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Yolanda Bryce, Brian Schiro, Kyle Cooper, Suvranu Ganguli, Mamdouh Khayat, Cuong Ken Lam, Rahmi Oklu, Geogy Vatakencherry, Ripal T Gandhi
Elective abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm, symptomatic, or rapidly expanding more than 0.5 cm in 6 months. Seventy-five percent of AAAs today are treated with endovascular aneurysm repair (EVAR) rather than open repair. This is fostered by the lower periprocedural mortality, complications, and length of hospital stay associated with EVAR. However, some studies have demonstrated EVAR to result in higher reintervention rates than with open repair, largely due to endoleaks...
April 2018: Cardiovascular Diagnosis and Therapy
Amy R Deipolyi, Christopher D Czaplicki, Rahmi Oklu
Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities.
April 2018: Cardiovascular Diagnosis and Therapy
Patrick Hangge, Yash Pershad, Avery A Witting, Hassan Albadawi, Rahmi Oklu
Three-dimensional (3D) printing is a process which generates prototypes from virtual objects in computer-aided design (CAD) software. Since 3D printing enables the creation of customized objects, it is a rapidly expanding field in an age of personalized medicine. We discuss the use of 3D printing in surgical planning, training, and creation of devices for the treatment of aortic diseases. 3D printing can provide operators with a hands-on model to interact with complex anatomy, enable prototyping of devices for implantation based upon anatomy, or even provide pre-procedural simulation...
April 2018: Cardiovascular Diagnosis and Therapy
William W Sheaffer, Patrick T Hangge, Anthony H Chau, Sadeer J Alzubaidi, M-Grace Knuttinen, Sailendra G Naidu, Suvranu Ganguli, Rahmi Oklu, Victor J Davila
Dialysis associated steal syndrome (DASS) is a relatively rare but debilitating complication of arteriovenous fistulas. While mild symptoms can be observed, if severe symptoms are left untreated, DASS can result in ulcerations and limb threatening ischemia. High-flow with resultant heart failure is another documented complication following dialysis access procedures. Historically, open surgical procedures have been the mainstay of therapy for both DASS as well as high-flow. These procedures included ligation, open surgical banding, distal revascularization-interval ligation, revascularization using distal inflow, and proximal invasion of arterial inflow...
May 29, 2018: Journal of Clinical Medicine
Yash Pershad, Patrick T Hangge, Hassan Albadawi, Rahmi Oklu
Social media enables the public sharing of information. With the recent emphasis on transparency and the open sharing of information between doctors and patients, the intersection of social media and healthcare is of particular interest. Twitter is currently the most popular form of social media used for healthcare communication; here, we examine the use of Twitter in medicine and specifically explore in what capacity using Twitter to share information on treatments and research has the potential to improve care...
May 28, 2018: Journal of Clinical Medicine
Aditya Khurana, Patrick T Hangge, Hassan Albadawi, M-Grace Knuttinen, Sadeer J Alzubaidi, Sailendra G Naidu, J Scott Kriegshauser, Rahmi Oklu, Brian W Chong
Arteriovenous malformations (AVMs) are a subset of congenital vascular malformations (CVMs). They comprise abnormal connections between arterial and venous circulation; treatment approaches are dependent on the angioarchitecture of the AVM, specifically the number and arrangement of the feeder arteries and outflow veins. Various imaging modalities can be used to diagnose and plan treatment. Here we will review the use of transarterial approaches to treat AVMs.
May 9, 2018: Journal of Clinical Medicine
Patrick T Hangge, Nikhil Gupta, Aditya Khurana, Keith B Quencer, Hassan Albadawi, Sadeer J Alzubaidi, M-Grace Knuttinen, Sailendra G Naidu, Rahmi Oklu
Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment. We aimed to evaluate the specificity of LRV compression to NS symptoms through a retrospective study including 33 NS and 103 control patients. The size of the patent lumen at point of compression and normal portions of the LRV were measured for all patients...
May 8, 2018: Journal of Clinical Medicine
Gokhan Kuyumcu, Igor Latich, Rulon L Hardman, Gabriel C Fine, Rahmi Oklu, Keith B Quencer
The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will summarize anatomy and embryology of the GDA, indications, outcomes and complications of GDA embolization.
