Treating Vascular Malformations 
Peter Choi (DO ’24)

March 31, 2023

Growing up in North Wales, Pennsylvania, Peter Choi (DO ’24) initially wanted to attend culinary school to become a chef. Even while he was an undergraduate student at Lehigh University majoring in psychology, the thought of studying medicine seemed like learning a whole new language. Choi didn’t have any mentors, life-altering personal stories, or family members in medicine that would give him easy access to a healthcare career. He didn’t know where to start and said he felt like the new kid at school holding a lunch tray and not knowing where to sit.

He recalls that switching from learning about Sigmund Freud at Lehigh to ideal gas laws for the MCAT was an adventure. “Fast forward to now as a third year medical student, and I realize I was very fortunate to obtain those mentors and personal experiences throughout my time at PCOM Georgia. Not only am I now applying medicine in clinical rotations, but I am also part of the evidence-based research process that drives how medicine is practiced,” he said.

“I didn’t become a chef in the end, but I still was able to create something amazing that I can be proud of.”

He said, “Research can be perceived as this mysterious, invisible entity that is only reserved for a select few and the elite. This cannot be further from the truth. I challenge students to seek out people who are willing to take a chance on them. If finding someone is not realistic, create your own project. Start your own timeline and become the person that other students come to.”

In lay terms, what are you studying?

The International Society for the Study of Vascular Anomalies (ISSVA) classifies low-flow vascular malformations as lymphatic and venous malformations, many of which occur in the head and neck. Clinical diagnosis of these vascular lesions is aided by several imaging modalities such as US and MRI which provide findings that are characteristic of each vascular malformation. Following diagnosis, interventional radiologists and otolaryngologists may offer several treatment options in tandem or together aimed at reducing the progression of and preventing further complications of low-flow malformations. I am studying treatment strategies that best detail the collaborative work between ENT and IR including indications for several sclerosants (STS embolic foam, bleomycin, and doxycycline) and novel therapeutics (Sirolimus and Alpelisib), and how these treatments can be used in conjunction with otolaryngology. Special attention is given to indications to appropriate treatment, diagnostic and treatment pitfalls, technical considerations, and clinical follow-up.

What prompted you to pursue research?

To be transparent, I initially wanted to pursue research because I wanted to check off a box for my resume. I naively thought that’s just what all students did but didn’t want to admit. However, I decided to stay in the game and continue research on my own free accord because I have grown to enjoy the process of generating an idea, delineating a plan, handpicking my own team, executing goals, learning the language of statistics as well as intensely working with colleagues and attendings that ultimately deepen and add a new dimension to the professional relationship. Everyone says that having a mentor is key to doing research. The word mentor however is vague and doesn’t specifically delineate their role in relation to the student. I believe a more accurate description is to find someone who will take a chance on you. Research projects are an investment in time and finding a PI who is willing to take a chance on you is the reason why I have continued to pursue and be fulfilled in my research projects.

What experience do you have conducting research?

I first started working in the Public Health and Psychology departments at Lehigh University where I analyzed adolescent alcohol usage literature, coded data categorizing specific protective behavior strategies, as well as beta tested peer health initiatives that focused on plans to reduce harmful adolescent behavior. During my first year at PCOM Georgia, I decided to challenge myself and completely start my own project from scratch. The most important aspect of research is to consider whether it’s a niche topic, meaning the topic should offer new information that has limited literature and data. For example, the USMLE Step 1 had gone Pass/Fail and my class of 2024 will be the first to undergo Match Day with Pass/Fail scores. I wanted to know how this will influence dermatology program directors in whom they choose to interview and what parts of the application they will focus on since previously, Step 1 scores were an important screening metric. My current project involves exploring the effects of different diagnostic and treatment modalities that encourage interdisciplinary involvement from otolaryngologists and interventional radiologists in treating vascular low flow malformations of the head and neck. As first author for both of these projects, I had to familiarize myself with every aspect of the process from the initial idea, to final publication.

What were your responsibilities in the research project?

My responsibilities started with the initial literature review of the topic at hand. I had to make sure that I had all my ducks in a row and ensure that my topic was a new area of research that is meaningful, and had not been done before. Afterwards, I had to create my team of people who made sense to be part of the project, as well as attendings who wanted to take a chance on me. Drafting the proposal as well as obtaining IRB approval was the next priority. Becoming familiar with the software that collected data was my next goal. After the data was collected, I sought out the help of a statistician to help me analyze the data. After interpreting our results, the next step was drafting the full manuscript. I then created my poster with the help of PCOM and submitted my project to the American Association of Colleges of Osteopathic Medicine Emerging Leaders Conference where I was the primary presenter. The next step was finding the appropriate journal to submit to. After being deferred four times and having to hire multiple professional editors and constant revisions on my end, my article was finally published.

What is the broader impact of your research?

The broader impact of my research is that vascular malformations of the head and neck can involve certain high-risk areas such as the orbit and tongue. Many specialists are hesitant to treat around this area and opting to not recommend treatment is common. The use of certain sclerosants such as bleomycin, for example, has recently been used to embolize these vascular malformations due to their strong mesenchymal destabilization properties and low inflammatory profile. The study has shown that the patients with these malformations in the eye for example, have been successfully treated with bleomycin with complete resolution of symptoms. In patients with more advanced lesions, a combination of sclerosant use from interventional radiology and laser debulking surgery from otolaryngology can be utilized to maximize efficacy and minimize adverse events.

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