Bio

Bio


Andrew C. Picel, MD, is a board-certified interventional radiologist who specializes in diagnosing and treating disease with minimally invasive image guided procedures. These imaging techniques include X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound.

Dr. Picel was one of the first physicians in the region to test a minimally invasive therapy to treat severe lower urinary tract symptoms related to benign prostate hyperplasia (BPH), called prostate artery embolization (PAE). This now FDA-approved treatment does not have the sexual side effects of transurethral resection of the prostate (TURP), the standard treatment for men who have not responded to medications and lifestyle modifications. He currently works closely with urologists to evaluate and treat patients with BPH.

Dr. Picel provides treatment for individuals with circulatory system diseases, such as peripheral arterial and venous disease. He performs numerous procedures for the treatment of venous insufficiency and varicose veins. These procedures commonly include endovenous ablation and sclerotherapy. Clinically, Dr. Picel also has a special interest in interventional oncology and performs TACE and TARE to treat patients with hepatocellular carcinoma (HCC). He also performs uterine fibroid embolization and occlusion balloon placement for invasive placenta.

An assistant professor in the Department of Radiology at Stanford University, Dr. Picel trains interventional radiology fellows and residents. His research interests focus on prostate artery embolization and pelvic embolization for invasive placenta.

Outside of work, Dr. Picel enjoys sailing, spending time with family, and traveling.

Academic Appointments


  • Clinical Assistant Professor, Radiology

Administrative Appointments


  • IR Residency and Fellowship Program Director, UC San Diego (2018 - 2019)
  • Assistant Clinical Professor, UC San Diego (2015 - 2019)

Honors & Awards


  • RNSA Clinical Trials Methodology Workshop, Radiologic Society of North America (2019)
  • Academic Medicine Leadership Training Program, National Center of Leadership in Academic Medicine (2018)
  • Award for Excellence in Clinical Care, UC San Diego (2017)
  • JVIR Editorial Fellow, Journal of Vascular and Interventional Radiology (2017)
  • Academic Faculty Development Program, Association of University Radiologists (2016)
  • Award for Excellence in Clinical Care, UC San Diego (2015)
  • Chief Resident, UC San Diego Radiology (2014)

Professional Education


  • MD, UC San Diego, Radiology Residency and Interventional Radiology fellowship (2014)
  • MD, Wake Forest University School of Medicine, Medicine (2007)
  • BS, University of Georgia, Mathematics, Biology (2002)

Research & Scholarship

Current Research and Scholarly Interests


Prostate artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH).

Prophylactic balloon occlusion catheters and uterine artery embolization to reduce blood loss in patients with invasive placenta.

Geniculate artery embolization for relief of osteoarthritis related knee pain.

Publications

All Publications


  • Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment. Radiographics : a review publication of the Radiological Society of North America, Inc Picel, A. C., Hsieh, T. C., Shapiro, R. M., Vezeridis, A. M., Isaacson, A. J. 2019: 180195

    Abstract

    Symptomatic benign prostatic hyperplasia is a common condition in the aging population that results in bothersome lower urinary tract symptoms and decreased quality of life. Patients often are treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is considered the traditional standard of care, but several minimally invasive surgical treatments also are offered. Prostatic artery embolization (PAE) is emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalization. The procedure is offered to patients with moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolization are critical to optimize results. To perform PAE safely and avoid nontarget embolization, interventional radiologists must have a detailed understanding of the pelvic arterial anatomy. Although the prostatic arteries often arise from the internal pudendal arteries, several anatomic variants and pelvic anastomoses are encountered. Prospective cohort studies, small randomized controlled trials, and meta-analyses have shown improved symptoms after treatment, with serious adverse effects occurring rarely. This article reviews the basic principles of PAE that must be understood to develop a thriving PAE practice. These principles include patient evaluation, review of surgical therapies, details of pelvic arterial anatomy, basic principles of embolization, and an overview of published results. Online supplemental material is available for this article.©RSNA, 2019.

    View details for DOI 10.1148/rg.2019180195

    View details for PubMedID 31348735

  • Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection (vol 61, e00954-17, 2017) ANTIMICROBIAL AGENTS AND CHEMOTHERAPY Schooley, R. T., Biswas, B., Gill, J. J., Hernandez-Morales, A., Lancaster, J., Lessor, L., Barr, J. J., Reed, S. L., Rohwer, F., Benler, S., Segall, A. M., Taplitz, R., Smith, D. M., Kerr, K., Kumaraswamy, M., Nizet, V., Lin, L., McCauley, M. D., Strathdee, S. A., Benson, C. A., Pope, R. K., Leroux, B. M., Picel, A. C., Mateczun, A. J., Cilwa, K. E., Regeimbal, J. M., Estrella, L. A., Wolfe, D. M., Henry, M. S., Quinones, J., Salka, S., Bishop-Lilly, K. A., Young, R., Hamilton, T. 2018; 62 (12)

    View details for PubMedID 30478181

  • Endovascular Management of a Large Persistent Sciatic Artery Aneurysm Inui, T. S., Picel, A. C., Barleben, A., Lane, J. S. ELSEVIER SCIENCE INC. 2018: 312.e13–312.e16

    Abstract

    The persistent sciatic artery (PSA) is a remnant of the fetal circulatory system that is preserved in less than 0.1% of the population. Up to 60% of patients with this vascular anomaly will go on to development of a PSA aneurysm (PSAA), which can produce a variety of symptoms including neuropathy, claudication, and acute limb-threatening ischemia. Historical management is by open operation and interposition grafting, which can be highly morbid. We describe successful management of a large, symptomatic PSAA by endovascular stent grafting with intermediate term follow-up.

