Mohamad Hamady

• MD, FRCR, EBIR
• Imperial College London

Purpose To describe the outcomes of a survey on the provision of interventional radiology procedures for the treatment of acute pulmonary embolism (PE) in Europe and beyond. Methods An online survey with 14 structured items was designed by the authors and was sent to 7116 CIRSE members via email. The anonymous online survey collected data for eigh...

Key Clinical Message The presence of multiple pseudoaneurysms in a patient should prompt investigations for the underlying etiologies including autoimmune and immunosuppressive disease processes. Treatment options include open repair and endovascular stenting. Abstract Pseudoaneurysms (also known as false aneurysms) are atypical dilatations or out...

Purpose Endovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK. Materials and Methods...

Introduction Left gastric artery embolisation (LGAE) is a well-established treatment for major upper gastrointestinal (GI) bleeding when control is not established via upper GI endoscopy and recently has shown promising results for weight loss in small single arm studies. LGAE could be a treatment option in between our current tier-3 and tier-4 ser...

Purpose To assess the current use of drug-eluting devices for peripheral arterial disease (PAD) among interventional radiologists following the controversy caused by the 2018 meta-analysis suggesting an increased mortality risk for paclitaxel-eluting devices. Methods An anonymous survey was sent to 7035 CIRSE members via email; only complete respo...

Objective Interventional radiology (IR) training in the UK has evolved since recognition as a subspecialty in 2010 and introduction of a new curriculum in 2021. The changing landscape, increasing workload and COVID-19 have affected training. The purpose of this study was to review trainees’ perspectives on training and develop strategies to further...

Restenosis typically occurs in regions of low and oscillating wall shear stress, which also favor the accumulation of atherogenic macromolecules such as low‐density lipoprotein (LDL). This study aims to evaluate LDL transport and accumulation at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulat...

Purpose: To assess the prevalence of burnout amongst Interventional Radiologists (IRs) in the United Kingdom and identify demographic and practice-related stressors that may adversely affect well-being. Materials and methods: A survey of 36 questions was divided into two sections. Section A consisted of 14 questions that assessed demographics an...

Objectives: This umbrella review aims to quality assess published meta-analyses, conduct a de-novo meta-analysis of the available randomized control trials (RCTs), and test the hypothesis that there is a long-term difference in mortality between OSR and EVAR. Methods: A systematic search was conducted in MEDLINE and EMBASE's bibliographic databa...

Introduction: Thoracic endovascular aortic repair (TEVAR) carries a 3%-6.1% stroke risk, including risk of 'silent' cerebral infarction (SCI). Stent-grafts are manufactured in room air and retain air. Instructions for use recommend saline flushing to 'de-air' the system prior to insertion, but substantial amounts of air are released when deploying...

As a relatively new specialty with a minimally invasive nature, the field of interventional radiology is rapidly growing. Although the application of robotic systems in this field shows great promise, such as with increased precision, accuracy, and safety, as well as reduced radiation dose and potential for teleoperated procedures, the progression...

Thoracic endovascular aortic repair (TEVAR) of aortic aneurysms and dissections involving the arch has evolved over the last two decades. Compared to conventional surgical methods, endovascular repair offers a less invasive treatment option with lower risk and faster recovery. Endografts used in TEVAR vary in design depending on the procedure and a...

Previous fluid-structure interaction (FSI) studies on carotid bifurcation focused on the effect of wall compliance on the predicted hemodynamic features in normal or atherosclerotic carotid arteries. However, FSI study on patient-specific post-stent carotid model is still lacking, and to the authors knowledge no such a study has been reported so fa...

Introduction Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded r...

Purpose Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). Methods MEDLINE, EMBASE and PUBMED online databases were searched, with studi...

This study aims to investigate the haemodynamic response induced by implantation of a double-branched endograft used in thoracic endovascular aortic repair (TEVAR) of the aortic arch. Anatomically realistic models were reconstructed from CT images obtained from patients who underwent TEVAR using the RelayPlus double-branched endograft implanted in...

Background Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to – or remember – their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vascul...

Introduction During subintimal angioplasty (SIA), it is not always possible to re-enter the vessel lumen due to a variety of factors. Recanalization using hydrophilic wires and catheters alone, apart from its potential technical failure, is also limited by minimal control over the re-entry point. This is frequently well beyond the point of occlusio...

Interventional radiology and cardiology are rapidly growing areas of minimally invasive surgery, covering multiple diagnostic and interventional procedures. Treatment via endovascular techniques has become the go-to approach, thanks to its minimally invasive nature and its effectiveness in reducing hospitalisation and total time to recovery when co...

Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disab...

Purpose To describe the dual purpose of left subclavian artery (LSA) scallop endografts to create the proximal landing zone (PLZ) and facilitate antegrade left-sided upper extremity access for branched endovascular aortic repair (BEVAR) of Type II thoracoabdominal aneurysms (TAAA) with a short PLZ. Technique Three patients with an inadequate (< 20...

Introduction CT-guided interventions are taught using a mentored approach on real patients. It is well established that simulation is a valuable training tool in medicine. This project assessed the feasibility and acceptance of replicating a CT-guided intervention using a bespoke software application with an augmented reality head-mounted display (...

Introduction: Thoracic endovascular aortic repair with a scallop design (scallop-TEVAR) is a useful treatment strategy to extend the proximal landing zone (PLZ), whilst maintaining perfusion to one or more of the supra-aortic trunks when treating aortic pathology with an unfavourable PLZ. The durability of this approach with the Bolton Relay scall...

Background: Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to – or remember – their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vascu...

Purpose Endovascular robotics is an emerging technology within the developing field of medical robotics. This was a prospective evaluation to assess safety and feasibility of robotic-assisted carotid artery stenting. Materials and Methods Consecutive cases of carotid artery stenting cases performed over period of 24 months, from May 2015 to Octobe...

OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay...

Background: The COVID-19 pandemic has had an unprecedented effect upon the National Health Service (NHS). Like other specialties, Interventional Radiology (IR) rapidly adapted to the evolving situation. Members of BSIR were surveyed to obtain a snapshot of the experiences of UK IRs in response to COVID-19. An electronic survey was compiled using G...

PurposeRobotic endovascular technology may offer advantages over conventional manual catheter techniques. Our aim was to compare the endovascular catheter path-length (PL) for robotic versus manual contralateral gate cannulation during endovascular aneurysm repair (EVAR), using video motion analysis (VMA). Methods This was a multicentre retrospecti...

PurposeAssess international interventional radiology (IR) training standards and trainee satisfaction to identify challenges and drive positive change.Materials and Methods An anonymous survey was created using Survey Monkey and distributed as a single-use web link via eight IR national and international societies around the world. It consisted of...

IntroductionThis was a retrospective case–control study at a single tertiary centre investigating all UFE procedures between January 2013 and December 2018 for symptomatic fibroids. The aim was to determine the clinical, imaging and procedural risk factors which impact upon the risk of post-uterine fibroid embolisation (UFE) intrauterine infection....

Although rare, subclavian artery injuries are associated with significant mortality and morbidity, with almost two-thirds of patients dying before reaching hospital. Recent advances in technology have resulted in increasing use of endovascular therapy in management of these injuries. In this report, we present a case of a successful hybrid repair o...

Open surgical repair of the aortic arch for degenerative aortic disease in an unfit patient is associated with significant morbidity and mortality. Endoluminal techniques have advanced over the last decade. Contemporary endovascular options including a hybrid approach (supra-aortic debranching and aortic stent graft), inner branched endograft, chim...

Background Previous clinical studies have shown that the incidence of restenosis after carotid and coronary stenting varies with stent design and deployment configuration. This study aims to determine how stent design may affect in-stent hemodynamics in stented carotid arteries by means of Computational Fluid Dynamics (CFD). Methods A robust compu...

IntroductionTwitter is the most used social media platform by medical professionals and has become an effective way to disseminate ideas and information.AimTo evaluate Twitter usage by some of the larger diagnostic radiology (DR) and interventional radiology (IR) societies.Materials and Methods Data were collected from the publicly available Twitte...

Background: The optimum management of isolated penetrating aortic ulceration (PAU), with no associated intramural hematoma or aortic dissection is not clear. We evaluate the short- and long-term outcomes in isolated PAU to better inform management strategies. Methods: We conducted a retrospective review of 43 consecutive patients (mean age, 72.2...

Branched endografts have been developed to treat complex pathology in the aortic arch and ascending aorta. This study aims to evaluate the haemodynamic performance of a double-branched thoracic endograft by detailed comparison of flow patterns and wall shear stress in the aorta and supra-aortic branches before and after stent-graft implantation. Pr...

Continuous development in endovascular treatment of abdominal and thoracic aortic aneurysms, together with growing experience and encouraging results, have paved the way for a new generation of stent-grafts to treat those previously unsuitable for conventional endovascular repair. One such advancement is the fenestrated graft, which allows extensio...

