Ep. 315 Arterial Thrombectomy with Dr. Alexander Ushinsky

Dr. Dylan Suttle and Dr. Harris Chengazi delve into recent advancements in transjugular intrahepatic portosystemic shunt (TIPS) procedures, highlighting the significant reduction in procedural time and improvements in outcomes due to the introduction of Intracardiac Echo (ICE) and the Scorpion Portal Vein Access Series. --- CHECK OUT OUR SPONSOR Argon Medical http://www.argonmedical.com/ --- SYNPOSIS The doctors share their experiences, techniques, and the evolution of their approaches. They emphasize benefits such as high-resolution imaging, cost-effectiveness, and new technologies that make TIPS cases more approachable. --- TIMESTAMPS 00:00 - Introduction 06:17 - Portal Hypertension Clinics 13:17 - Technical Aspects of TIPS Procedures 35:17 - Challenges in Selecting the Right Hepatic Vein 38:48 - Pre-Procedure Planning 39:36 - Puncture Techniques 50:04 - Stent Deployment and Placement 55:35 - Learning Curve of ICE & Advantages 01:07:58 - The Future of TIPS Procedures --- RESOURCES BackTable VI Episode #123 - TIPS University Freshman Year: Referrals and Pre-op Workup with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup BackTable VI Episode #124 - TIPS University Sophomore Year: Basic Procedure Technique with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique BackTable VI Episode #125 - TIPS University Junior Year: Advanced Techniques, ICE, and Splenic Access with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access BackTable VI Episode #126 - TIPS University Senior Year: Gunsight Technique & Splenic Closure with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure Dr. Suttle TIPS Technique Video: https://www.youtube.com/watch?v=jYfr_rWe5Ck TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis: https://www.journal-of-hepatology.eu/article/S0168-8278(23)00314-8/abstract Intracardiac Echocardiography–Guided TIPS: A Primer for New Operators: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540636/

18 Kesä 20241h 12min

In this episode of the BackTable Podcast, host Dr. Ally Baheti discusses the concept of moral injury with Dr. Mina Makary from Ohio State University and Dr. Jeff Chick from the University of Washington. The conversation focuses on their recent study published in Academic Radiology, which employed a survey to analyze prevalence of moral injury, factors contributing to its occurrence, and strategies to address it. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS It is important to distinguish burnout from moral injury, with the former concept more focused on personal resilience, and the latter defined as extrinsic circumstances that lead to disconnection with one’s career. A key finding from the study was the negative correlation between degree of moral injury and quality of life. Respondents’ free text answers identified a variety of factors contributing to moral injury. The doctors also speak about strategies for addressing moral injury such as psychotherapy, spiritual care, and physical exercise. Most importantly, they believe it is crucial to target systemic factors with efforts to increase physician leadership, administrative support, and research in physician wellness. --- TIMESTAMPS 00:00 - Introduction 02:14 - Defining Moral Injury 05:31 - Survey Methodology and Respondent Demographics 07:52 - Key Survey Findings 11:07 - Causes of Moral Injury 12:11 - Personal and Systemic Strategies for Addressing Moral Injury --- RESOURCES Moral Injury Among Interventional Radiologists (Woerner, 2024): https://pubmed.ncbi.nlm.nih.gov/37926643/ Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP (Mantri, 2020): https://pubmed.ncbi.nlm.nih.gov/32681398/

14 Kesä 202423min

In this episode, Dr. Paul Lewis discusses best practices for thoracentesis. He shares insights on using image guidance, managing complex effusions, and managing complications such as pneumothorax and hemothorax. Dr. Lewis is an interventional radiologist at the University of Pittsburgh Medical Center. --- CHECK OUT OUR SPONSOR Laborie RenovaRP Centesis System https://www.laborie.com/product/renovarp-products/ --- SYNPOSIS Dr. Lewis also speaks on patient selection, procedural techniques, equipment choices, and other troubleshooting tips. Additionally, the doctors cover procedural nuances such as bilateral thoracentesis and patient positioning and highlight the efficiency of the RenovaRP Centesis System. --- TIMESTAMPS 00:00 - Introduction 06:07 - Thoracentesis Procedure Walkthrough 16:49 - Equipment Used 22:14 - Troubleshooting 30:56 - Post-Procedural Care 36:12 - Complications 48:07 - Helpful Resources --- RESOURCES Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety: https://pubmed.ncbi.nlm.nih.gov/38042055/ Paracentesis: Faster and easier using the RenovaRP® pump: https://pubmed.ncbi.nlm.nih.gov/35548901/ Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations: https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial: https://pubmed.ncbi.nlm.nih.gov/31711990/

