Ep. 290 SVC Sharp Recanalizations with Dr. Abdulaziz Alharbi

Ep. 290 SVC Sharp Recanalizations with Dr. Abdulaziz Alharbi

In this episode, Dr. Aaron Fritts interviews interventional radiologist Dr. Abdulaziz Alharbi of the Ministry of National Guard Health Affairs in Saudi Arabia. They discuss Dr. Alharbi’s approach to planning and performing sharp recanalization of the superior vena cava (SVC) for dialysis, transplant, and cancer patients. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/sJLY3K --- SHOW NOTES Dr. Alharbi starts by describing how patients get referred to him, mainly due to end stage renal disease, chronic obstruction, and the need for dialysis access. Additionally, some patients seek access for central lines, and others have acute obstructions due to malignancies. Depending on the patient’s clinical condition, comorbidities, upcoming medical procedures, and anatomy, he will then decide if the patient is an appropriate candidate for SVC recanalization and obtain a CT scan. This imaging guides further decision-making on whether to access the obstruction from the internal jugular or brachiocephalic vein. The CT also helps him think about potential complications, such as cardiac tamponade in an obstruction close to the heart and pulmonary edema in all recanalizations. These risks are communicated to each patient accordingly. Prior to starting the procedure, Dr. Alharbi ensures that there are multiple access sites prepared, including neck, bilateral arms, and femoral access. He also ensures that there are tools that he is comfortable using and a support team in place. A colleague will usually help him by obtaining femoral access and placing a target snare distal to the obstruction. Dr. Alharbi walks us through a typical case. First he slowly advances a Chiba needle towards the target. His choice in sheath length depends on the length of the occlusion and the access point. A longer occlusion accessed through the brachiocephalic vein requires a longer sheath than a short occlusion accessed through the internal jugular vein. Next, we discuss stent sizing. Dr. Alharbi notes that it is preferable to oversize, to prevent stagnation of flow. In short occlusions, he uses bare self-expandable stents. In longer occlusions or cancer patients, he uses covered stents since there is more precise deployment. The post-procedure anticoagulation regimen usually includes heparin and an antiplatelet agent for 2-3 weeks. Then, patients are switched to apixaban for 6 months. Beyond this, patients are either taken off of anticoagulation if they are asymptomatic and there is good SVC inflow, or reverted back to their preexisting anticoagulation regimen that they had due to other comorbidities. --- RESOURCES PAIRS 2023: https://pairscongress.com/ Dr. Abdulaziz Alharbi Twitter: https://twitter.com/DrAlHarbiA_Aziz

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Ep. 75 The Role of IR in Stroke Interventions (Part 2) with Dr. David Sacks and Dr. Martin Radvany

Ep. 75 The Role of IR in Stroke Interventions (Part 2) with Dr. David Sacks and Dr. Martin Radvany

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/07FYzi Part II of the discussion with Dr. Martin Radvany and Dr. David Sacks on the role of Interventional Radiologists in stroke interventions, including addressing training requirements and rural access to care.

4 Elo 202046min

Ep. 74 The Role of IR in Stroke Interventions (Part 1) with Dr. David Sacks and Dr. Martin Radvany

Ep. 74 The Role of IR in Stroke Interventions (Part 1) with Dr. David Sacks and Dr. Martin Radvany

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/yS6TGL Dr. Martin Radvany and Dr. David Sacks discuss the role of Interventional Radiologists in the treatment of acute ischemic stroke, including training requirements, the multidisciplinary team approach, and ways to improve patient access to high quality care.

2 Elo 202057min

Ep. 73 Iliocaval Stenting with Dr. Gerry O'Sullivan

Ep. 73 Iliocaval Stenting with Dr. Gerry O'Sullivan

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/TFABaN Interventional Radiologist Dr. Gerry O'Sullivan shares his experiences with Iliocaval stenting in post-thrombotic patients, including pearls and pitfalls and the "Aiming for the bottom corner" technique.

27 Heinä 202048min

Ep. 72 Uterine Fibroid Embolizations in the OBL with Dr. John Lipman

Ep. 72 Uterine Fibroid Embolizations in the OBL with Dr. John Lipman

John Lipman, MD discusses UFE practice building, patient workup, and embolization technique in his dedicated Women's interventional practice, Atlanta Interventional Institute. --- CHECK OUT OUR SPONSORS RADPAD® Radiation Protection https://www.radpad.com/ Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/10vK6b

20 Heinä 202052min

Ep. 71 Building a MedEd platform with Dr. Sarel Gaur

Ep. 71 Building a MedEd platform with Dr. Sarel Gaur

We talk with Interventional Radiologist Sarel Gaur about what inspired his #medEd #YouTube channel, where his topics come from, and tips for success for others.

13 Heinä 202028min

Ep. 70 CO2 Angiography with Dr. James Caridi

Ep. 70 CO2 Angiography with Dr. James Caridi

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/F6p0sz In this episode, Dr. James Caridi joins Dr. Christopher Beck to discuss the benefits of using CO2 for an angiography as well as some important tips for proper use. Dr. Caridi mentions some of the reasons for choosing CO2 rather than contrast, including its solubility, low viscosity, and buoyancy. He also speaks about CO2 angiography approaches for imaging difficult to access vasculature. Dr. Caridi also speaks to specific uses of CO2 angiography for use for mesenteric angiography and how CO2 angiography can improve the sensitivity for detection and localization of GI bleeds. Dr. Caridi and Dr. Beck also discuss some non-vascular uses for CO2 angiography as well as a technique for imaging with CO2 without having to give up wire access. We talk through safely preparing a delivery system and gently injecting CO2 to prevent/reduce reflux in the patient if needed. Finally, we go into some notes concerning dialysis, contrast induced nephropathy, and some instances when CO2 angiography should not be used. Resources mentioned: CO2 Angiography Society http://www.co2angio.org/index.php This website features over 100 pieces of literature related to CO2 angiography, information about the newest developments, and access to membership in the society. Dr. Jim Caridi explains CO2mmander and AngiAssist https://www.youtube.com/watch?v=MjsnHWmRZQI This video explains the portable delivery system and the gas management system.

6 Heinä 202051min

Ep. 69 Retrograde Pedal Access with Dr. Jim Melton and Dr. Blake Parsons

Ep. 69 Retrograde Pedal Access with Dr. Jim Melton and Dr. Blake Parsons

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/wS9UCY Dr. Jim Melton and Dr. Blake Parsons discuss the benefits of retrograde pedal access in the treatment of PAD, as well as the team approach of their outpatient CardioVascular Health Clinic , which includes Vascular Surgery, Interventional Radiology, and Interventional Cardiology working together as partners for better patient care.

22 Kesä 202052min

Ep. 68 RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla

Ep. 68 RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla

Dr. Jason Levy and Dr. Sandeep Bagla discuss palliative treatment of bone metastases with radiofrequency ablation, as well as recent results from the OPuS One trial.

15 Kesä 202040min

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