May 2, 2018: Journal of Clinical Medicine
Keith B Quencer, Anthony S Tadros, Keyan B Marashi, Ziga Cizman, Eric Reiner, Ryan O'Hara, Rahmi Oklu
Of all procedures in interventional radiology, percutaneous transhepatic biliary drainage (PTBD) is amongst the most technically challenging. Successful placement requires a high level of assorted skills. While this procedure can be life-saving, it can also lead to significant iatrogenic harm, often manifesting as bleeding. Readers of this article will come to understand the pathophysiology and anatomy underlying post-PTBD bleeding, its incidence, its varied clinical manifestations and its initial management...
May 1, 2018: Journal of Clinical Medicine
Cameron Adler, Patrick T Hangge, Hassan Albadawi, M-Grace Knuttinen, Sadeer J Alzubaidi, Sailendra G Naidu, Rahmi Oklu
Cross-sectional imaging has become a critical aspect in the evaluation of arterial injuries. In particular, angiography using computed tomography (CT) is the imaging of choice. A variety of techniques and options are available when evaluating for arterial injuries. Techniques involve contrast bolus, various phases of contrast enhancement, multiplanar reconstruction, volume rendering, and maximum intensity projection. After the images are rendered, a variety of features may be seen that diagnose the injury. This article provides a general overview of the techniques, important findings, and pitfalls in cross sectional imaging of arterial imaging, particularly in relation to computed tomography...
April 24, 2018: Journal of Clinical Medicine
M-Grace Knuttinen, Johnny Yi, Paul Magtibay, Christina T Miller, Sadeer Alzubaidi, Sailendra Naidu, Rahmi Oklu, J Scott Kriegshauser, Winnie A Mar
Colovaginal and/or rectovaginal fistulas cause significant and distressing symptoms, including vaginitis, passage of flatus/feces through the vagina, and painful skin excoriation. These fistulas can be a challenging condition to treat. Although most fistulas can be treated with surgical repair, for those patients who are not operative candidates, limited options remain. As minimally-invasive interventional techniques have evolved, the possibility of fistula occlusion has enriched the therapeutic armamentarium for the treatment of these complex patients...
April 22, 2018: Journal of Clinical Medicine
Patrick T Hangge, Ilana Breen, Hassan Albadawi, M Grace Knuttinen, Sailendra G Naidu, Rahmi Oklu
Quadrilateral space syndrome (QSS) is a rare disorder characterized by axillary nerve and posterior humeral circumflex artery (PHCA) compression within the quadrilateral space. Impingement is most frequently due to trauma, fibrous bands, or hypertrophy of one of the muscular borders. Diagnosis can be complicated by the presence of concurrent traumatic injuries, particularly in athletes. Since many other conditions can mimic QSS, it is often a diagnosis of exclusion. Conservative treatment is often first trialed, including physical exercise modification, physical therapy, and therapeutic massage...
April 21, 2018: Journal of Clinical Medicine
Thomas T DeLeon, Daniel H Ahn, James M Bogenberger, Panos Z Anastasiadis, Mansi Arora, Ramesh K Ramanathan, Bashar A Aqel, George Vasmatzis, Mark J Truty, Rahmi Oklu, Tanios S Bekaii-Saab, Mitesh J Borad
Worldwide hepatobiliary cancers are the second leading cause of cancer related death. Despite their relevance, hepatobiliary cancers have a paucity of approved systemic therapy options. However, there are a number of emerging therapeutic biomarkers and therapeutic concepts that show promise. In hepatocellular carcinoma, nivolumab appears particularly promising and recently received US FDA approval. In intrahepatic cholangiocarcinoma, therapies targeting FGFR2 and IDH1 and immune checkpoint inhibitors are the furthest along and generating the most excitement...
