David J Aria

Interests

No activities entered.

Courses

No activities entered.

Scholarly Contributions

Chapters

• Towbin, R., Aria, D., Davis, T., Kaye, R., & Schaefer, C. (2018). Pediatric genitourinary intervention. In Pediatric Interventional Radiology. Springer Verlag. doi:10.1007/978-3-319-39202-8_38
  More info

  Percutaneous techniques offer several advantages over open surgery in the treatment of many pediatric genitourinary diseases. The pediatric interventionalist routinely performs minimally invasive procedures on patients, frequently as outpatients utilizing procedural sedation, which would otherwise require general anesthesia and lengthy hospital admissions if treated surgically. The minimally invasive nature of percutaneous therapy also results in cost reduction. The outcomes of percutaneous techniques have now been established as equal to or better than the corresponding surgical techniques in many instances. In spite of this, pediatric genitourinary intervention has grown relatively slowly over the past decade. Limited growth in this area is likely due to a variety of factors, especially the preference of urologists to perform combined percutaneous and surgical procedures in the operating room. Most referrals to pediatric interventional radiologists are cases that are difficult to treat operatively or with endoscopic techniques. Consequently, a relatively small number of children are referred to pediatric interventionalists for routine percutaneous urologic procedures. This trend continues today.

Journals/Publications

• Nissim, L., Aria, D. J., Willard, S., Towbin, A. J., & Towbin, R. B. (2022). Endovascular Retrieval of Transthoracic Right Atrial Catheter Fragment. Applied Radiology, 51(Issue 2).
• Rosette, T. H., Towbin, R. B., Schaefer, C. M., Towbin, A. J., & Aria, D. J. (2022). Hydranencephaly. Applied Radiology, 51(Issue 1).
• Wellard, J., Sfondouris, J., Jorgensen, S. A., Aria, D., Schaefer, C. M., Towbin, R. B., & Towbin, A. J. (2022). Medulloblastoma. Applied Radiology, 51(Issue 1).
• Dominianni, A. N., Towbin, R. B., Schaefer, C. M., Towbin, A. J., & Aria, D. J. (2021). Craniopharyngioma. Applied Radiology, 50(Issue 5).
• Dominianni, A. N., Towbin, R. B., Towbin, A. J., Schaefer, C. M., & Aria, D. J. (2021). May-thurner syndrome. Applied Radiology, 50(Issue 4).
  More info

  Case Summary An adolescent female presented to the emergency department with a chief complaint of left lower-extrem-ity swelling and pain for three days. A detailed medical history revealed that the patient was taking oral con-traceptive pills but was otherwise un-remarkable. On physical assessment, the entire left leg was edematous, warm, and painful on palpation. The patient was referred to intervention-al radiology for thrombolysis and possible stent placement.
• Jubran, J. H., Towbin, R. B., Towbin, A. J., Schaefer, C. M., & Aria, D. J. (2021). Paget-schroetter syndrome. Applied Radiology, 50(Issue 4).
  More info

  A adolescent volleyball player presented with intermittent right-arm numbness, and more than one month of worsening right upper extremity swelling.
• Mousa, M. A., Aria, D. J., Mousa, A. A., Schaefer, C. M., Temkit, M. H., & Towbin, R. B. (2021). Sphenopalatine ganglion nerve block for the treatment of migraine headaches in the pediatric population. Pain Physician, 24(Issue 1).
  More info

  Background: Persistent headaches and migraines are common in pediatrics with various treatment options. The sphenopalatine ganglion (SPG) has been identified as communicating with the parasympathetic autonomic nervous system and pain receptors. In adults, SPG block is an established treatment but there is no published literature in pediatrics. Objectives: The purpose of this study is to analyze the SPG block in pediatrics. Study Design: Retrospective, single-center study. Setting: This study was conducted at Phoenix Children’s Hospital in Phoenix, Arizona. Methods: A comprehensive review of patient charts from 2015-2018 of all pediatric SPG blockades performed by interventional radiology were included in the analysis. Utilizing fluoroscopic guidance, a SphenoCath was inserted into each nostril and after confirming position, and 4% lidocaine injected. Pre- and postprocedural pain was assessed using the Visual Analog Scale (VAS). Immediate and acute complications were documented. Results: A total of 489 SPG blocks were performed in patients between ages 6 and 26 years who were diagnosed with migraine or status migrainosus. One hundred percent technical success was achieved with mean reduction of pain scores of 2.4, which was statistically significant (P < 0.0001). There were no immediate or acute complications. Limitations: Results of this study were based on retrospective study. The use of VAS may be subjective, and the need of a prospective study may be necessary. Conclusions: With 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission.
• Mousa, M., Alzate, D., Bisht, R., Towbin, R. B., Towbin, A. J., & Aria, D. J. (2021). Angiomyolipoma in tuberous sclerosis. Applied Radiology, 50(Issue 4).
  More info

