Ep. 549 Liquid Embolics: Practical Applications and Techniques with Dr. Gary Siskin

What’s needed to build a successful lymphangiography practice? Dr. Bill Majdalany joins host Dr. Chris Beck to answer this question and to discuss advancements in lymphangiography over the past decade. Dr. Majdalany is the Chief and Vice Chair of Research of Interventional Radiology at University of Vermont. --- CHECK OUT OUR SPONSOR Guerbet --- SYNPOSIS The doctors provide insights on various lymphatic procedures such as thoracic duct embolization, stenting, and recanalization. They also discuss the evolving significance of lymphatic medicine in interventional radiology and its potential applications in treating conditions like ascites and variceal bleeding. The conversation underscores the interconnected nature of the lymphatic system throughout the body, emphasizing the revolutionary potential of lymphangiography in modern medicine. --- TIMESTAMPS 00:00 - Introduction 04:23 - Building a Lymphangiography Practice 08:36 - The Lymphatic Revolution 17:42 - Practical Tips and Equipment for Lymphangiography 30:09 - Advanced Interventions and Tools 48:45 - Future of Lymphatic Interventions 51:23 - Conclusion and Resources --- RESOURCES BackTable VI Podcast Episode #135 - IR Residency Pathways & Getting In! (Part 1) with Dr. Jeff Bodner and Dr. Bill Majdalany: https://www.backtable.com/shows/vi/contributors/dr-bill-majdalany Seminars in Interventional Radiology - Lymphatics: https://www.thieme-connect.com/products/ejournals/issue/10.1055/s-010-49075 Lymphatic Anatomy: https://www.techvir.com/article/S1089-2516(16)30042-7/abstract

3 Syys 202454min

What is the final frontier of interventional radiology? Dominic Tanzillo and Dr. Richard Moon believe it could be space. Dominic is a 3rd year medical student at Duke University interested in interventional radiology (IR) and space medicine, and Dr. Moon is a Professor at Duke University and an expert in hyperbaric and aerospace medicine. --- CHECK OUT OUR SPONSOR Medtronic DCB https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/drug-coated-balloons.html --- SYNPOSIS Dominic and Dr. Moon cover the potential for IR in deep space missions, focusing on the unique challenges astronauts face, such as altered blood flow, increased clotting risks, and the impacts of microgravity on the human body. The episode dives into NASA’s investments in portable medical technologies, the practicalities of emergency medical procedures in space, and the need for minimally invasive interventions. The significance of IR in diagnosing and managing vascular issues in space is discussed, as well as the broader implications for future Mars missions and long-term space travel. --- TIMESTAMPS 00:00 - Introduction 02:36 - IR in Space 20:04 - Medical Issues Astronauts Face 26:27 - Remote Surgery and Telesurgery 30:45 - Emergency Evacuations in Space 32:32 - More on Space Medicine --- RESOURCES Aerospace Medicine Association: https://www.asma.org/about-asma/careers/aerospace-medicine Translational Research Institute for Space Health: https://www.bcm.edu/academic-centers/space-medicine/translational-research-institute Space Medicine Coursera: https://www.coursera.org/learn/space-medicine-duke What Space Medicine Taught Me About Science Communication | Dominic Tanzillo | TEDxDuke: https://www.youtube.com/watch?v=PBkdvSByneM Dominic Tanzillo: https://dominictanzillo.github.io/

27 Elo 202437min

While GLP-1 agonists continue to gain popularity in the medical management of diabetes and obesity, Dr. Cliff Weiss is exploring bariatric arterial embolization (BAE) as an adjunctive therapy to help patients sustain weight loss. Dr. Weiss, the Director of IR Research at Johns Hopkins, joins the show to discuss the techniques and impacts of BAE for obesity treatment. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Weiss outlines his initial research interest in gastric embolization of the fundus to reduce ghrelin production. He began by studying the use of sclerosants for embolization but later shifted to using embolic spheres. BAE involves the targeted embolization of the left gastric artery, with or without the left gastroepiploic artery, using 300-500 micron embolic spheres. Dr. Weiss also employs a dilute mixture of spheres and a vasodilator to achieve distal arterial penetration. He describes the role of BAE in conjunction with existing surgical and pharmaceutical treatments. According to his experience, patients undergoing BAE achieve maximum weight loss 6-9 months after the procedure and can maintain this weight when they follow up in a weight management clinic. Additionally, Dr. Weiss reviews data from BAE studies, including the BEAT Obesity Trial and the recent BEATLES Trial. --- TIMESTAMPS 00:00 - Introduction 03:21 - Early Research and Development of BAE 07:39 - Potential Role of BAE in Obesity Treatment 16:03 - Procedure Details 25:28 - Post-Procedure Care and Patient Management 28:06 - Insights from the BEAT Obesity Trial 33:38 - BEATLES Trial 37:38 - Combination Therapy for Obesity --- RESOURCES BEAT Obesity Trial: https://pubs.rsna.org/doi/full/10.1148/radiol.2019182354 LC Bead/Bead Block: https://www.bostonscientific.com/en-US/products/embolization/lc-bead.html EmboSpheres: https://www.merit.com/product/embosphere-microspheres/ EMBIO Trial: https://bmjopen.bmj.com/content/13/9/e072327 BEATLES Trial: https://www.jvir.org/article/S1051-0443(23)01155-7/fulltext

