Bio


Tori grew up in Cleveland, Ohio and attended Duke University, where she majored in Biology and minored in Computer Science. After graduation, she moved to San Diego, where she worked at a biotechnology company researching stabilization of blood products at room temperature. In 2014, she moved to Palo Alto and began medical school at Stanford. During medical school, she worked with Dr. Rusty Hofmann in interventional radiology researching best practices in venous interventions, leading to multiple publications and presentations at SIR. After graduating from medical school in 2018, she began her general surgery intern year at the Cleveland Clinic and after a year in Cleveland, she returned to the California sunshine to begin radiology residency in July 2019. Tori continues to be active in her research into the treatment of venous disease. Outside of residency, she also enjoys hiking around northern California, traveling the world, running, and reading all types of books.

Clinical Focus


  • Residency

All Publications


  • Lower extremity vein segment diameters: Analysis of patent, unstented vein segment diameters in 266 patients with underlying venous disease. Journal of vascular surgery. Venous and lymphatic disorders Arendt, V. A., Mabud, T. S., Jeon, G. S., An, X., Cohn, D. M., Fu, J. X., Hofmann, L. V. 2020

    Abstract

    OBJECTIVE: The objective of this study was to characterize the average maximum diameters of widely patent lower extremity vein segments in patients with underlying venous disease and the demographic factors that affect these diameters.METHODS: Maximum axial diameters of each deep vein segment from the diaphragm to the knee were measured from computed tomography venography studies for all patients who underwent venous stent placement during a 20-year period at a single quaternary venous referral institution. Limbs containing only widely patent, unstented vein segments without variant anatomy were identified for inclusion. The final analysis involved diameter measurements from 870 imaging studies of 266 patients. Multivariate linear regression was used to identify factors associated with vein segment diameters.RESULTS: Average vein segment diameters ranged from 7.8mm for the left and right femoral veins to 27.9mm for the long axis of the suprarenal inferior vena cava. Multivariate linear regression demonstrated that women had larger IVC, common iliac vein, and external iliac vein diameters, whereas men had larger common femoral veins. Laterality, height, weight, and sex also had statistically significant associations with the diameters of select vein segments.CONCLUSIONS: This study provides an estimate of the average diameters of widely patent deep vein segments in the lower extremities from the diaphragm to the knees in patients with underlying venous disease and characterizes covariates that significantly affect vein diameter. These findings may help interventionalists better select devices for endovascular intervention.

    View details for DOI 10.1016/j.jvsv.2019.12.078

    View details for PubMedID 32107163

  • Diagnostic performance of lower extremity Doppler ultrasound in detecting iliocaval obstruction. Journal of vascular surgery. Venous and lymphatic disorders Hui, J. Z., Goldman, R. E., Mabud, T. S., Arendt, V. A., Kuo, W. T., Hofmann, L. V. 2020

    Abstract

    To retrospectively evaluate the performance of two commonly used Doppler ultrasound parameters, namely, venous flow phasicity and response to Valsalva maneuver, in detecting iliocaval obstruction.All imaging studies of patients seen by interventional radiology for lower extremity venous disease at a single institution from 1996 to 2018 were retrospectively identified. Lower extremity ultrasounds with a concurrent magnetic resonance, computed tomography, or conventional venogram performed within the next 7 days, which served as gold standard, were further identified (n = 192 examinations, including 313 limbs). Iliocaval obstruction were assessed by two ultrasound criteria: (1) nonphasic flow and/or (2) nonresponsive flow to Valsalva in the common femoral vein. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for diagnosing iliocaval obstruction were calculated for each ultrasound criterion, and also for when the two criteria were assessed jointly.Of the 313 limbs assessed for venous flow phasicity, 133 (42.5%) had an iliocaval obstruction confirmed on subsequent venography. Nonphasic flow demonstrated a sensitivity of 69.2%, specificity of 82.8%, NPV of 78.4%, and PPV of 74.8% for diagnosing iliocaval obstruction. Of the 212 limbs assessed for Valsalva response, 88 (41.5%) had a confirmed iliocaval obstruction. Nonresponsive flow to Valsalva demonstrated a sensitivity of 13.6%, specificity of 97.6%, NPV of 61.6%, and PPV of 80.0% for diagnosing iliocaval obstruction. Joint assessment using phasicity and Valsalva criteria demonstrated a sensitivity of 68.2%, specificity of 87.2%, NPV of 79.6%, and PPV of 78.9%.In this tertiary care setting, Doppler ultrasound examination was not a reliable diagnostic tool for detecting iliocaval obstruction.

