High intensity focused ultrasound (HIFU) is an exciting new therapeutic technology with numerous significant potential clinical benefits. This technique involves delivering high levels of energy (e.g., 2000 watts/ cm2) to a region of tissue and elevating its temperature to 60 - 80 degrees C within seconds. The effect is similar to the way a magnifying glass focuses sunrays onto a piece of paper to burn it. This ultrasound action can ablate tumors, pre-coagulate a region of an organ to be surgically resected and obtain hemostasis in hemorrhaging parenchyma and vessels. Further, regions of tissue can be treated that are not only on the organ surface but deep within the organ itself, without appreciable exposure or harm to the intervening tissue. Specifically, the researchers at the University of Washington have demonstrated the potential of HIFU in achieving rapid hemostasis in vivo, using models of organ and blood vessel injuries. Herein, a research team of bioengineers and surgeons proposes to further develop, refine and clinically test HIFU methodology for the operating room. Traumatic liver and spleen injury are the focus because they are common injuries with high morbidity and mortality, where conventional therapies have limited efficacy. Plans are made to a) investigate HIFU hemostasis mechanisms, b) engineer practical surgical devices, c) optimize the devices, d) refine and test them in pre-clinical, in vivo hemorrhage models, e) clinically test them in liver and spleen trauma, and f) finally conduct clinical assessment in reducing trauma mortality and morbidity. Two surgical problem areas will be investigated: 1) when the bleeding site is visible to the surgeon and 2) when blood or investing tissue hide it. Thus, two hemostasis device styles will be developed. The first will be simple probes for HIFU application when the bleeding region is visible. The second will be more complicated and include simultaneous ultrasound detection methods for locating the bleeding site and electronic focusing for guiding HIFU to the bleeding regions. The investigators believe these devices will promote significantly improved and cost effective methods for stopping bleeding in the injured liver and spleen. The devices will facilitate accelerated hemostasis, reduced blood loss, increase splenic salvage, shorten surgical time, avoid damage control surgery and attendant secondary repair, and finally improve hemodynamics in patients with multiple injuries. Thus, the investigators believe that their proposed studies will result in a new and clinically applicable methodology for reducing mortality and morbidity in abnormal trauma.

Agency
National Institute of Health (NIH)
Institute
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Type
Research Project (R01)
Project #
8R01EB000292-03
Application #
6476911
Study Section
Surgery, Anesthesiology and Trauma Study Section (SAT)
Program Officer
Haller, John W
Project Start
2000-02-22
Project End
2003-11-30
Budget Start
2001-12-01
Budget End
2002-11-30
Support Year
3
Fiscal Year
2002
Total Cost
$414,387
Indirect Cost
Name
University of Washington
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
Zderic, Vesna; Foley, Jessica; Luo, Wenbo et al. (2008) Prevention of post-focal thermal damage by formation of bubbles at the focus during high intensity focused ultrasound therapy. Med Phys 35:4292-9
Zderic, Vesna; O'Keefe, Grant E; Foley, Jessica L et al. (2007) Resection of abdominal solid organs using high-intensity focused ultrasound. Ultrasound Med Biol 33:1251-8
Greaby, Robyn; Zderic, Vesna; Vaezy, Shahram (2007) Pulsatile flow phantom for ultrasound image-guided HIFU treatment of vascular injuries. Ultrasound Med Biol 33:1269-76
Vaezy, Shahram; Zderic, Vesna (2007) Hemorrhage control using high intensity focused ultrasound. Int J Hyperthermia 23:203-11
Vaezy, Shahram; Zderic, Vesna; Karmy-Jones, Riyad et al. (2007) Hemostasis and sealing of air leaks in the lung using high-intensity focused ultrasound. J Trauma 62:1390-5
Burgess, Sean; Zderic, Vesna; Vaezy, Shahram (2007) Image-guided acoustic hemostasis for hemorrhage in the posterior liver. Ultrasound Med Biol 33:113-9
Zderic, Vesna; Brayman, Andrew A; Sharar, Sam R et al. (2006) Microbubble-enhanced hemorrhage control using high intensity focused ultrasound. Ultrasonics 45:113-20
Vaezy, Sara; Vaezy, Shahram; Starr, Frank et al. (2005) Intra-operative acoustic hemostasis of liver: production of a homogenate for effective treatment. Ultrasonics 43:265-9
Vaezy, Shahram; Noble, Misty L; Keshavarzi, Amid et al. (2004) Liver hemostasis with high-intensity ultrasound: repair and healing. J Ultrasound Med 23:217-25
Cornejo, Carol J; Vaezy, Shahram; Jurkovich, Gregory J et al. (2004) High-intensity ultrasound treatment of blunt abdominal solid organ injury: an animal model. J Trauma 57:152-6

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