David Valenti - Academia.edu (original) (raw)

Papers by David Valenti

Journal of Interventional Medicine

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Background: Women who undergo uterine artery embolization (UAE) and subsequently have heavy vagin... more Background: Women who undergo uterine artery embolization (UAE) and subsequently have heavy vaginal bleeding require assessment to establish the cause. Endometrial sampling in such women should not necessarily carry more than the usual risk Cases: Two women who had undergone UAE presented with recurrence of heavy vaginal bleeding. In order to rule out possible endometrial malignancy, we performed an endometrial biopsy. Both patients had large and necrotic intramural myomas adjacent to the endometrium. They developed septic uterus shortly after endometrial biopsy and each required a hysterectomy. The postoperative course in the first case was complicated by deep vein thrombosis and enterovaginal fistula. Conclusion: Because of the high risk of infection, women with a history of UAE and necrotic myoma adjacent to the endometrium

International Journal of Health Care Quality Assurance, 2021

PurposeSmall-bore drains (≤ 16 Fr) are used in many centers to manage all pleural effusions. The ... more PurposeSmall-bore drains (≤ 16 Fr) are used in many centers to manage all pleural effusions. The goal of this study was to determine the proportion of avoidable chest drains and associated complications when a strategy of routine chest drain insertion is in place.Design/methodology/approachWe retrospectively reviewed consecutive pleural procedures performed in the Radiology Department of the McGill University Health Centre over one year (August 2015–July 2016). Drain insertion was the default drainage strategy. An interdisciplinary workgroup established criteria for drain insertion, namely: pneumothorax, pleural infection (confirmed/highly suspected), massive effusion (more than 2/3 of hemithorax with severe dyspnea /hypoxemia), effusions in ventilated patients and hemothorax. Drains inserted without any of these criteria were deemed potentially avoidable.FindingsA total of 288 procedures performed in 205 patients were reviewed: 249 (86.5%) drain insertions and 39 (13.5%) thoracente...

Gastrointestinal Endoscopy, 2021

Globally, hepatocellular carcinoma (hcc) is the third most common cause of death from cancer, aft... more Globally, hepatocellular carcinoma (hcc) is the third most common cause of death from cancer, after lung and stomach cancer. The incidence of hcc in Canada is increasing and is expected to continue to increase over the next decade. Given the high mortality rate associated with hcc, steps are required to mitigate the impact of the disease. To address this challeng- ing situation, a panel of 17 hcc experts, representing gastroenterologists, hepatologists, hepatobiliary surgeons, medical oncologists, pathologists, and ra- diologists from across Canada, convened to provide a framework that, using an evidence-based approach, will assist clinicians in optimizing the management and treatment of hcc. The recommendations, sum- marized here, were developed based on a rigorous methodology in a pre-specified process that was overseen by the steering committee. Specific topics were identified by the steering committee and del - egated to a group of content experts within the expert panel, who th...

Clinical Cancer Research, 2020

Purpose: Pancreatic ductal adenocarcinoma (PDAC) arising in patients with a germline BRCA1 or BRC... more Purpose: Pancreatic ductal adenocarcinoma (PDAC) arising in patients with a germline BRCA1 or BRCA2 (gBRCA) mutation may be sensitive to platinum and PARP inhibitors (PARPi). However, treatment stratification based on gBRCA mutational status alone is associated with heterogeneous responses. Experimental Design: We performed a seven-arm preclinical trial consisting of 471 mice, representing 12 unique PDAC patient-derived xenografts, of which nine were gBRCA mutated. From 179 patients whose PDAC was whole-genome and transcriptome sequenced, we identified 21 cases with homologous recombination deficiency (HRD), and investigated prognostic biomarkers. Results: We found that biallelic inactivation of BRCA1/BRCA2 is associated with genomic hallmarks of HRD and required for cisplatin and talazoparib (PARPi) sensitivity. However, HRD genomic hallmarks persisted in xenografts despite the emergence of therapy resistance, indicating the presence of a genomic scar. We identified tumor polyploid...

Journal of Vascular and Interventional Radiology, 2021

Transhepatic duodenal stent placement may be a solution when endoscopy fails or when duodenal and... more Transhepatic duodenal stent placement may be a solution when endoscopy fails or when duodenal and biliary stents are needed simultaneously. This approach is usually not considered an option when the stent must be deployed entirely across the ampulla of Vater. We present a case series of 10 patients having undergone a novel transhepatic technique to place a duodenal stent across the ampulla of Vater, by establishing a wire scaffold from the liver toward the jejunum, then curving back on itself retrogradely through the duodenal tumor and out the mouth. Technical success was 90% with no associated mortality.

Endoscopy, 2021

Introduction We recently developed a double-balloon device, using widely available existing techn... more Introduction We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success. Results 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patie...

European Journal of Trauma and Emergency Surgery, 2021

Purpose Hemodynamically unstable trauma patients who would benefit from angioembolization (AE) ty... more Purpose Hemodynamically unstable trauma patients who would benefit from angioembolization (AE) typically also require emergent surgery for their injuries. The critical decision of transferring a patient to the operating room versus the interventional radiology (IR) suite can be bypassed with the advent of intra-operative AE (IOAE). Previously limited by the availability of costly rooms termed RAPTOR (resuscitation with angiography, percutaneous techniques and open repair) suites, it has been suggested that using C-arm digital subtraction angiography (DSA) is a comparable alternative. This case series aims to establish the feasibility and safety of IOAE. Methods We conducted a retrospective analysis of all trauma patients at our level 1 trauma center who underwent IOAE with a concomitant surgical intervention from January 2011 to May 2019. Descriptive analyses were conducted. Results A total of 49 patients (80% male, 44 ± 17 years, 92% blunt) underwent IOAE using the C-arm DSA during the study period. All but one patient underwent exploratory laparotomy, 56% of which underwent an additional surgical procedure (ex. exploratory thoracotomy, orthopedic). Either Gelfoam ® (Pfizer, New York, USA) (90%), coils (2.0%), or a combination (8.2%) were used for embolization. Internal iliac embolization was performed in 88% of cases (59% bilateral). IOAE was successful in all but four cases (8.2%) and thirty-day mortality was 31%. Conclusion IOAE appears to be a feasible and safe management option in severe trauma patients with the advantage of concurrent operative intervention and ongoing active resuscitation with good success in hemorrhage control.