    View details for DOI 10.1016/j.jvsv.2019.12.074

    View details for PubMedID 32107162

  • Inferior Vena Cava Atresia: Characterisation of Risk Factors, Treatment, and Outcomes. Cardiovascular and interventional radiology Mabud, T. S., Sailer, A. M., Swee, J. K., Tamboli, M., Arendt, V. A., Jeon, G., An, X., Cohn, D. M., Kuo, W. T., Hofmann, L. V. 2019

    Abstract

    PURPOSE: To characterise (1) the risk factors associated with inferior vena cava (IVC) atresia, (2) the radiographic and clinical presentations of deep vein thrombosis (DVT) in patients with IVC atresia, and (3) the treatment and outcome of DVT in patients with IVC atresia.METHODS: The electronic medical record was systematically reviewed for thrombotic risk factors in patients who presented with lower-extremity DVT (n=409) at a single centre between 1996 and 2017. Patients with IVC atresia were identified based on imaging and chart review. Differences in demographics and thrombotic risk factors between patients with and without IVC atresia were statistically assessed. Extent and chronicity of DVT on imaging, clinical presentation, treatment, and outcomes were evaluated for all patients with IVC atresia.RESULTS: 4.2% of DVT patients (17/409) were found to have IVC atresia; mean age at diagnosis was 25.5±9.4years. The rate of heritable thrombophiliawas significantly higher in patients with IVC atresia compared to patients without IVC atresia (52.9% vs. 17.9%, p<0.0001). There were bilateral DVT in 70.6% of IVC atresia patients; DVT was chronic in 41.2% and acute on chronic in 58.8%. Pre-intervention Villalta scores were 13.9±9.8 in the left limb and 8.5±7.0 in the right limb. DVT in IVC atresia patients was typically treated with catheter-directed thrombolysis followed by stent placement, achieving complete or partial symptom resolution in 78.6% of cases.CONCLUSION: Thrombotic risk factors such as heritable thrombophilia are associated with IVC atresia. IVC atresia patients can experience high burdens of lower-extremity thrombotic disease at a young age which benefit from endovascular treatment.LEVEL OF EVIDENCE: Level 4.

    View details for DOI 10.1007/s00270-019-02353-z

    View details for PubMedID 31650242

  • Toward Data-Driven Learning Healthcare Systems in Interventional Radiology: Implementation to Evaluate Venous Stent Patency. Journal of digital imaging Cohn, D. M., Mabud, T. S., Arendt, V. A., Souffrant, A. D., Jeon, G. S., An, X., Kuo, W. T., Sze, D. Y., Hofmann, L. V., Rubin, D. L. 2019

    Abstract

    We developed a code and data-driven system (learning healthcare system) for gleaning actionable clinical insight from interventional radiology (IR) data. To this end, we constructed a workflow for the collection, processing and analysis of electronic health record (EHR), imaging, and cancer registry data for a cohort of interventional radiology patients seen in the IR Clinic at our institution over a more than 20-year period. As part of this pipeline, we created a database in REDCap (VITAL) to store raw data, as collected by a team of clinical investigators and the Data Coordinating Center at our university. We developed a single, universal pre-processing codebank for our VITAL data in R; in addition, we also wrote widely extendable and easily modifiable analysis code in R that presents results from summary statistics, statistical tests, visualizations, Kaplan-Meier analyses, and Cox proportional hazard modeling, among other analysis techniques. We present our findings for a test case of supra versus infra-inguinal ligament stenting. The developed pre-processing and analysis pipelines were memory and speed-efficient, with both pipelines running in less than 2min. Three different supra-inguinal ligament veins had a statistically significant improvement in vein diameters post-stenting versus pre-stenting, while no infra-inguinal ligament veins had a statistically significant improvement (due either to an insufficient sample size or a non-significant p value). However, infra-inguinal ligament stenting was not associated with worse restenosis or patency outcomes in either a univariate (summary-statistics and Kaplan-Meier based) or multivariate (Cox proportional hazard model based) analysis.