  Case Summary An adolecent presented to an outside institution with syncope, right upper quadrant abdominal pain, and pallor. The child’s medical history was significant for tuberous sclerosis, developmental delay, and an hepatic cavernous malformation. Physical exam demonstrated ash-leaf patches over the torso. Laboratory findings revealed a hemoglobin level of 9.6 g/dL, while a CT abdo-men/pelvis demonstrated an acute, large, intra-abdominal hemorrhage. The patient was transferred to our emergency department and active bleeding was confirmed with a repeat hemoglobin of 6.6 g/dL. Vital signs were stable but significant for tachypnea with a respiratory rate of 40 breaths/min, tachycardia with a heart rate of 109 bpm, and normotensive with a blood pressure of 129/98 mmHg. The patient was transfused packed red blood cells while interventional radiology was consulted for embolization.
• Abbas, A., Aria, D., Schaefer, C., Kaye, R., Jorgensen, S. A., Abruzzo, T., & Towbin, R. (2020).

  Tumoral calcinosis

  . Applied Radiology, 49(Issue 2). doi:10.1136/bmj.2.5649.120-a
• Aria, D. J., Mousa, M., Mousa, A. A., Schaefer, C. M., Temkit, M. H., & Towbin, R. B. (2020).

  Sphenopalatine Ganglion Nerve Block for the Treatment of Migraine Headaches in the Pediatric Population

  . Pain Physician. doi:10.36076/ppj.2021.24.e111-e116
  More info

  BACKGROUND: Persistent headaches and migraines are common in pediatrics with various treatment options. The sphenopalatine ganglion (SPG) has been identified as communicating with the parasympathetic autonomic nervous system and pain receptors. In adults, SPG block is an established treatment but there is no published literature in pediatrics. OBJECTIVES: The purpose of this study is to analyze the SPG block in pediatrics. STUDY DESIGN: Retrospective, single-center study. SETTING: This study was conducted at Phoenix Children’s Hospital in Phoenix, Arizona. METHODS: A comprehensive review of patient charts from 2015–2018 of all pediatric SPG blockades performed by interventional radiology were included in the analysis. Utilizing fluoroscopic guidance, a SphenoCath was inserted into each nostril and after confirming position, and 4% lidocaine injected. Pre- and postprocedural pain was assessed using the Visual Analog Scale (VAS). Immediate and acute complications were documented. RESULTS: A total of 489 SPG blocks were performed in patients between ages 6 and 26 years who were diagnosed with migraine or status migrainosus. One hundred percent technical success was achieved with mean reduction of pain scores of 2.4, which was statistically significant (P < 0.0001). There were no immediate or acute complications. LIMITATIONS: Results of this study were based on retrospective study. The use of VAS may be subjective, and the need of a prospective study may be necessary. CONCLUSIONS: With 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission. KEY WORDS: Chronic, migraine, minimally invasive, nerve block, pediatric, sphenopalatine
• Greenhill, M., Aria, D., Schaefer, C., Kaye, R., Jorgensen, S. A., Abruzzo, T., Towbin, A., & Towbin, R. (2020). Inflammatory myofibroblastic tumor. Applied Radiology, 49(Issue 1).
• Kent, A., Towbin, R., Schaefer, C., Kaye, R., Jorgensen, S., Abruzzo, T., Towbin, A., & Aria, D. (2020). Orbital venous malformation. Applied Radiology, 49(Issue 2).
• Rubin, J., Towbin, R. B., Schaefer, C. M., Aria, D. J., & Towbin, A. J. (2020). Invasive pulmonary aspergillosis. Applied Radiology, 49(Issue 6).
• Greenhill, M., Schafernak, K., Schaefer, C., Kaye, R., Aria, D., Abruzzo, T., Towbin, A., & Towbin, R. (2019). Langerhans cell histiocytosis. Applied Radiology, 48(Issue 3).
• Towbin, R., Schaefer, C., Kaye, R., Abruzzo, T., & Aria, D. J. (2019). The complex spine in children with spinal muscular atrophy: The transforaminal approach - A transformative technique. American Journal of Neuroradiology, 40(Issue 8). doi:10.3174/ajnr.a6131
  More info

