies.

    View details for DOI 10.1186/s13287-019-1185-1

    View details for PubMedID 30867069

    View details for PubMedCentralID PMC6416973

  • Computer-assisted 3D bowel length measurement for quantitative laparoscopy. Surgical endoscopy Wagner, M., Mayer, B. F., Bodenstedt, S., Stemmer, K., Fereydooni, A., Speidel, S., Dillmann, R., Nickel, F., Fischer, L., Kenngott, H. G. 2018; 32 (9): 4052-4061

    Abstract

    This study aimed at developing and evaluating a tool for computer-assisted 3D bowel length measurement (BMS) to improve objective measurement in minimally invasive surgery. Standardization and quality of surgery as well as its documentation are currently limited by lack of objective intraoperative measurements. To solve this problem, we developed BMS as a clinical application of Quantitative Laparoscopy (QL).BMS processes images from a conventional 3D laparoscope. Computer vision algorithms are used to measure the distance between laparoscopic instruments along a 3D reconstruction of the bowel surface. Preclinical evaluation was performed in phantom, ex vivo porcine, and in vivo porcine models. A bowel length of 70 cm was measured with BMS and compared to a manually obtained ground truth. Afterwards 70 cm of bowel (ground truth) was measured and compared to BMS.Ground truth was 66.1 ± 2.7 cm (relative error + 5.8%) in phantom, 65.8 ± 2.5 cm (relative error + 6.4%) in ex vivo, and 67.5 ± 6.6 cm (relative error + 3.7%) in in vivo porcine evaluation when 70 cm was measured with BMS. Using 70 cm of bowel, BMS measured 75.0 ± 2.9 cm (relative error + 7.2%) in phantom and 74.4 ± 2.8 cm (relative error + 6.3%) in ex vivo porcine evaluation. After thorough preclinical evaluation, BMS was successfully used in a patient undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity.QL using BMS was shown to be feasible and was successfully translated from studies on phantom, ex vivo, and in vivo porcine bowel to a clinical feasibility study.

    View details for DOI 10.1007/s00464-018-6135-y

    View details for PubMedID 29508142

  • Irinotecan-Eluting 75-150-μm Embolics Lobar Chemoembolization in Patients with Colorectal Cancer Liver Metastases: A Prospective Single-Center Phase I Study. Journal of vascular and interventional radiology : JVIR Fereydooni, A. n., Letzen, B. n., Ghani, M. A., Miszczuk, M. A., Huber, S. n., Chapiro, J. n., Schlachter, T. n., Geschwind, J. F., Georgiades, C. n. 2018; 29 (12): 1646–53.e5

    Abstract

    The primary end point of this trial was to determine the feasibility and safety of transarterial chemoembolization with the use of 75-150-μm drug-eluting embolics loaded with irinotecan (DEE-IRI) for the treatment of metastatic colorectal cancer (CRC) refractory to systemic chemotherapy.Fourteen patients (mean age 57.9 years) with liver-dominant metastatic disease (14.3% unilobar, 85.7% bilobar), who had failed at least 1 line of chemotherapy, were enrolled and received up to 4 (mean 2.3) cycles of DEE-IRI lobar transarterial chemoembolization. Technical complications and adverse events were recorded, and response was assessed by means of imaging-based criteria. Levels of irinotecan and angiogenesis biomarkers in the serum were measured at multiple time points.Thirty-two DEE-IRI transarterial chemoembolizations were successfully performed, and the full dose (100 mg) was delivered in all cases. The only grade 3-4 toxicity was abdominal pain (29%). One patient had objective response according to the Response Evaluation Criteria in Solid Tumors and World Health Organization, and 3 patients had objective response according to the European Association for the Study of the Liver. The median overall survival was 18.14 months, and the 1-year survival was 65%. The average plasma Cmax of the active metabolite was 41.5 ± 26.1 ng/mL, with average Tmax of 1.3 ± 0.5 hours. The treatment significantly reduced levels of vascular endothelial growth factor receptor 1 (VEGFR1) at 24 hours.Lobar transarterial chemoembolization with the use of DEE-IRI is a technically feasible and well tolerated palliative treatment for patients with refractory liver-predominant CRC metastatic disease and has acceptable pharmacokinetics. VEGFR1 is a potential biomarker for predicting treatment efficacy and risk of adverse events.

    View details for DOI 10.1016/j.jvir.2018.08.010

    View details for PubMedID 30337148