    View details for DOI 10.1007/s10278-019-00280-6

    View details for PubMedID 31650318

  • Lower Extremity Venous Stent Placement: A Large Retrospective Single-Center Analysis. Journal of vascular and interventional radiology : JVIR Mabud, T. S., Cohn, D. M., Arendt, V. A., Jeon, G., An, X., Fu, J., Souffrant, A. D., Sailer, A. M., Shah, R., Wang, D., Sze, D. Y., Kuo, W. T., Rubin, D. L., Hofmann, L. V. 2019

    Abstract

    PURPOSE: To study short-term and long-term outcomes of lower extremity venous stents placed at a single center and to characterize changes in vein diameter achieved by stent placement.MATERIALS AND METHODS: A database of all patients who received lower extremity venous stents between 1996 and 2018 revealed 1,094 stents were placed in 406 patients (172 men, 234 women; median age, 49 y) in 513 limbs, including patients with iliocaval stents (9.4% acute thrombosis, 65.3% chronic thrombosis, 25.3% nonthrombotic lesions). Primary, primary assisted, and secondary patency rates were assessed for lower extremity venous stents at 1, 3, and 5 years using Kaplan-Meier analyses and summary statistics. Subset analyses and Cox regression were performed to identify risk factors for patency loss. Vein diameters and Villalta scores before and up to 12 months after stent placement were compared. Complication and mortality rates were calculated.RESULTS: Primary, primary assisted, and secondary patency rates at 5 years were 57.3%, 77.2%, and 80.9% by Kaplan-Meier methods and 78.6%, 90.3%, and 92.8% by summary statistics. Median follow-up was 199 days (interquartile range, 35.2-712.0 d). Patency rates for the subset of patients (n= 46) with ≥ 5 years of follow-up (mean ± SD 9.1 y ± 3.4) were nearly identical to cohort patency rates at 5 years. Patients with inferior vena cava stent placement (hazard ratio 2.11, P < .0001) or acute thrombosis (hazard ratio 3.65, P < .0001) during the index procedure had significantly increased risk of losing primary patency status. Vein diameters were significantly greater after stent placement. There were no instances of stent fracture, migration, or structural deformities. In patients with chronic deep vein thrombosis, Villalta scores significantly decreased after stent placement (from 15.7 to 7.4, P < .0001). Perioperative mortality was < 1%, and major perioperative complication rate was 3.7%.CONCLUSIONS: Cavo-ilio-femoral stent placement for venous occlusive disease achieves improvement of vein disease severity scores, increase in treated vein diameters, and satisfactory long-term patency rates.

    View details for DOI 10.1016/j.jvir.2019.06.011

    View details for PubMedID 31542273

  • Automated Quantitative Imaging Measurements of Disease Severity in Patients with Nonthrombotic Iliac Vein Compression. Journal of vascular and interventional radiology : JVIR Reposar, A. L., Mabud, T. S., Eifler, A. C., Hoogi, A., Arendt, V., Cohn, D. M., Rubin, D. L., Hofmann, L. V. 2019

    Abstract

    PURPOSE: An automated segmentation technique (AST) for computed tomography (CT) venography was developed to quantify measures of disease severity before and after stent placement in patients with left-sided nonthrombotic iliac vein compression.MATERIALS AND METHODS: Twenty-one patients with left-sided nonthrombotic iliac vein compression who underwent venous stent placement were retrospectively identified. Pre- and poststent CT venography studies were quantitatively analyzed using an AST to determine leg volume, skin thickness, and water content of fat. These measures were compared between diseased and nondiseased limbs and between pre- and poststent images, using patients as their own controls. Additionally, patients with and without postthrombotic lesions were compared.RESULTS: The AST detected significantly increased leg volume (12,437 cm3 vs 10,748 cm3, P < .0001), skin thickness (0.531 cm vs 0.508 cm, P < .0001), and water content of fat (8.2% vs 5.0%, P < .0001) in diseased left limbs compared with the contralateral nondiseased limbs, on prestent imaging. After stent placement in the left leg, there was a significant decrease in the water content of fat in the right (4.9% vs 2.7%, P < .0001) and left (8.2% vs 3.2%, P < .0001) legs. There were no significant changes in leg volume or skin thickness in either leg after stent placement. There were no significant differences between patients with or without postthrombotic lesions in their poststent improvement across the 3 measures of disease severity.CONCLUSIONS: ASTs can be used to quantify measures of disease severity and postintervention changes on CT venography for patients with lower extremity venous disease. Further investigation may clarify the clinical benefit of such technologies.