11 Kesä 202454min

In this episode, Dr. Ally Baheti interviews interventional radiologist Dr. Lorenzo Patrone about his recent multidisciplinary editorial entitled "The 'Woundosome' Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia.” --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Patrone explains his interest in critical limb ischemia (CLI) and describes how he reached out to colleagues around the world with the intention of drafting a paper that summarizes research in below-the-ankle interventions and increases awareness of the woundosome concept. He explains the woundosome concept, which aims to understand how each patient’s foot vasculature influences the effectiveness of below-the-ankle interventions and tissue healing. Understanding each patient’s anatomy, having adequate imaging of the foot, obtaining pedal acceleration times, and using micro-oxygen sensors are strategies to assess wound perfusion, which is integral for treatment planning and prognosis. He illustrates these techniques in a case study of a non-healing wound. Finally, Dr. Patrone shares some technical tips for below-the-ankle interventions, including the benefits of ipsilateral antegrade access, sheath selection, and strategic contrast administration. --- TIMESTAMPS 00:00 - Introduction 02:25 - Multidisciplinary and Global Collaboration 05:59 - Explaining the Woundosome Concept 07:51 - Understanding Wound Perfusion 10:20 - Assessing the Effectiveness of Revascularization 20:09 - Case Example with Pictures 28:07 - Technical Tips for CLI Interventions --- RESOURCES Find Your Algorithm (FYA): https://fya-congress.com/ The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia: https://journals.sagepub.com/doi/10.1177/15266028241231745?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Vascular imaging of the foot: the first step toward endovascular recanalization (Manzi): https://pubmed.ncbi.nlm.nih.gov/21997985/ BASIL-2 Trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00462-2/fulltext BackTable VI Ep. 90- Pedal Acceleration Time for Limb Salvage with Jill Sommerset and Dr. Mary Constantino: https://www.backtable.com/shows/vi/podcasts/90/pedal-acceleration-time-for-limb-salvage The First-in-Man "Si Se Puede" Study for the use of micro-oxygen sensors (Montero-Baker): https://pubmed.ncbi.nlm.nih.gov/26004327/ PEDRA Perfusion Monitoring: https://www.pedratech.com/ Armada XT Balloon: https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/peripheral-dilatation-catheters/armada-14.html

7 Kesä 202429min

In this episode of the BackTable Podcast, vascular surgeon Dr. Nicolas Mouawad and interventional radiologist Dr. Raja Ramaswamy share their insights on the changing landscape of deep vein thrombosis (DVT) management, steps of mechanical thrombectomy, and current research on DVT interventions. --- CHECK OUT OUR SPONSOR Inari Medical https://www.inarimedical.com/ --- SYNPOSIS The guests start by describing their typical referral patterns, noting that most cases come through the emergency department. In terms of workup, it is important to distinguish between acute and chronic DVTs and classify the thrombosis location as either proximal (femoral vein or higher) or distal. Anticoagulation, usually with direct oral anticoagulants, is always started, with efficacy largely determined by patient compliance. Regarding endovascular intervention, thrombolysis may be an effective adjunctive treatment if the clot occurred within a two-week timespan, but it carries a bleeding risk and requires ICU monitoring. On the other hand, mechanical thrombectomy is an option for both acute and chronic clots, allows for intervention in patients with high bleeding risk, and does not require post-procedural hospitalization. Both physicians emphasize that interventions should be employed if there are long-term benefits of avoiding post-thrombotic syndrome and pulmonary embolism. The physicians walk through a typical mechanical thrombectomy procedure, which involves the thrombectomy device, venogram, intravascular ultrasound, and possible stent placement. Finally, they discuss recent data, including the ATTRACT Trial for thrombolytics and the CLOUT Registry and Trial for ClotTriever use. Notably, they mention the DEFIANCE Trial as a current prospective randomized clinical trial for ClotTriever use in the iliofemoral region. --- TIMESTAMPS 00:00 - Introduction 03:48 - DVT Referral Patterns and Treatment Algorithms 08:55 - Choosing an Anticoagulation Regimen 11:01 - DVT Interventions 13:54 - Patient Scenarios and Treatment Decisions 22:29 - Post-Thrombotic Syndrome 26:16 - Mechanical Thrombectomy Technique 35:45 - Postoperative Care 39:09 - The Evolution of Mechanical Thrombectomy 43:38 - ATTRACT Trial 46:20 - CLOUT Trial --- RESOURCES Inari ClotTriever System: https://www.inarimedical.com/clottriever-system ATTRACT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1615066 CLOUT Trial: https://pubmed.ncbi.nlm.nih.gov/35218955/ DEFIANCE Trial: https://evtoday.com/news/inari-medical-begins-defiance-randomized-clinical-trial-of-clottriever-system-in-dvt

