Avnesh Thakor, MD, PhD

Associate Professor, Pediatric Radiology
Director, IRIS (Interventional Radiology Innovation at Stanford)

CLINICAL SUBSPECIALTIES

Advanced Technologies: Interventional Radiologists are at the cutting-edge interface of medical innovation and can integrate multiple imaging modalities with advanced technologies to deliver minimally invasive care for patients. These technologies include imaging equipment, machines that can cause focal tissue destruction, equipment that can be deployed in blood vessels and luminal structures and software programs that help guide interventions.
Innovative Techniques: Dr Thakor and the Interventional Radiology team at LPCH are pushing forward the boundaries of how to treat children using minimally invasive high-end techniques. In addition, we are able to cause the local destruction of tumors using percutaneous thermal or endovascular tumor blocking techniques, or more recently using completely non-invasive ways via soundwaves (i.e. HIFU).
Pioneering Care: The Interventional Radiology team provides essential services that are integrated into the care pathway of children in almost all other service lines. As such we offer emergency care, urgent care, and routine elective care. We work closely with our anesthesiology colleagues to provide 24/7 care, all year round, for children from the time they are born, when they can be small as 500g, all the way through to when they become adults. Our goal is to provide the highest quality care to children using minimally invasive techniques that help to support the physical and mental wellbeing of a child and family throughout their journey through our healthcare system.

State-of-the-art Fluoroscopy & Ultrasound Systems: Technologies to allow us to perform minimally invasive procedures
High Intensity Focused Ultrasound (HIFU) Therapy: Using soundwaves to non-invasively destroy tumors without any incisions
Endovascular Tumor Removal: Endovascular tumor removal from the IVC and renal veins in a child with metastatic tumor using specialized novel equipment (Inari Clot and Flow Triever Systems)
Intravascular Assessment of Blood Vessels: Intravascular ultrasound (IVUS) to assess the IVC in a patient with a liver transplant with mismatch between with the adult donor and child recipient liver

Minimally Invasive Imaged Guided Biopsies

3D guided targeting of lesions for tissue sampling	Fusion of different imaging modalities (i.e. MRI fused with CT images) for precision sampling

Tumor Ablations

Percutaneous freezing (cryoablation) of a soft tissue tumor in the arm of a child	Percutaneous radiofrequency ablation (RFA) of bone tumors in children	Percutaneous microwave ablation of soft tissue tumors in children

Research Interests

Interventional Regenerative Medicine: Restoring cellular health and function of injured tissues through the local delivery of regenerative and stem cell therapies.
Interventional Oncology: Treating solid tumors through the local delivery of drug, cellular and thermal/ablative therapies. We specifically work on the differences in organ regeneration between children and adults. Furthermore, as children have much higher bioenergetic requirements, we are focusing on novel therapies to address this specific need.
Clinical Translation of Research: Our goal at IRIS is to push the boundaries of pediatric clinical care by developing new therapies and technologies in the laboratory and then seamlessly delivering these innovative treatments to children at LPCH, while always keeping the physical and mental wellbeing of the child and family at the center of our approach

Biliary System Interventions

3D reconstruction of the biliary system in a child with a liver transplant used to open up a biliary stricture with subsequent percutaneous placement of internal stents
Innovative access of the common bile duct through the gallbladder in a patient with multiple strictured internal bile ducts

Endovascular Local Therapy Delivery

Therapy administration into the bowel circulation for children with inflammatory bowel disease (IBD)	Therapy administration into the liver circulation for children with graft-vs-host disease (GvHD)	Therapy administration into the transplanted bowel with the site of rejection localized with an endoscopically placed clip

Interventions of the Urinary System

Percutaneous access, salvage and reconstruction of the urinary outlet of a transplanted kidney

Percutaneous Access of the Lymphatic System for Therapy Delivery
Embolization of the lymphatic system to treat children with persistent chylous effusions
Access to the lymphatic system in children through the liver lymphatic channels

Thrombectomy and Venous Reconstruction

Treating and removing blood clot (thrombus) in the leg veins of children using endovascular approaches with the placement of a protective filter and reconstruction of the iliac vein with angioplasty and stent placement

Embolization Techniques

Retrograde embolization of a leaking thoracic duct in a child	Image-guided percutaneous embolization of a ruptured pseudoaneurysm	Image-guided endovascular embolization of a ruptured and bleeding kidney in a child following trauma to save them surgical resection

Endovascular Catheter Stripping

Fibrin sheath blocking the tip of the port which was removed using an endovascular snare

Venous Reconstruction with Angioplasty

Venous Reconstruction with Angioplasty Percutaneous re-establishment of inline flow following chronic upper limb venous occlusion from long term vascular access

Arterial Angioplasty

Endovascular renal arterial angioplasty to restore blood flow to the kidney to correct high blood pressure in a child

Combination Ablative and Sclerotherapy

Combination of percutaneous cryotherapy and chemical sclerotherapy to treat cystic bone tumors

Newborn Interventions
Evaluating the biliary system in a newborn
Vascular line placements for babies who need dialysis

Vascular Access

Temporary / Apheresis Line, PICC, Tunneled Line, Port

Biopsies
Ultrasound-guided biopsy of a transplant kidney with tract sealing using gelfoam pledgets
Ultrasound-guided targeted biopsy of indeterminate liver lesion
Fluoroscopically-guided transjugular liver biopsy

Targeted Injections
Xperguide intrathecal injection of Spinraza for patients with spinal muscular atrophy
Joint Injection of steroids for patients with juvenile rheumatoid arthritisJoint Injection of steroids for patients with juvenile rheumatoid arthritis
CT guided percutaneous injection of Botox and analgesia to block the celiac ganglion for patients with abdominal pain

Percutaneous Drainage Catheter Placement

Bypassing an obstructed Kidney; Draining fluid in the pleural space; Draining an abscess from a perforated appendix; Bypassing a biliary leak following a liver resection

At Stanford, Dr. Thakor is leading a unique one-of-a-kind multidisciplinary program called IRIS - Interventional Radiology Innovation at Stanford, which aims to bring together scientists, physicians, healthcare providers, thought-leaders, and industry partners, in a cohesive and unified approach with the goal of improving, and leading, care for sick and terminally ill children.