Background Evidence supporting uterine artery embolisation (UAE) for giant fibroids (≥ 10 cm and/or uterine volume ≥ 700 CC) remains sparse. We performed a systemic review and meta-analysis of UAE outcomes for symptomatic giant versus non-giant fibroids. Methods The literature was systematically reviewed. Research studies of UAE as an adjunct to s...

The inferior mesenteric artery (IMA) is usually safely covered during endovascular aortic aneurysm repair (EVAR), but preserving it with a fenestration may sometimes be necessary. An 81-year-old man was referred for consideration of treatment of his 6.8 cm abdominal aortic aneurysm. His left iliac arteries were occluded, and he had a proximal occlu...

Restenosis typically occurs in regions of low and oscillating wall shear stress which also favours the accumulation of atherogenic macromolecules such as low-density lipoprotein (LDL). This study aims to determine how stent strut design may affect in-stent restenosis at the carotid artery bifurcation following carotid artery stenting (CAS) by means...

Purpose: To review short-term and midterm results of the fenestrated Anaconda stent graft in management of patients with pre-existing endovascular aortic stent graft and persistent type 1a endoleak. Materials and methods: This single-center retrospective study assessed all consecutive patients with type 1a endoleak and pre-existing endovascular...

Upon publication of this article (Kok et al., 2018), the authors noticed that author ‘Miguel Casares Santiago’ was spelt incorrectly. This has been corrected by means of this correction article.

Background In this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve. Case presentation Seventy year old...

Objective: Video motion analysis (VMA) uses fluoroscopic sequences to derive information on catheter and guidewire movement and is able to calculate two-dimensional catheter tip path length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to evaluate the effect of anatomic complexity on the efficiency of compl...

Robotic endovascular systems have been successfully used to treat a wide range of pathologies including endovascular aneurysm repairs, uterine artery embolizations, and cardiac electrophysiology ablations. Limited research suggests that the use of robotic systems may help to achieve a more accurate manipulation and increased steerability of the cat...

Background The purpose of this survey was to determine the current trends in endovascular practice by Interventional Radiologists (IR’s) across Europe and to understand the engagement by Interventional Radiology (IR) with clinical practice. CIRSE European members were invited to participate in an online survey between July 11th, 2016 and August 8th...

Background: Stroke occurs in 3% to 8% and silent cerebral infarction in >60% of patients undergoing thoracic endovascular aortic repair (TEVAR). We investigated the utility of a filter cerebral embolic protection device (CEPD) to reduce diffusion-weighted magnetic resonance imaging (DW-MRI) detected cerebral injury and gaseous and solid embolizati...

Flexible robotic catheters are an emerging technology which provide an elegant solution to the challenges of conventional endovascular intervention. Originally developed for interventional cardiology and electrophysiology procedures, remotely steerable robotic catheters such as the Magellan system enable greater precision and enhanced stability dur...

Objective Despite centralisation of the provision of vascular care, not all areas in England and Wales are able to offer emergency treatment for patients with acute conditions affecting the aorta proximal to the renal arteries. While cardiothoracic centres have made network arrangements to coordinate care for the repair of type A dissections, a sim...

Background: Silent cerebral infarction is brain injury detected incidentally on imaging; it can be associated with cognitive decline and future stroke. This study investigated cerebral embolization, silent cerebral infarction and neurocognitive decline following thoracic endovascular aortic repair (TEVAR). Methods: Patients undergoing elective o...

Interventional Radiology procedures, equipment and techniques as well as image guidance have developed dramatically over the last few decades. The evidence for minimally invasive interventions in vascular and oncology fields is rapidly growing and several procedures are considered the first line management. However, radiation exposure, image guidan...

Aneurysmal disease involving the origins of supra aortic vessels often requires complex open and/or endovascular repair that is not only associated with significant risk of mortality and morbidity but also often with perioperative blood loss requiring transfusion. We report a successful repair of a large thoracic aortic aneurysm (TAA) involving the...

Right-sided aortic arches are rare, affecting approximately 0.1% of the population. They are a result of abnormal development of the primitive aortic arches and may present later in life with later life with aneurysmal expansion of the aberrant left subclavian artery ‘Kommerell’s diverticulum’. These can be challenging to treat effectively. We repo...

A 25-year-old man presented to a major trauma centre with multiple stab wounds, most significantly to the right buttock. Triple-phase CT revealed no acute bleeding and his wounds were closed. In the month following injury, he re-presented seven times to the emergency department (ED) complaining of bleeding and wound breakdown. After his seventh ED...

