Imaging of vascular malformations with a high-intensity focused ultrasound probe for treatment planning.

OBJECTIVE: We aimed to investigate whether a current commercially available high-intensity focused ultrasound (HIFU) probe can adequately image targeted vascular malformations (VMs) in anticipation of HIFU treatment planning and delivery. METHODS: We enrolled 10 consecutive patients who were scheduled to undergo treatment of symptomatic peripheral VMs confirmed by routine preoperative contrast-enhanced magnetic resonance imaging and soft tissue duplex ultrasound. The lesions were situated no more than 6 cm from the skin. After induction of general anesthesia and before surgical intervention, we prepared and positioned the Sonablate HIFU probe (SonaCare Medical, LLC, Charlotte, NC) to obtain multiple B-mode images of the targeted VM in the transverse and longitudinal dimensions. We then rated the quality of the images and the feasibility of the imaging process itself using a previously devised questionnaire aimed at evaluating the adequacy of the images for potential HIFU treatment planning and delivery. The patients subsequently underwent surgical intervention and clinical follow-up for their VM per the standard protocol. RESULTS: The study included 10 participants aged 21 to 67 years (mean ± standard deviation, 36.5 ± 16.5 years). Six patients (60%) identified as female. The VMs imaged consisted of eight venous (80%), one lymphatic (10%), and one combined lymphovenous (10%) malformation. The lesions were in the extremities only (50%), trunk only (20%), trunk and extremities (20%), or neck and extremities (10%). Pain related to the VM was present in all 10 patients (100%). In all 10 patients, the boundary and location of the VM could be visualized via the HIFU probe despite the diminished B-mode imaging resolution. The absence of Doppler functionality in the HIFU probe did not prevent the identification of the VMs in any patient up to a depth of 6 cm. The results from the postimaging survey showed that difficulty in preparing the study device for imaging was 1.1 ± 0.3 and difficulty in use was 1.1 ± 0.1, with a score of 1 equal to easy and 5 to difficult. The stability of the acoustic coupling to the patient was 1.3 ± 0.2, with a score of 1 representing very stable. CONCLUSIONS: We were able to ultrasonically identify and outline all targeted peripheral VMs using a commercially available HIFU probe in anticipation of treatment planning and delivery. Baseline magnetic resonance imaging and soft tissue duplex ultrasound remain essential tools for guiding probe placement and HIFU imaging.

COVID-19 drive-through testing survey: Measuring the burden on healthcare workers.

Objective: To survey individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at 1 of 4 Trinity Health of New England drive-through testing centers to assess their demographic information, hospitalization rate, preexisting conditions, possible routes of exposures, duration of symptoms, and subsequent household infections of healthcare workers (HCWs) when compared to non-HCWs. Methods: Data were collected via a telephone survey using a standardized script. Between March 1, 2020 and June 17, 2020, 28,903 people were tested at 4 Connecticut drive-through testing centers. Individuals who tested positive between March 16 and April 21, 2020 were randomly contacted. Of those individuals, 100 people agreed to complete the survey. Bivariate analysis and logistic regression were performed. Results: HCWs comprised 46% of the 100 survey respondents during the study period. Similarly, HCWs comprised 42.1% of all individuals who tested positive and listed an employer between March 1 and June 17, 2020. HCWs reported a longer duration of symptoms (17.39 vs 13.44 days) and were more likely to report work as their route of exposure (80.4% vs 27.8%) than non-HCWs. Conclusions: HCWs may face a disproportionate risk of contracting COVID-19 and self-report a longer duration of symptoms than the general public. The data suggest a need for an increased recovery time away from work than is currently recommended by the Centers for Disease Control and Prevention, as well as an increase in infection precautions for HCWs.

Retreatment of a recanalized splenic artery aneurysm using a low-profile microembolization platform.

Recanalization of a splenic artery aneurysm owing to incomplete transcatheter coil embolization is uncommon. In addition to the challenges of inherent vessel tortuosity, reintervention via catheterization of the main splenic artery presents unique difficulties in navigating across potentially obstructive preexisting coils. We describe here the application of a low-profile microembolization platform, most commonly used in neurovascular interventions, in the treatment of a tortuous, expanding splenic artery aneurysm that had previously undergone failed coil embolization.