title: Targeted long-term venous occlusion using pulsed high-intensity focused ultrasound combined with a pro-inflammatory agent.
abstract: Esophageal and gastric varices are associated with significant morbidity and mortality for cirrhotic patients. The current modalities available for treating bleeding esophageal and gastric varices, namely endoscopic band ligation and sclerotherapy, require frequent sessions to obtain effective thrombosis and are associated with significant adverse effects. A more effective therapy that results in long-term vascular occlusion has the potential to improve patient outcomes. In this study, we investigated a new potential method for inducing long-term vascular occlusion by targeting segments of a rabbit's auricular vein in vivo with low-duty-cycle, high-peak-rarefaction pressure (9 MPa), pulsed high-intensity focused ultrasound in the presence of intravenously administered ultrasound microbubbles followed by local injection of fibrinogen and a pro-inflammatory agent (ethanol, cyanoacrylate or morrhuate sodium). The novel method introduced in this study resulted in acute and long-term complete vascular occlusions when injecting a pro-inflammatory agent with fibrinogen. Future investigation and translational studies are needed to assess its clinical applicability.
authors.affiliation: Division of Engineering Mechanics, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Zhou
authors.forename: Jasmine
authors.initials: J
authors.lastname: Zia
authors.forename: Cinderella
authors.initials: C
authors.lastname: Warren
authors.forename: Frank L
authors.initials: FL
authors.lastname: Starr
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Brayman
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Crum
authors.forename: Joo Ha
authors.initials: JH
authors.lastname: Hwang
mesh_terms: D000818:Animals; D007611:Aprotinin / Q000008:administration & dosage; D003487:Cyanoacrylates / Q000008:administration & dosage; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D000431:Ethanol / Q000008:administration & dosage; D005340:Fibrinogen / Q000008:administration & dosage; D005466:Fluorocarbons / Q000008:administration & dosage; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods; D011817:Rabbits; D012976:Sodium Morrhuate / Q000008:administration & dosage; D013927:Thrombosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D003487:Cyanoacrylates; D005466:Fluorocarbons; D000431:Ethanol; D012976:Sodium Morrhuate; D005340:Fibrinogen; D007611:Aprotinin; C042852:perflutren