20 Elo 202445min

How can physicians and industry partners collaborate effectively to enhance patient care? Dr. Adam Tanious, Assistant Professor of Vascular Surgery at the Medical University of South Carolina, joins host Dr. Aaron Fritts to explore strategies for navigating physician-industry relationships. --- SYNPOSIS The doctors share their experiences in partnering with the medical device industry. The conversation covers the benefits of industry partnerships, the challenges of avoiding conflicts of interest, and the critical role of education in preparing new physicians for these interactions. Dr. Tanious also delves into his thought-provoking TED Talk on big business in surgery, and discusses the value of business education for physicians. --- TIMESTAMPS 00:00 - Introduction 02:12 - Medicine and Business 05:01 - Business Knowledge for Physicians 15:05 - Physician-Industry Relationships 27:26 - Industry Relationships in Medical Training 33:08 - Ethical Considerations and Influence in the OR 35:00 - Leveraging Industry Resources for Better Training 43:24 - Future of Medical Technology and Collaboration --- RESOURCES Big Business and Surgery: Who Belongs in Your Operating Room?: https://youtu.be/kksVjF0fI_w?si=LADwqrbXPz3VsFm4 Quantic MBA Program: https://quantic.edu/blog/category/fields-of-study/accounting/ The price of a cup of coffee: https://vascularspecialistonline.com/the-price-of-a-cup-of-coffee/

16 Elo 202456min

The management of portal hypertension has drastically evolved over the years. What are the current best practices? And what’s coming next? Dr. Tom Leventhal and Dr. Siobahn Flanagan from University of Minnesota Medical School join us for an interdisciplinary discussion. Dr. Leventhal is an Associate Professor of Transplant Hepatology and Dr. Siobhan is an Associate Professor of Interventional Radiology. --- CHECK OUT OUR SPONSOR Cook Medical Embolization https://www.cookmedical.com/interventional-radiology/coils-home/cook-products/?utm_source=backtable&utm_medium=digital&utm_campaign=vasc_ir_p_awa_embolization_2024_amer --- SYNPOSIS The doctors discuss current collaborative approaches that are improving portal hypertension patient care, the impact of contemporary clinical practices in transplant hepatology and IR, and the imminent future of portal hypertension treatments. Dr. Leventhal also gives his insight on what could be on the horizon, touching on in-vitro organ creation, xenotransplants, and stem cells phasing out immunosuppression. --- TIMESTAMPS 00:00 - Introduction 06:10 - Managing Portal Hypertension 07:51 - Current Collaborative Practices 10:38 - Patient Referral and Management 15:25 - Initial Workup for Portal Hypertension 19:27 - Role of Biopsy in Diagnosis 24:02 - Patient Scenarios for TIPS Referral 32:04 - Ultrasound and Intracardiac Echocardiography (ICE) in TIPS 38:09 - Clinical Management 52:48 - Future of Transplant and Organ Growth

13 Elo 202458min

We are back with Part 2 of All Things Enteral Access with Dr. Peter Bream! We discuss various aspects of enteric access and management of complications with G and GJ-tubes. --- SYNPOSIS Dr. Bream provides detailed advice on troubleshooting common issues such as leaking tubes, infections, and clogs. He emphasizes the importance of a multidisciplinary approach in managing special populations, such as patients with ALS and head and neck cancer, and offers guidance for safe and effective procedures. The conversation is rich with practical tips, tricks, and valuable insights that cater to both new and experienced practitioners. --- TIMESTAMPS 00:00 - Introduction 01:47 - Special Populations 07:21 - ALS Patients 09:57 - Head and Neck Cancer Patients 14:05 - Techniques for Gastric Bypass and Altered Anatomy 18:11 - Addressing G-Tube Issues 27:16 - Converting G to GJ-Tubes 31:11 - Advanced Tips and Tricks --- RESOURCES Weighted Tip Extensions Result in Fewer Gastrojejunostomy Tube Migrations and Increase Tube Lifespan: https://www.jvir.org/article/S1051-0443(22)01243-X/abstract

