Patrick D. Sutphin's research while affiliated with Massachusetts General Hospital and other places

Publications (87)

Article
Introduction: Inferior vena cava (IVC) filters are mechanical filtration devices designed as an alternative to surgical ligation/plication of the IVC. Their use has been controversial, especially with the introduction of retrievable filters and expanded/prophylactic indications. Areas covered: Authors discuss the types of available IVC filters, ind...
Article
An 82-year-old woman was admitted with pain, swelling, and discoloration of the left arm. CT revealed hematoma involving the brachioradialis muscle. The prothrombin time was 13.3 seconds (normal range, 11.5 to 14.5) and the activated partial-thromboplastin time 72.4 seconds (normal range, 22 to 36). A diagnostic test was performed.
Article
A 37-year-old woman with a history of injection-drug use was admitted with 3 weeks of abdominal pain. CT angiography showed aneurysmal dilatation of the infrarenal abdominal aorta (aortic diameter, 3.9 cm). Management decisions were made.
Article
Full-text available
Objectives To evaluate the utility of a transseptal needle for balloon-assisted sharp recanalization of chronically occluded central venous structures. Background Chronically occluded central veins are not an uncommon problem, which may arise due to a plethora of reasons. Traditionally, wire and catheter techniques are often used first in an attemp...
Article
The liver is the most common site of metastatic disease in colorectal cancer, and, in the setting of liver-dominant disease, a chief contributor to mortality. Chemotherapy is the backbone of treatment for metastatic colorectal cancer; however, the duration of response is limited and resistance to therapy inevitably develops. Radioembolization repre...
Article
Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatm...
Article
Computed tomography provides a wealth of diagnostic information in the trauma patient including the presence of organ, bone, and vasculature injuries for the rapid triage of trauma patients. In the context of interventional radiology, appropriately protocoled studies can be reviewed for vascular injury and help focus the angiographic assessment of...
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Purpose To evaluate the operational and financial impact of an interventional radiology (IR) clinic at a tertiary county hospital system. Methods The IR clinic, which opened in January 2017, evaluates outpatient referrals and completes preprocedure workups, nonimage-guided procedures, and postprocedure follow-up visits. Procedural volumes, location...
Chapter
At the end of 2013, approximately 421,000 persons in the United States with end stage renal disease (ESRD) were treated with hemodialysis, with the number of patients requiring hemodialysis expected to increase in the foreseeable future. The mortality rate for ESRD patients receiving dialysis has been declining since 2002. Though the incidence of E...
Article
Hepatic-arterial infusion (HAI) of low-density lipoprotein (LDL) nanoparticles reconstituted with docosahexaenoic acid (DHA) (LDL-DHA) has been shown in a rat hepatoma model to be a promising treatment for hepatocellular carcinoma. To date, little is known regarding the safety of HAI of LDL-DHA to the liver. Therefore, we aimed to investigate the d...
Article
Contrast-enhanced sonography is a safe, radiation-free, and minimally invasive imaging technique. It takes advantage of the nonlinear behavior of microbubble contrast agents to produce microbubble-only images, which allows for the assessment of the extracranial carotid arteries, with a minuscule total dose of <1 mL. This review highlights the curre...
Article
Modern systemic therapies provide a significant survival benefit in metastatic colorectal cancer. Despite these advances, the durability of response remains limited and nearly all patients progress on systemic treatment. Colorectal liver metastases (CLM) develop in approximately half of patients with metastatic disease and contribute to mortality i...
Poster
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Purpose: To examine factors that may lead to failure to occlude previously treated recanalized pulmonary arteriovenous malformations (PAVMs) with a polytetrafluoroethylene-covered (PTFE) nitinol microvascular plug.
Article
DESCRIPTION OF THE PROBLEM Wait time from request to placement of ports in Interventional Radiology (IR) had increased from 14 to 27 days over a 4-month period. The goal of this project was to reduce the wait time by 15% within 4 months while accommodating additional volume. INSTITUIONAL APPROACH TO ADDRESS PROBLEM Capacity analysis revealed two b...
Article
Purpose To compare percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of Hepatocellular carcinoma (HCC) and to identify risk factors for treatment failure and local progression. Methods 145 unique HCC [87 (60%) RFA, 58 (40%) MWA] were retrospectively reviewed from a single tertiary medical center. Adverse events...
Article
Iliofemoral venous thrombosis carries a high risk for pulmonary embolism, recurrent deep vein thrombosis, and post-thrombotic syndrome complicating 30% to 71% of those affected. The clinical scenarios in which iliofemoral venous thrombosis is managed may be diverse, presenting a challenge to identify optimum therapy tailored to each situation. Goal...
