Noninvasive vascular occlusion with HIFU for venous insufficiency treatment: preclinical feasibility experience in rabbits

Barnat, Nesrine; Grisey, A.; Lecuelle, Benoit; Anquez, Jérémie; Gerold, Bjoern; Yon, Sylvain; Aubry, Jean‐François

doi:10.1088/1361-6560/aaf58d

Cited by 17 publications

(15 citation statements)

References 55 publications

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“…Experimental studies have also searched for ways to focus the damage to specific vessels by echo contrast and beam control, but the results are still initial 12 . One experimental study in rabbits showed that the HIFU can close by thermal ablation veins as large as 6 mm with 15 days of follow up 13 . Obermayer has recently shown that HIFU can cause thermal ablation of varicose veins, perforators and great saphenous veins.…”

Section: Discussionmentioning

confidence: 99%

Occlusion of the popliteal artery after focused ultrasound treatment - a case report

Faccini¹,

Souza²,

Arendt³

2018

JTAVR

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The use of focused ultrasound and highintensity focused ultrasound (HIFU) is common in physical therapy and medical procedures. The ultrasound produces heat and can be used to treat several diseases. We report a case of a 49-year-old male that had a knee injury after mild trauma. The patient started physical therapy sessions to treat the injury. Ipsilateral calf claudication started a few hours after the focused ultrasound was used to heat the popliteal area progressing to symptoms of acute arterial occlusion in two weeks. We started anticoagulation and confirmed popliteal thrombosis with duplex scan and computed tomography. The 5 years follow up showed good clinical recovery and recanalization of the artery. This case reminds us that the focused ultrasound should not be considered harmless and life-threatening complications may occur. The inadvertent heating of neighboring structures and recanalization of the heated vessel may happen.

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Section: Discussionmentioning

confidence: 99%

Occlusion of the popliteal artery after focused ultrasound treatment - a case report

Faccini¹,

Souza²,

Arendt³

2018

JTAVR

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“…Each vein was treated with a sequence of HIFU sonications distributed in a row of multiple spots along the vein with a 3.5 mm spacing. Continuous HIFU sonications were applied for 8 s with a mean acoustic power of 84 ± 6 W, according to the power used in a preliminary study performed on rabbit saphenous veins [22]. The corresponding spatial-peak intensity estimated from linear extrapolation from low power hydrophone measurement in water is 28 kW.cm À2 .…”

Section: Clinical Signs Evaluatedmentioning

confidence: 99%

“…The use of HIFU as a noninvasive alternative to endovenous treatments of varicose veins has already been investigated in a number of preclinical studies [17][18][19][20][21][22] and the ability to occlude small veins in vivo noninvasively with thermal HIFU has been demonstrated [18,22]. However, the efficacy and safety of the ablative procedures were demonstrated in the short term only, at most two weeks after treatments [22]. One study conducted by Delon-Martin et al [18] examined HIFU-mediated vascular occlusion with a longer follow-up and reported that a vein was successfully occluded 2 days post-HIFU but recanalized 28 days after treatment.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety assessment of an ultrasound-based thermal treatment of varicose veins in a sheep model

Barnat

Grisey

Gerold

et al. 2020

International Journal of Hyperthermia

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Purpose: Varicose veins are a common pathology that can be treated by endovenous thermal procedures like radiofrequency ablation (RFA). Such catheter-based techniques consist in raising the temperature of the vein wall to 70 to 120 C to induce vein wall coagulation. Although effective, this treatment option is not suited for all types of veins and can be technically challenging. Materials and methods: In this study, we used High-Intensity Focused Ultrasound (HIFU) as a noninvasive thermal ablation procedure to treat varicose veins and we assessed the long-term efficacy and safety of the procedure in a sheep model. In vivo experiments were first conducted on two saphenous veins to measure the temperature rise induced at the vein wall during HIFU ablation and were compared with reported RFA-induced thermal rise. Thermocouples were inserted in situ to perform 20 measurements during 8-s ultrasound pulses at 3 MHz. Eighteen saphenous veins of nine anesthetized sheep (2-2.5 % Isoflurane) were then exposed to similar pulses (85 W acoustic, 8 s). After treatments, animals recovered from anesthesia and were followed up 30, 60 and 90 days post-treatment (n ¼ 3 animals per group). At the end of the follow-up, vein segments and perivenous tissues were harvested and histologically examined. Results: Temperatures induced by HIFU pulses were found to be comparable to reported RFA treatments. Likewise, histological findings were similar to the ones reported after RFA and laser-based coagulation necrosis of the vein wall, thrombotic occlusions and vein wall fibrosis. Conclusion: These results support strongly the effectiveness and safety of HIFU for ablating non-invasively veins.

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“…Skin, fat and muscle tissue could not be segmented on the CT scans. Soft tissues were thus modeled as homogeneous tissues as was done in [36]. Table 1 summarizes the acoustical properties of the tissues and gel that were used in the simulation.…”

Section: Acoustic Modelingmentioning

confidence: 99%

An incoherent HIFU transducer for treatment of the medial branch nerve: Numerical study and in vivo validation

Chen

LeBlang

Hananel

et al. 2020

International Journal of Hyperthermia

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Background: Chronic back pain due to facet related degenerative changes affects 4-6 million patients a year in the United States. Patients refractory to conservative therapy may warrant targeted injections of steroids into the joint or percutaneous medial branch nerve denervation with radiofrequency ablation. We numerically tested a novel noninvasive high intensity focused ultrasound transducer to optimize nerve ablation near a bone-soft tissue interface. Methods: A transducer with 4 elements operating in an incoherent mode was modeled numerically and tested pre-clinically under fluoroscopic guidance. After 6 lumbar medial branch nerve ablations were performed in 2 pigs, they were followed clinically for 1 week and then sacrificed for pathological evaluation. Results: Simulations show that the acoustic spot size in water at 6 dB was 14mm axial x 1.6mm lateral and 52mm axial x 1.6mm lateral for coherent and incoherent modes, respectively. We measured the size of N = 6 lesions induced in vivo in a pig model and compared them to the size of the simulated thermal dose. The best match between the simulated and measured lesion size was found with a maximum absorption coefficient in the cortical bone adjusted to 30 dB/cm/MHz. This absorption was used to simulate clinical scenarios in humans to generate lesions with no potential side effects at 1000 and 1500 J. Conclusion: The elongated spot obtained with the incoherent mode facilitates the targeting during fluoroscopic-guided medial branch nerve ablation.

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Noninvasive vascular occlusion with HIFU for venous insufficiency treatment: preclinical feasibility experience in rabbits

Cited by 17 publications

References 55 publications

Occlusion of the popliteal artery after focused ultrasound treatment - a case report

Occlusion of the popliteal artery after focused ultrasound treatment - a case report

Efficacy and safety assessment of an ultrasound-based thermal treatment of varicose veins in a sheep model

An incoherent HIFU transducer for treatment of the medial branch nerve: Numerical study and in vivo validation

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