    View details for DOI 10.1016/j.jvir.2019.04.034

    View details for PubMedID 31542272

  • Endovascular Management of May-Thurner Syndrome in Adolescents: A Single-Center Experience JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Goldman, R. E., Arendt, V. A., Kothary, N., Kuo, W. T., Sze, D. Y., Hofmann, L. V., Lungren, M. P. 2017; 28 (1): 71-77

    Abstract

    To report a single-center experience in regard to the technique, safety, and clinical outcomes of endovascular therapy for treatment of May-Thurner syndrome (MTS) in adolescent patients.A retrospective review identified 10 patients (6 female; mean age, 16 y; range, 12-18 y; mean weight, 73 kg; range, 50-116 kg) treated by endovascular therapy for MTS from 1998 to 2015. Clinical presentations consisted of acute thrombotic MTS (n = 6) and nonthrombotic MTS (n = 4). Catheter-directed thrombolysis was performed in all cases of thrombosis. Venoplasty and stent placement were performed in all cases. Self-expanding stents 12-16 mm in diameter and 4-9 cm in length were deployed.No major periprocedural complications were observed. Median follow-up was 32 months (range, 6-109 mo). Primary and secondary patency rates were 79% and 100% at 12 months and 79% and 89% at 36 months, respectively. In a single patient with permanent loss of flow in the treated segment, multiple risk factors for thrombosis were identified. Rates of posttreatment symptoms were 0% by Villalta score and 60% (n = 6; mild symptoms) by modified Villalta score at the last clinical follow-up.Endovascular therapy for the treatment of MTS in our adolescent cohort was safe and effective in relieving venous obstruction. Stent placement in patients with underlying thrombophilic disorders is associated with loss of secondary patency, suggesting the need for further consideration in this population.

    View details for DOI 10.1016/j.jvir.2016.09.005

    View details for Web of Science ID 000392465200010

  • Endovascular Management of May-Thurner Syndrome in Adolescents: A Single-Center Experience. Journal of vascular and interventional radiology Goldman, R. E., Arendt, V. A., Kothary, N., Kuo, W. T., Sze, D. Y., Hofmann, L. V., Lungren, M. P. 2016

    Abstract

    To report a single-center experience in regard to the technique, safety, and clinical outcomes of endovascular therapy for treatment of May-Thurner syndrome (MTS) in adolescent patients.A retrospective review identified 10 patients (6 female; mean age, 16 y; range, 12-18 y; mean weight, 73 kg; range, 50-116 kg) treated by endovascular therapy for MTS from 1998 to 2015. Clinical presentations consisted of acute thrombotic MTS (n = 6) and nonthrombotic MTS (n = 4). Catheter-directed thrombolysis was performed in all cases of thrombosis. Venoplasty and stent placement were performed in all cases. Self-expanding stents 12-16 mm in diameter and 4-9 cm in length were deployed.No major periprocedural complications were observed. Median follow-up was 32 months (range, 6-109 mo). Primary and secondary patency rates were 79% and 100% at 12 months and 79% and 89% at 36 months, respectively. In a single patient with permanent loss of flow in the treated segment, multiple risk factors for thrombosis were identified. Rates of posttreatment symptoms were 0% by Villalta score and 60% (n = 6; mild symptoms) by modified Villalta score at the last clinical follow-up.Endovascular therapy for the treatment of MTS in our adolescent cohort was safe and effective in relieving venous obstruction. Stent placement in patients with underlying thrombophilic disorders is associated with loss of secondary patency, suggesting the need for further consideration in this population.

    View details for DOI 10.1016/j.jvir.2016.09.005

    View details for PubMedID 27818112