Article
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Thoracic outlet syndrome (TOS) is the clinical entity that occurs with compression of the brachial plexus, subclavian artery, and/or subclavian vein at the superior thoracic outlet. Compression of each of these structures results in characteristic symptoms divided into three variants: neurogenic TOS, venous TOS, and arterial TOS, each arising from...
Article
Imaging and image-guided procedures play an imperative role in the screening, diagnosis, and surveillance of cancer. Although emerging imaging techniques now enable more precise molecular characterization of tumors, multigenetic tumor profiling for targeted therapeutic selection remains limited to direct tissue acquisition. Even in the context of t...
Article
Vascular malformations of the extremities represent a wide spectrum of lesions, broadly divided into high-flow and low-flow categories. High-flow lesions include arteriovenous malformations and arteriovenous fistulas, while the more common low-flow lesions consist of venous and lymphatic malformations. The clinical presentation of vascular malforma...
Chapter
Hepatocellular carcinoma (HCC) is dominantly supplied by arterial blood flow, whereas the normal underlying liver parenchyma is supplied by both the portal vein (75%) and hepatic artery (25%). This distinction in blood supply of tumor tissue relative to liver tissue led to the exploration of targeting the arterial blood supply as a means of therape...
Article
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A broad range of nonatherosclerotic diseases affect the peripheral arteries. The appropriate initial diagnostic imaging studies vary, depending upon the clinical presentation and suspicion of disease. Accurate vascular imaging relies upon visualization of the vessel lumen, vessel wall, and surrounding soft-tissue structures, with some modalities al...
Article
Abdominal aortic aneurysm (AAA) is defined as aneurysmal dilation of the abdominal aorta to 3 cm or greater. A high degree of morbidity and mortality is associated with AAA rupture, and imaging surveillance plays an essential role in mitigating the risk of rupture. Aneurysm size and growth rate are factors associated with the risk of rupture, thus...
Article
Purpose: To evaluate effectiveness of the polytetrafluoroethylene-covered nitinol mesh microvascular plug (MVP) and compare it with other devices in pulmonary arteriovenous malformation (PAVM) embolization in patients with hereditary hemorrhagic telangiectasia (HHT). Materials and methods: Twenty-five patients (average age 35 y; range, 15-56 y)...
Article
Staging of hepatocellular carcinoma (HCC) is necessary for guiding prognostication, management, and research purposes that further aid in the improvement of existing clinical and epidemiological health services. Though there are some new staging systems for HCC developed in different parts of the world, there is no globally accepted staging system...
Article
Objective To assess the feasibility of creating virtual monoenergetic arterial images from venous phase CTA obtained on a detector-based spectral CT scanner and quantitatively compare the signal-to-noise (SNR) and contrast-to-noise (CNR) ratios of the major arteries to those on polyenergetic true arterial phase images. Methods In this retrospectiv...
Article
Pulmonary artery aneurysms (PAAs) and pseudoaneurysms are rare entities in the spectrum of pulmonary arterial diseases. The etiology of these aneurysms is varied and patients present with nonspecific symptoms which make their diagnosis both difficult and less often considered. In this review, we will discuss the clinical manifestations, etiologies,...
Article
Chronic thromboembolic pulmonary hypertension (CTEPH) is a debilitating but potentially reversible complication of chronic pulmonary thromboembolic disease characterized by progressive right heart dysfunction secondary to pulmonary arterial stenosis or occlusion. Balloon pulmonary angioplasty (BPA) has recently emerged as an alternative interventio...
Article
Pulmonary arteriovenous malformations (PAVM) are abnormal direct communications between the branches of pulmonary arteries and veins, and are often seen in patients with hereditary hemorrhagic telangiectasia (HHT). If untreated, the right to left shunt can result in symptoms of hypoxemia, paradoxical emboli to the left side circulation, stroke and...
Article
Pulmonary arteriovenous malformations (PAVMs) are rare, abnormal low resistance vascular structures that connect a pulmonary artery to a pulmonary vein, thereby bypassing the normal pulmonary capillary bed and resulting in an intrapulmonary right-to-left shunt. The spectrum of PAVMs extends from microscopic lesions causing profound hypoxemia and gr...
Article
Full-text available
Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or o...
Article
Abdominal aortic aneurysms (AAAs) are a relatively common vascular problem that can be treated with either open, surgical repair or endovascular aortic aneurysm repair (EVAR). Both approaches to AAA repair require dedicated preoperative imaging to minimize adverse outcomes. After EVAR, cross-sectional imaging has an integral role in confirming the...