    View details for DOI 10.1016/j.avsg.2018.03.003

    View details for Web of Science ID 000443980600041

    View details for PubMedID 29772318

  • Needle localization of small pulmonary nodules: Lessons learned JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Thistlethwaite, P. A., Gower, J. R., Hernandez, M., Zhang, Y., Picel, A. C., Roberts, A. C. 2018; 155 (5): 2140–47

    Abstract

    Lung nodules that are small and deep within lung parenchyma, and have semisolid characteristics are often challenging to localize with video-assisted thoracoscopic surgery (VATS). We describe our cumulative experience using needle localization of small nodules before surgical resection. We report procedural tips, operative results, and lessons learned over time.A retrospective review of all needle localization cases between July 1, 2006, and December 30, 2016, at a single institution was performed. A total of 253 patients who underwent needle localization of lung nodules ranging from 0.6 to 1.2 cm before operation were enrolled. Nodules were localized by placing two 20-gauge Hawkins III coaxial needles from different trajectories with tips adjacent to the nodule, injection of 0.3 to 0.6 mL of methylene blue, and deployment of 2 hookwires, under computed tomography guidance. Patients then underwent VATS wedge resection for diagnosis, followed by anatomic resection for lung carcinoma. Procedural and perioperative outcomes were assessed.Needle localization was successful in 245 patients (96.8%). Failures included both wires falling out of lung parenchyma before operation (5 patients), wire migration (2 patients), and bleeding resulting in hematoma requiring transfusion (1 patient). The most common complication of needle localization was asymptomatic pneumothorax (11/253 total patients; 4.3%) and was higher in patients with bullous emphysema (9/35 patients; 25.7%). Of the 8 individuals who had unsuccessful needle localization, 7 had successful wedge resection in the area of methylene blue injection that included the nodule; 1 required segmentectomy for diagnosis. Completion lobectomy (154 VATS, 2 minithoracotomies) or VATS segmentectomy (18 patients) was performed in 174 individuals with a diagnosis of non-small cell carcinoma or carcinoid. The average length of hospital stay was 1.4 days for wedge resection, 1.9 days for VATS segmentectomy, 3.1 days for VATS lobectomy, and 4.9 days for minithoracotomy. Perioperative survival was 100%.Needle localization with hookwire deployment and methylene blue injection is a safe and feasible strategy to localize small, deep lung nodules for wedge resection and diagnosis. Multidisciplinary coordination between the thoracic surgeon and the interventional radiologist is key to the success of this procedure.

    View details for DOI 10.1016/j.jtcvs.2018.01.007

    View details for Web of Science ID 000430195900067

    View details for PubMedID 29455962

  • Prophylactic Internal Iliac Artery Occlusion Balloon Placement to Reduce Operative Blood Loss in Patients with Invasive Placenta JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Picel, A. C., Wolford, B., Cochran, R. L., Ramos, G. A., Roberts, A. C. 2018; 29 (2): 219–24

    Abstract

    To evaluate efficacy and safety of prophylactic internal iliac occlusion balloon placement before cesarean hysterectomy for invasive placenta.A retrospective analysis was performed of patients with invasive placenta treated with and without occlusion balloon placement. Preoperative occlusion balloons were placed in 90 patients; 61 patients were treated without balloon placement (control group). Baseline demographics, including patient age, gestational age at delivery, gravidity, parity, and number of previous cesarean sections, were not significantly different (P > .05). Of the balloon placement group, 56% had placenta percreta compared with 25% in the control group (P < .001), and 83% had placenta previa compared with 66% in the control group (P = .012).Median blood loss was 2 L (range, 1.5-2.5 L) in the balloon placement group versus 2.5 L (range, 2-4 L) in the control group (P = .002). Patients with occlusion balloons were transfused a median of 2 U (range, 0-5 U) of packed red blood cells versus 5 U (range, 2-8 U) in patients in the control group (P = .002). In the balloon placement group, 34% had large volume blood loss > 2,500 mL versus 61% in the control group (P = .001), and 21% required blood transfusion > 6 U versus 44% in the control group (P = .002). Eight complications (9%) were attributed to occlusion balloon placement.Prophylactic internal iliac artery occlusion balloon placement reduces operative blood loss and transfusion requirements in patients undergoing hysterectomy for invasive placenta.