  BACKGROUND AND PURPOSE: Spinal muscular atrophy, a genetic disease resulting in loss of motor function, presents from in utero to adulthood. Depending on progression and secondary scoliosis, spinal stabilization may be necessary. When planning intrathecal access in these patients, spinal anatomy is the most important factor. Therefore, when planning intrathecal nusinersen injections, we subdivided patients with spinal muscular atrophy into simple-versus-complex spine subgroups. Our purpose was to present our experience with our first 42 transforaminal intrathecal nusinersen injections. MATERIALS AND METHODS: We reviewed 31 consecutive patients with spinal muscular atrophy types 1-3 who presented for intrathecal nusinersen injections from March 2017 to September 2018. Nine children had complex spines (ie, spinal instrumentation and/or fusion) and required preprocedural imaging for route planning for subarachnoid space access via transforaminal or cervical approaches. RESULTS: A total of 164 intrathecal nusinersen injections were performed in 31 children 4 -226 months of age, with 100% technical success in accessing the subarachnoid space. Nine patients with complex spinal anatomy underwent 45 intrathecal nusinersen injections; 42 of 45 procedures were performed via a transforaminal approach with the remaining 3 via cervical techniques. There were no complications. CONCLUSIONS: Our initial experience has resulted in a protocol-driven approach based on simple or complex spinal anatomy. Patients with simple spines do not need preprocedural imaging or imaging-guided intrathecal nusinersen injections. In contrast, the complex spine subgroup requires preprocedural imaging for route planning and imaging guidance for therapy, with the primary approach being the transforaminal approach for intrathecal nusinersen injections.
• Abruzzo, T. A., Aria, D. J., Bernes, S., Kaye, R. D., Mousa, M. A., Riemann, M., Schaefer, C. M., Towbin, R. B., & Willard, S. D. (2018).

  A comprehensive institutional overview of intrathecal nusinersen injections for spinal muscular atrophy

  . Pediatric Radiology. doi:10.1007/s00247-018-4206-9
• Schaefer, C. M., Towbin, R. B., Aria, D. J., & Kaye, R. D. (2016). Safety and effectiveness of percutaneous cholecystostomy in critically ill children who are immune compromised. Pediatric Radiology, 46(Issue 7). doi:10.1007/s00247-016-3562-6
  More info

  Background: Acalculous cholecystitis is known to develop in critically ill patients without cystic duct obstruction. In the past, treatment for acalculous cholecystitis has been cholecystectomy; however, many children who are critically ill are Percutaneous cholecystostomy is likely the procedure of choice in this subgroup of patients. Objective: To assess the safety and effectiveness of percutaneous cholecystostomy in critically ill and immune-compromised children with acalculous cholecystitis. Materials and methods: Retrospective review of immune-compromised and critically ill children who underwent percutaneous cholecystostomy between 2006 and 2013. Diagnostic imaging performed included ultrasound, CT and hepatobiliary scintigraphy. Every percutaneous cholecystostomy was performed using imaging guidance. Results: Ten critically ill and immune-compromised children with acalculous cholecystitis underwent percutaneous cholecystostomy. Seven boys and 3 girls, ranging in age from 10 months to 15 years 8 months, were treated. Six of the immune-compromised children had received a bone marrow transplant for leukemia (5 children) or severe combined immunodeficiency (SCID) (1 child), and ranged from 18 to 307 days post bone marrow transplant at the time of their percutaneous cholecystostomy. Of the remaining four immune-compromised children with acalculous cholecystitis who underwent percutaneous cholecystostomy, two had leukemia, one had SCID and lymphoma, and the fourth was undergoing treatment for undifferentiated germ cell tumor. The 10 percutaneous gallbladder drains were placed using a transhepatic approach, except one unintentional transperitoneal approach. There were no complications. Three gallbladder drains were removed in Interventional Radiology. Those three patients had a return to normal gallbladder function and didn’t require cholecystectomy. Two drains were removed during cholecystectomy and another as an outpatient. Four patients died in the hospital due to multiorgan system failure, with indwelling gallbladder drains. Conclusion: Percutaneous cholecystostomy is a safe procedure in immune-compromised and critically ill children with acalculous cholecystitis. Percutaneous cholecystostomy may obviate the need for future cholecystectomy.
• Aria, D. J., Vatsky, S., Kaye, R., Schaefer, C., & Towbin, R. (2014). Greater saphenous venous access as an alternative in children. Pediatric Radiology, 44(Issue 2). doi:10.1007/s00247-013-2794-y
  More info

  Background: In the pediatric population, obtaining venous access in high-risk neonates, severely ill children with cardiac anomalies or very young children (
• Aria, D., Vatsky, S., Towbin, R., Schaefer, C. M., & Kaye, R. (2014). Interventional radiology in the neonate and young infant. Seminars in Ultrasound, CT and MRI, 35(Issue 6). doi:10.1053/j.sult.2014.07.002