4 Kesä 202458min

Trigger warning: This episode contains discussions about suicide. In this episode of the BackTable podcast, interventional radiologist Dr. Jenanan Vairavamurthy shares about the tragic loss of his physician brother to suicide and discusses his own mental health journey. He highlights the immense pressures and challenges that medical training and practice impose on providers. --- SYNPOSIS The discussion emphasizes the need for mental health awareness and the importance of creating supportive environments within the medical community. He advocates for open conversations about mental health struggles and urges those in leadership positions to prioritize the well-being of colleagues and trainees. This powerful conversation aims to destigmatize mental health issues in the medical field and encourages medical providers to seek and provide support for each other. --- TIMESTAMPS 00:00 Introduction 04:11 Assessing Personal Mental Health 06:31 Personal Tragedy and Mindset Shift 11:49 The Realities of Wellness in Medicine 21:59 Creating Supportive Environments Within Medicine 25:58 Navigating Personal and Professional Challenges 35:15 Building and Leading Supportive Networks --- RESOURCES Physician Supp​​ort Line: https://www.physiciansupportline.com/

31 Touko 202442min

In this episode, interventional cardiologist Dr. Peter Soukas joins us to discuss percutaneous transmural arterial bypass (PTAB) using the DETOUR system, a novel percutaneous treatment for extensive and complex blockages in the superficial femoral artery (SFA). --- CHECK OUT OUR SPONSOR Endologix https://endologix.com/ --- SYNPOSIS Dr. Soukas shares his extensive experience and insights into PTAB development, benefits, patient selection, and procedural details. The idea behind PTAB is to create an SFA-to-popliteal artery bypass through endovascular means, using a system of overlapping stent grafts within the femoral vein as a conduit. When planning the procedure, it is important to consider the location of reentry into the popliteal artery, avoid calcified zones, and meet femoral vein size criteria. Additionally, we explore the advantages of PTAB over other endovascular options and traditional open surgical bypass, which carry a higher likelihood of restenosis and longer recovery times, respectively. We also discuss the types of training and support available for physicians interested in adopting this technique, cost and reimbursement aspects, and the future direction of PTAB, including ongoing post-market studies. --- TIMESTAMPS 00:00 Introduction 02:38 Dr. Soukas’ Career in Vascular Medicine 05:19 Introduction to PTAB 13:00 Landing Zones 19:37 Stent Graft Sizing 23:14 Patient Selection and Adjunctive Medical Therapy 28:04 Procedural Risks 29:18 Navigating PTAB Implementation 32:20 Opportunities for Learning PTAB --- RESOURCES PTAB with the DETOUR System: https://endologix.com/ptab/detour/ Brown Vascular and Endovascular Fellowship: https://brownmedicine.org/3/cardiology-vascular-endovascular-fellowship/ COMPASS Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118 VOYAGER Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2000052 DETOUR 2 Trial: https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext

28 Touko 202439min

In this episode, Dr. Marta Lobato explores advanced endovascular techniques in below the knee (BTK) and below the ankle (BTA) interventions for critical limb ischemia (CLI). She introduces various skills that were developed and used by her team, such as the telescopic needle, buddy needle, balloon-assisted puncture, and vasodilation to prevent artery spasm. Dr. Lobato is a vascular surgeon at Hospital de Cruces in Barakaldo, Spain. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS The discussion covers the importance of visualizing the fifth metatarsal for effective lateral views in X-rays, the intricacies of accessing the lateral and medial plantar arteries, and the significance of starting with easier procedures before attempting more complex interventions. Additionally, Dr. Lobato highlights the role of social media in learning about innovative medical practices. --- TIMESTAMPS 00:00 - Introduction 05:54 - Below the Knee and Ankle Interventions 15:35 - Complexities of Zone 2 and 3 Access 23:12 - Buddy Needle Technique for Calcified Arteries 30:12 - Advanced Techniques for Supporting the Wire 34:13 - Vasodilator Use 37:12 - Balloon-Assisted Techniques 41:02 - Advancing Your Endovascular Skills --- RESOURCES Tips and Tricks for Simple and Complex Below-the-Ankle Punctures: https://pubmed.ncbi.nlm.nih.gov/38441118/ Buddy Needle Technique to Facilitate Retrograde Puncture of Heavily Calcified Tibial Vessels: https://pubmed.ncbi.nlm.nih.gov/28587566/ Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach: https://pubmed.ncbi.nlm.nih.gov/34989276/ Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures: https://pubmed.ncbi.nlm.nih.gov/36415934/ The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia: https://pubmed.ncbi.nlm.nih.gov/38523459/ New antioxidant therapy for hard-to-heal neuroischaemic diabetic foot ulcers with deep exposure: https://pubmed.ncbi.nlm.nih.gov/37029973/ Percutaneous endovascular arteriovenous fistula creation for hemodialysis access using "off-the-shelf" conventional devices: https://pubmed.ncbi.nlm.nih.gov/33251393/

24 Touko 202445min