Aims: Video-motion analysis (VMA) uses fluoroscopic sequences to derive on catheter and guide-wire movement, and is able to calculate 2D catheter-tip path-length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to validate VMA in coronary angiography as a method of skill assessment. Methods and results: 47 c...

Purpose The aim of this paper is to report our experience of type II endoleak treatment after endovascular aneurysm repair with intra-arterial injection of the embolizing liquid material, Onyx liquid embolic system. Methods From 2005 to 2012, we performed a retrospective review of 600 patients, who underwent endovascular repair of an abdominal aor...

Aim: To investigate the effect of playing computer games and manual dexterity on catheter-wire manipulation in a mechanical aortic model. Material and methods: Medical student volunteers filled in a preprocedure questionnaire assessing their exposure to computer games. Their manual dexterity was measured using a smartphone game. They were then s...

Purpose: Interventional radiology (IR) is traditionally underrepresented in undergraduate medical curricula. Final-year medical students ought to be familiar with some common IR procedures in order to make adequate referrals and work-up patients appropriately. We evaluated the knowledge of final-year medical students on common IR procedures and co...

Robust tracking of interventional tools, such as guidewires and catheters, in X-ray fluoroscopic video sequences has a wide range of clinical applications for endovascular procedures. Thus far, the tracking is usually achieved by finding the optimal displacement of the control points of a spline, which models the guidewire, between consecutive fram...

Objective: Stroke caused by cerebral embolization constitutes a principal risk during arch manipulation and thoracic endovascular aortic repair (TEVAR). This study investigates the incidence of cerebral embolization during catheter placement in the aortic arch, and compares robotic and manual techniques. Methods: Intra-operative transcranial Dop...

Objective: Patient specific rehearsal (PsR) prior to endovascular aneurysm repair (EVAR) enables the endovascular team to practice and evaluate the procedure prior to treating the real patient. This multicentre trial aimed to evaluate the utility of PsR prior to EVAR as a pre-operative planning and briefing tool. Material and methods: Patients w...

Thoracic outlet syndrome refers to a multitude of signs and symptoms in the upper limb resulting from compression of the neurovascular bundle within the interscalene triangle. It is a complex clinical entity to diagnose on imaging, given its transient and postural nature, which is not often appreciable on nondynamic imaging. Here we describe an unc...

Purpose: To quantify the hemodynamic impact of a flared renal stent on the performance of fenestrated stent-grafts (FSGs) by analyzing flow patterns and wall shear stress–derived parameters in flared and nonflared FSGs in different physiologic scenarios. Methods: Hypothetical models of FSGs were created with and without flaring of the proximal port...

Symptomatic peripheral arterial disease in the upper limb is significantly less common than that below the diaphragm, but is nonetheless just as challenging. Ischaemic symptoms occur not only in the hand and arm, but also due to disturbances in flow in the cerebral and coronary artery territories. Both open surgical and minimally-invasive options e...

The Oxford Textbook of Vascular Surgery comprises of ten sections written byover 130 specialist contributors. The volume discusses the epidemiology, vascular biology, clinical features and management of diseases that affect the vasculature and contains dedicated chapters which address topics such as paediatric surgery, damage control surgery and am...

Purpose: To evaluate the short- and long-term outcomes of hybrid repair of the arch and proximal descending aorta in a single tertiary center for aortic disease. Methods: A retrospective analysis was performed of 55 patients (median age 67 years; 36 men) who underwent hybrid repair of thoracic aortic pathology with involvement of the arch between J...

The aim of this study was to assess the haemodynamic performance of a patient-specific Fenestrated Stent-Graft (FSG) under different physiological conditions, including normal resting, hypertension, and hypertension with moderate lower limb exercise. A patient-specific FSG model was constructed from computed tomography images and was discretised in...

Objective: To assess safety, performance, and efficacy of the RELAY thoracic stent graft (Bolton Medical, Barcelona, Spain) in the treatment of patients who require elective thoracic endovascular aortic repair including aneurysms and dissections. Methods: The RELAY Endovascular Registry for Thoracic Disease II (RESTORE II) is a multicenter, pros...

Abdominal aortic aneurysms with hostile anatomy are a recognized hindrance to the continuing application of endovascular aortic interventions. Narrowed aneurysm necks pose technical difficulties, particularly in the absence of customized endografts. There are multiple suggested approaches to overcome shortened and angulated necks endovascularly; ho...