Article
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Purpose To evaluate nonprocedural percutaneous nephrostomy (PCN) complications and assess whether the protocol of routine 3-month exchange of PCN is optimal in patients with malignant ureteral obstruction (MUO) and benign ureteral obstruction (BUO). Materials and Methods Retrospective study of 103 patients with a mean age of 48 years (36 men, 67 wo...
Article
Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Imaging studies are important in diagnosing and categorizing the extent of the aneurysm and may aid in treatment planning. The consensus of the literature supports the use of ultrasound as the initial screening test i...
Article
Full-text available
May–Thurner syndrome is a common cause of left lower extremity venous thrombosis resulting from repetitive and dynamic compression of the left common iliac vein by the right common iliac artery, commonly seen in young to middle-aged women. The diagnosis requires high clinical suspicion. Computed tomography venography and magnetic resonance venograp...
Chapter
CT venography employs the use of contrast material-enhanced CT imaging to evaluate the venous system. In this chapter CT venography of the extremities, pulmonary, mesenteric, renal, pelvic, and iliocaval venous systems are described. The respective indications, findings on imaging, scanning protocols, advantages, and limitations are outlined in det...
Article
Purpose: Treatment response to drug-eluting bead chemoembolization (DEB-TACE) is well established for patients with hepatocellular carcinoma (HCC); however, few studies have evaluated tumor imaging characteristics associated with treatment responses. The aim of our study was to identify imaging characteristics associated with treatment responses a...
Article
Noninvasive physiologic vascular studies play an important role in the diagnosis and characterization in peripheral arterial disease (PAD) of the lower extremity. These studies evaluate the physiologic parameters of blood flow through segmental arterial pressures, Doppler waveforms, and pulse volume recordings. Collectively, they comprise a powerfu...
Article
Purpose: The purpose of the study is to evaluate the clinical safety and effectiveness of the Denali (Bard, Tempe, Arizona) retrievable inferior vena cava (IVC) filter. Materials and methods: In this retrospective study, authors reviewed the data of Denali IVC filters placed at their institution between 2013 and 2015. The clinical presentation,...
Article
Chronic mesenteric ischemia (CMI) is a vascular occlusive disease process that generally affects the elderly population. Clinical presentation occurs when two of the three mesenteric arteries are affected and includes non-specific abdominal pain and weight loss. The most common cause of CMI is atherosclerotic arterial occlusion. The aim of this rev...
Article
At the end of 2009, 370,077 persons with end stage renal disease (ESRD) were treated with hemodialysis, and the number of ESRD individuals requiring hemodialysis will continue to increase in the foreseeable future [1]. The mortality rate for ESRD patients receiving dialysis has been declining since 2002 [1]. The combination of increasing prevalence...
Article
An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presentin...
Article
Full-text available
To assess the effect of technical parameters on outcomes of transjugular intrahepatic portosystemic shunt (TIPS) created using a stent graft. The medical records of 68 patients who underwent TIPS placement with a stent graft from 2008 to 2014 were reviewed by two radiologists blinded to the patient outcomes. Digital Subtraction Angiographic images...
Article
Portosystemic shunts (PSS) are common in patients with chronic liver disease and portal hypertension, however, their occurrence in noncirrhotic individuals is likely under appreciated. Patients may present with symptoms of hepatic encephalopathy and/or gastrointestinal bleeding and undergo extensive work up for liver disease to no avail. Often, the...
Article
Ureteroarterial fistula (UAF) is an uncommon condition with only approximately 150 cases reported in the literature. Patients typically present with hematuria in the setting of prolonged ureteral stenting, prior pelvic surgery, malignancy, or radiation. Presentation can vary from intermittent hematuria to life-threatening hemorrhagic shock. Recogni...
Article
To design a sustainable process to improve optional inferior vena cava (IVC) filter retrieval rates based on the DMAIC methodology of the Six Sigma process improvement paradigm. DMAIC, an acronym for Define, Measure, Analyze, Improve, and Control, was employed to design and implement a quality improvement project to increase IVC filter retrieval ra...
Article
MR angiography is a powerful tool in evaluating anatomy and pathology when applied to the male pelvis. MR angiography produces high-quality images of the arterial system approaching the resolution of CT angiography, without ionizing radiation. Additional advantages include the ability to obtain angiographic images in the absence of contrast materia...
Chapter
Uterine artery embolization (UAE) is a well-established, safe, and effective endovascular technique for the management of uterine pathology including obstetric hemorrhage, uterine fibroids, adenomyosis, and uterine vascular malformations. This chapter will focus on the use of UAE in the treatment of postpartum hemorrhage (PPH) and uterine leiomyoma...