9 Elo 202437min

Do you have questions about enteral access? Dr. Peter Bream’s got you covered! In this episode Dr. Bream, former Professor at UNC Chapel Hill School of Medicine and current private practice interventional radiologist, shares his extensive knowledge on enteral access. --- CHECK OUT OUR SPONSOR Medtronic Concerto https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/concerto.html --- SYNPOSIS The discussion covers various insertion techniques, the use of different types of tubes including NG, G, and GJ tubes, and specialized methods like the Balloon-Assisted Gastrostomy (BAG) and Percutaneous Transesophageal Gastrostomy (PTEG). Dr. Bream also provides valuable insights on handling complications, patient preparation, and post-procedure care, making this episode a comprehensive guide for all things enteral access. Be sure to check out Part 2 next. --- TIMESTAMPS 00:00 - Introduction 03:00 - Tubes for Enteral Access 15:48 - Techniques and Personal Experiences 29:59 - Limitations and Techniques for Stroke Patients 30:45 - Patient Comfort and Sedation 37:16 - Complications and Safety Measures 39:14 - Palliative Techniques and Special Cases 49:49 - Post-Procedure Care and Maintenance --- RESOURCES Percutaneous gastrostomy: https://pubmed.ncbi.nlm.nih.gov/6414043/ Retrospective comparison of outcomes and associated complications between large bore radiologically inserted gastrostomy tube types: https://pubmed.ncbi.nlm.nih.gov/30073401/ Single-Step Method for Pull-Type Gastrostomy Tube Placement: https://pubmed.ncbi.nlm.nih.gov/31542269/ Balloon Assisted Gastrostomy (BAG) YouTube Video: https://youtu.be/GuF7BYW2Hm0?si=6xUIDQaQV-ywX1ua IR Playbook: A Comprehensive Introduction to Interventional Radiology (1st edition): https://link.springer.com/book/10.1007/978-3-319-71300-7 IR Playbook: A Comprehensive Introduction to Interventional Radiology Second Edition 2024: https://link.springer.com/book/10.1007/978-3-031-52546-9 Pediatric gastrostomy tubes and techniques: making safer and cleaner choices: https://pubmed.ncbi.nlm.nih.gov/29180216/

8 Elo 202458min

The use of drug-coated balloons (DCBs) for peripheral arterial disease has been controversial in the past. However, new data and updated FDA guidance have helped these devices regain popularity. In this episode of the BackTable Podcast, Dr. Ally Baheti hosts a discussion with Dr. Sahil Parikh, an interventional cardiologist in New York City, and Dr. John Park, a vascular surgeon in Omaha. --- CHECK OUT OUR SPONSOR BD Lutonix https://www.bd.com/en-us/products-and-solutions/products/product-families/lutonix-drug-coated-balloon-pta-catheters --- SYNPOSIS They review the historical controversy surrounding the potential late-mortality risks associated with Paclitaxel-coated devices, discuss more recent literature on the safety and efficacy of DCBs, and examine the implications of the FDA’s updated guidance in 2023. This update was made possible through collaborative efforts across specialties and regulatory bodies to establish best practices for vascular interventions. They also delve into patient selection criteria, lesion characteristics, and practical considerations for choosing between DCBs and other revascularization options. Each provider shares their treatment algorithm for DCB use in peripheral arterial disease. Dr. Park uses DCBs as a first-line treatment for patients with complete occlusions, CLTI symptoms, or lifestyle-limiting claudication, with adjunctive stenting sometimes required afterwards. In his experience, DCBs work best in lesions shorter than 100 mm and are preferable in locations where stenting is not feasible, such as across the knee joint. Dr. Parikh similarly prefers DCBs over plain balloon angioplasty and places stents in longer lesions. He notes that Hunter’s canal is a challenging area to treat with DCBs alone and may require atherectomy or intravascular lithotripsy. He recommends considering drug-eluting stents as a proactive measure to prevent more costly interventions for future restenosis. --- TIMESTAMPS 00:00 - Introduction 02:14 - History of DCB and Controversy 07:46 - Updated Research and 2023 FDA Guidelines 16:44 - Importance of Collaboration and Patient Preference 26:34 - DCB Treatment Algorithms 33:31 - Drug-Eluting Stents 35:46 - Approach for Patients with Claudication 37:22 - DCB Sizing and Dose --- RESOURCES Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (2018): https://www.ahajournals.org/doi/10.1161/JAHA.118.011245 FDA- Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality–Letter to Health Care Providers (2018): www.fda.gov/medical-devices/letters-health-care-providers/update-treatment-peripheral-arterial-disease-paclitaxel-coated-balloons-and-paclitaxel-eluting FDA- Paclitaxel-Coated Devices to Treat Peripheral Arterial Disease Unlikely to Increase Risk of Mortality - Letter to Health Care Providers (2023): https://www.fda.gov/medical-devices/letters-health-care-providers/update-paclitaxel-coated-devices-treat-peripheral-arterial-disease-unlikely-increase-risk-mortality Mortality in randomised controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis (2023): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02189-X/abstract

6 Elo 202446min