    View details for PubMedID 29128157

  • Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection ANTIMICROBIAL AGENTS AND CHEMOTHERAPY Schooley, R. T., Biswas, B., Gill, J. J., Hernandez-Morales, A., Lancaster, J., Lessor, L., Barr, J. J., Reed, S. L., Rohwer, F., Benler, S., Segall, A. M., Taplitz, R., Smith, D. M., Kerr, K., Kumaraswamy, M., Nizet, V., Lin, L., McCauley, M. D., Strathdee, S. A., Benson, C. A., Pope, R. K., Leroux, B. M., Picel, A. C., Mateczun, A. J., Cilwa, K. E., Regeimbal, J. M., Estrella, L. A., Wolfe, D. M., Henry, M. S., Quinones, J., Salka, S., Bishop-Lilly, K. A., Young, R., Hamilton, T. 2017; 61 (10)

    Abstract

    Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including Acinetobacter baumannii We report on a method used to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR A. baumannii infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an A. baumannii isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the A. baumannii infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted.

    View details for PubMedID 28807909

  • Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Kao, S. D., Morshedi, M. M., Narsinh, K. H., Kinney, T. B., Minocha, J., Picel, A. C., Newton, I., Rose, S. C., Roberts, A. C., Kuo, A., Aryafar, H. 2016; 27 (8): 1148–53

    Abstract

    To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS).Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded.The two groups were well matched by sex, age, etiology of liver disease, Child-Pugh class, Model for End-Stage Liver Disease scores, and indication for TIPS (P range = .19-.94). Fewer intrahepatic needle passes were required in intravascular US-guided TIPS creation compared with conventional TIPS (2 passes vs 6 passes, P < .01). Less iodinated contrast material was used in intravascular US cases (57 mL vs 140 mL, P < .01). Radiation exposure, as measured by cumulative dose, dose area product, and fluoroscopy time, was reduced with intravascular US (174 mGy vs 981 mGy, P < .01; 3,793 μGy * m(2) vs 21,414 μGy * m(2), P < .01; 19 min vs 34 min, P < .01). Procedure time was shortened with intravascular US (86 min vs 125 min, P < .01).Intravascular US guidance resulted in fewer intrahepatic needle passes, decreased contrast medium usage, decreased radiation dosage, and shortened procedure time in TIPS creation.

    View details for PubMedID 27052948

  • Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY Picel, A. C., Koo, S. J., Roberts, A. C. 2016; 39 (8): 1170–76

    Abstract

    The purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs).A retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %).Embolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization.TAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.

    View details for PubMedID 27021069

  • May-Thurner Syndrome and Horseshoe Kidney JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Nwoke, F., Picel, A. C. 2016; 27 (3): 369

    View details for DOI 10.1016/j.jvir.2015.11.049

    View details for Web of Science ID 000372855700009

    View details for PubMedID 26916939

  • Foreign Body Ingestion Resulting in Hydronephrosis JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Ramaswamy, R. S., Picel, A. C. 2015; 26 (5): 679

    View details for DOI 10.1016/j.jvir.2014.11.022

    View details for Web of Science ID 000354504000008

    View details for PubMedID 25636668

  • Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm with Arteriovenous Fistula and Duplication of the Inferior Vena Cava JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Picel, A. C., Lane, J. S. 2014; 25 (12): 1901–2

    View details for DOI 10.1016/j.jvir.2014.08.017

    View details for Web of Science ID 000345676700010

    View details for PubMedID 25457139

  • Essentials of Endovascular Abdominal Aortic Aneurysm Repair Imaging: Preprocedural Assessment AMERICAN JOURNAL OF ROENTGENOLOGY Picel, A. C., Kansal, N. 2014; 203 (4): W347–W357

    Abstract

    To understand the abdominal aortic aneurysm imaging characteristics that must be accurately described for endovascular aortic aneurysm repair treatment planning, including evaluation of the landing zones, aneurysm morphology, and vascular access..A comprehensive understanding of preprocedural imaging is necessary to produce detailed and clinically useful imaging reports and assist the interventionalist in planning endovascular abdominal aortic aneurysm repair.

    View details for PubMedID 25247964

  • Essentials of Endovascular Abdominal Aortic Aneurysm Repair Imaging: Postprocedure Surveillance and Complications AMERICAN JOURNAL OF ROENTGENOLOGY Picel, A. C., Kansal, N. 2014; 203 (4): W358–W372

    Abstract

    Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure.A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.

    View details for PubMedID 25247965

  • An aberrant internal carotid artery discovered during evaluation of obstructive sleep apnea: A report of 2 cases with consideration of a possible association ENT-EAR NOSE & THROAT JOURNAL Picel, A. C., Davidson, T. M. 2011; 90 (1): 29–31

    Abstract

    Obstructive sleep apnea (OSA) is often associated with reduced pharyngeal muscle tone and an anatomically narrowed pharyngeal airspace. We describe 2 cases of aberrant internal carotid arteries that were diagnosed during evaluations of patients with suspected OSA. It is possible that these anatomic anomalies contributed to airspace narrowing in these patients. These 2 cases represent an interesting presentation of sleep apnea, and they provide a reminder of the importance of clinically recognizing carotid artery aberrations in order to avoid arterial damage during routine oropharyngeal procedures.

    View details for PubMedID 21229508