March 2018: Future Oncology
Sailen G Naidu, Christine O Menias, Rahmi Oklu, Robert S Hines, Kinan Alhalabi, Gerges Makar, Fadi E Shamoun, Stanislav Henkin, Robert D McBane
OBJECTIVE: The purpose of this study is to identify the imaging characteristics of segmental arterial mediolysis (SAM) at presentation and establish the longitudinal course of disease. MATERIALS AND METHODS: We retrospectively identified patients with SAM at a single institution from 2000 through 2015. Diagnosis was based on published guidelines with multidisciplinary consensus. Imaging studies obtained at initial evaluation were reviewed to evaluate imaging findings and vascular territory distribution...
April 2018: AJR. American Journal of Roentgenology
Yu Shrike Zhang, Rahmi Oklu, Hassan Albadawi
Thrombosis is a prevailing vascular disorder that has been historically studied in vivo with conventional animal models. Here we review recent advances in methods and techniques that allow for engineering of biomimetic in vitro models of thrombosis, usually combined with microfluidic devices, termed thrombosis-on-a-chip systems, to reproduce such vascular pathology outside living organisms. These human cell-based thrombosis-on-a-chip platforms recapitulate the important characteristics of native thrombosis in terms of vascular structures, extracellular matrix properties, cellular composition, and pathophysiology, making them enabling in vitro models to study this important class of vascular disorders as well as to develop personalized treatment regimens...
December 2017: Cardiovascular Diagnosis and Therapy
Sailen G Naidu, Martha-Gracia Knuttinen, J Scott Kriegshauser, William G Eversman, Rahmi Oklu
Pulmonary embolism (PE) is a widespread health concern associated with major morbidity and mortality. Catheter directed therapy (CDT) has emerged as a treatment option for acute PE adding to the current potential options of systemic thrombolysis or anticoagulation. The purpose of this review is to understand the rationale and indications for CDT in patients with PE. While numerous studies have shown the benefits of systemic thrombolysis compared to standard anticoagulation, these are balanced by the increased risk of major bleeding...
December 2017: Cardiovascular Diagnosis and Therapy
Keith Bertram Quencer, Rahmi Oklu
For the over 400,000 patients in the United States dependent on hemodialysis, arteriovenous (AV) access thrombosis may lead to missed dialysis sessions, inpatient admissions and the need for placement of temporary dialysis catheters. It is also the leading cause of permanent access loss. Percutaneous declotting is generally preferred over surgical thrombectomy. Various percutaneous approaches can be employed including the lyse-and-wait technique, thromboaspiration, pulse spray aided pharmacomechanical thrombolysis, and use of mechanical thrombectomy device...
December 2017: Cardiovascular Diagnosis and Therapy
Patrick Hangge, Lisa Rotellini-Coltvet, Amy R Deipolyi, Hassan Albadawi, Rahmi Oklu
Thoracic outlet syndrome (TOS) is a rare clinical entity with many etiologies. Venous thoracic outlet syndrome (VTOS), also called Paget-Schroetter syndrome (PSS), is a primary "effort" thrombosis. Here we will focus on the pathophysiology, anatomy, clinical presentation, treatments, and outcomes of VTOS. Treatment involves anticoagulation, catheter-directed thrombolysis, and surgical decompression. Early diagnosis and treatment can improve symptoms and quality of life.
December 2017: Cardiovascular Diagnosis and Therapy
Jonathan Stone, Patrick Hangge, Hassan Albadawi, Alex Wallace, Fadi Shamoun, M Grace Knuttien, Sailendra Naidu, Rahmi Oklu
Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000-100,000 deaths annually. Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors. Virchow's Triad distills the multitude of risk factors for DVT into three basic elements favoring thrombus formation: venous stasis, vascular injury, and hypercoagulability...
December 2017: Cardiovascular Diagnosis and Therapy
Patrick Hangge, Jonathan Stone, Hassan Albadawi, Yu Shrike Zhang, Ali Khademhosseini, Rahmi Oklu
Hemorrhage accounts for significant morbidity and mortality. Various techniques have been employed to augment hemostasis from simple tourniquets to self-assembling nanoparticles. A growing understanding of the natural clotting cascade has allowed agents to become more targeted for potential use in different clinical scenarios. This review discusses current and developing hemostatic techniques, including matrix agents, external agents, biologically inspired agents, and synthetic and cell-derived nanoparticles...
December 2017: Cardiovascular Diagnosis and Therapy
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