Journal of the Canadian Association of Gastroenterology, 2018

AJR. American journal of roentgenology, Jan 5, 2018

We aim to define the practice of interventional radiology (IR) in Canada, barriers that have been... more We aim to define the practice of interventional radiology (IR) in Canada, barriers that have been faced by interventional radiologists, and ways in which the Canadian Interventional Radiology Association (CIRA) have attempted to address these issues. IR has faced significant challenges in the Canadian setting. Recognizing the need to address these challenges, leaders in the field of IR in Canada founded the CIRA to serve as our national voice and lobby group.

Radiology, Jan 10, 2018

Purpose To evaluate the effectiveness of superior hypogastric nerve block (SHNB) in reducing narc... more Purpose To evaluate the effectiveness of superior hypogastric nerve block (SHNB) in reducing narcotic use after uterine artery embolization (UAE). Materials and Methods This study was a prospective, randomized, double-blind, parallel clinical trial in patients referred to a tertiary care university teaching hospital for UAE. Forty-four participants were enrolled (mean age, 46 years; range, 32-56 years). No consenting patient was excluded. All participants were randomized 1:1 to undergo either a sham procedure or SHNB. There were 22 participants in each group. One participant was lost to follow-up regarding home survey results. Use of narcotics and antiemetics was recorded in-hospital. Pain scores were recorded at home for 10 days with use of a visual analog scale (range, 1-10). Statistical analysis was performed by using the t test and χ test, with P < .05 considered indicative of a statistically significant difference. The full study protocol can be found at www.clinicaltrials.g...

Endoscopy, Jan 19, 2018

Video 1 Successful endoscopic ultrasound-guided double bypass in collaboration with interventiona... more Video 1 Successful endoscopic ultrasound-guided double bypass in collaboration with interventional radiology. ▶ Fig. 1 Imaging studies. a Endoscopic ultrasound (EUS) view of the inflated balloon in the jejunum, distal to the obstruction site. b Fluoroscopic view of the EUS-guided needle puncture of the inflated balloon. c Endoscopic view of full deployment of the lumen-apposing metal stent. Hashim Ahmad et al. Endoscopic double bypass in gastric outlet and biliary obstruction … Endoscopy 2018; 50: E237-E239 E237 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Journal of Vascular and Interventional Radiology, 2017

We demonstrated real-time, direct, label-free visualization of the coagulation process during RFA... more We demonstrated real-time, direct, label-free visualization of the coagulation process during RFA ablation at high-resolution using our integrated RFA therapy delivery and OFDI balloon catheter-based guidance system. Our histological analysis using nitroblue tetrazolium chloride (NBTC) frozen sections confirmed that the CDVbased technique accurately and directly delineates the thermal coagulation zone in porcine esophagus ex vivo. Conclusions: The ability to delineate thermal lesions at high resolution opens up the possibility of performing microscopic image-guided procedures in numerous clinical applications, especially in epithelial lesions where the precise delivery of thermal energy is critical.

Interventionelle Radiologie Scan, 2016

Journal of Vascular and Interventional Radiology, 2016

interventional strategy for the patients with CTEPH who are not candidates for pulmonary endarter... more interventional strategy for the patients with CTEPH who are not candidates for pulmonary endarterectomy. Clinical Findings/Procedure Details: MDCT findings of the pulmonary artery were classified into 5 subtypes for the planning of BPA procedure: type 1a, webs; type 1b, web with severe narrowing of the subsegmental artery; type 2, web and slits; type 3, slits; and type 4, pouch defect with complete occlusion. For type 1a lesion, BPA should only be performed for stenosis by a web in the segmental branch. For type 1b lesion, the guide wire should be passed through the web lesion at first, and BPA should be performed proximal to the web lesion. If the collapsed distal vessel is dilated after the first BPA because of the release of severe stenosis, and the slit is shown on angiography, BPA should be performed distal to the lesions. For type 2 lesion, BPA should be performed from the distal subsegmental artery to the proximal web in the segmental artery. BPA should not be performed in type 4 lesions, because of the safety issue. Conclusions: BPA using MDCT is feasible and reliable in patients with CTEPH.

The Journal of Vascular Access, 2017

Introduction The aim of this study is to determine if right arm peripherally inserted central cat... more Introduction The aim of this study is to determine if right arm peripherally inserted central catheters (PICCs) experienced fewer complications while controlling for gender, hand dominance, history of malignancy, dwell time and catheter size. Methods This was an intention-to-treat randomized controlled trial conducted in an academic medical center on two different sites between September 2012 and September 2015. All patients older than 18 years or age without known history of previous central line, contraindication to the use of a specific arm or hospitalized in the intensive care unit regardless of coagulation status, were considered for the study. Participants were randomized to the left or right arm group and were followed until catheter removal. Data collected included: PICC characteristics, insertion details, gender, arm dominance, history of malignancy, reason for insertion/removal, incidence of a complication and total dwell time. One-tailed hypothesis testing using a univari...