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Dr. Arash Momeni (Assistant Professor of Surgery) is the Ryan-Upon Scholar and Director of Clinical Outcomes Research in the Division of Plastic and Reconstructive Surgery at Stanford University. He graduated with magna cum laude honors from the Johannes Gutenberg University (Mainz, Germany). After completing his Plastic Surgery and Hand Surgery training at the University of Freiburg (Germany), Dr. Momeni completed a second residency in Plastic and Reconstructive Surgery at Stanford University. This was followed by a fellowship in Advanced Reconstructive Microsurgery at the University of Pennsylvania. Dr. Momeni’s clinical interests include complex reconstruction after cancer and trauma with the goal of helping patients get back to normal both from a functional and aesthetic standpoint. His clinical practice focuses on complex reconstructive surgery of the breast, head and neck, trunk, and extremities. He uses state-of-the-art surgical techniques, including perforator flaps. In addition to offering all reconstructive modalities following mastectomy, Dr. Momeni has developed cutting edge surgical approaches to post-mastectomy reconstruction such as hybrid breast reconstruction (i.e. the combination of free flap transfer and implant placement) and techniques of flap neurotization with the goal to improve sensory recovery to the reconstructed breast.Dr. Momeni is recognized nationally and internationally for his research in clinical outcomes after microsurgical reconstruction and Evidence-based medicine (EBM). He has authored over 200 peer-reviewed publications and numerous chapters in major plastic surgery textbooks. He speaks regularly at national and international meetings and is an ad hoc reviewer for numerous scientific journals, including Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery (JPRAS), Journal of Reconstructive Microsurgery, and Aesthetic Plastic Surgery. Additionally, he is the Associate Editor of Annals of Plastic Surgery and serves on the Editorial Board of leading plastic surgery journals, including Microsurgery and European Journal of Plastic Surgery.
Dr. Momeni's research focuses on clinical outcomes after microsurgical reconstruction, with a particular emphasis on VTE prevention.
Microsurgical Breast Reconstruction & VTE
Venous thromboembolism (VTE) encompasses pulmonary embolism (PE) and deep venous thrombosis
(DVT) and continues to be a major patient safety issue after reconstructive plastic surgery.
Significant morbidity and mortality is associated with VTE events. This disease entity
represents the most common cause of preventable in-hospital death as evidenced by over
100,000 annual VTE-related deaths in the U.S. The associated economic burden is substantial,
with annual costs to the U.S. healthcare system in excess of $7 billion.
Cancer patients have been identified as a particularly vulnerable patient population. Of
these, breast cancer patients represent the largest group treated by plastic surgeons. An
increasing number of breast reconstructions are performed in the U.S. with a documented 35%
increase in the annual number of breast reconstructions since 2000. Over 106,000 breast
reconstructions were performed in 2015 alone.
Of all reconstructive modalities, autologous breast reconstruction using abdominal flaps is
associated with the highest risk for VTE. We believe that a key element rendering these
patients susceptible to postoperative VTE is inadequate duration of chemoprophylaxis. This is
supported by the observation that VTE risk remains elevated for up to 12 weeks
postoperatively. We hypothesize that lower extremity deep venous system stasis is a
procedure-specific key contributing factor to postoperative VTE risk.
This study examines the duration of postoperative lower extremity venous stasis to identify
patients who might benefit from extended chemoprophylaxis. We will use Duplex imaging
technology to examine the lower extremity deep venous system preoperatively, on postoperative
day 1, and on the day of discharge to determine if patients display radiographic evidence of
lower extremity venous stasis at the time of hospital discharge.
A better understanding of pathophysiologic mechanisms that contribute to the development of
VTE as well as surgical means that reduce VTE risk factors have the potential to optimize VTE
prophylaxis, thus, favorably impacting clinical outcome in a large patient population.
Stanford is currently not accepting patients for this trial.
For more information, please contact Arash Momeni, MD, 650-723-6189.
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Apixaban vs Enoxaparin Following Microsurgical Breast Reconstruction-An RCT
Subcutaneous enoxaparin is currently the gold standard for VTE chemoprophylaxis. However, the
efficacy of chemoprophylaxis with subcutaneous enoxaparin is affected by patient-level
factors, thus, resulting in VTE events despite guideline-compliant prophylaxis. A population
at particular risk is the growing number of patients who undergo autologous breast
reconstruction. Direct oral anticoagulants (DOAC) might be a less invasive, yet, more
efficacious mode of chemoprophylaxis in this patient population. Hence, the proposed work has
the potential to cause a paradigm shift in chemoprophylaxis guidelines in a large population
of patients undergoing plastic surgery.