Ep. 564 Pressure-Enabled Drug Delivery in HCC & Metastatic Liver Lesions with Dr. Zach Berman

Ep. 564 Pressure-Enabled Drug Delivery in HCC & Metastatic Liver Lesions with Dr. Zach Berman

Can you manipulate blood flow in the tumor microenvironment to optimize drug delivery? In this episode of the BackTable Podcast, interventional oncologist Dr. Zachary Berman (UC San Diego) joins host Dr. Christopher Beck to discuss real-world applications of pressure-enabled drug delivery in locoregional liver-directed therapies like TACE and Y90.---This podcast is supported by:TriSalus Life Scienceshttp://trinavinfusion.com/---SYNPOSISThe conversation begins with an overview of the tumor microvascular environment, focusing on the abnormal nature of the new vessels that feed tumors. They then discuss the genesis of pressure-enabled drug delivery and the theory behind its efficacy. Dr. Berman explains the TriNav catheter’s micro-valve design, its anti-reflux properties, and how these features enhance tumor drug delivery. He walks through his own procedure technique, comparing and contrasting it to standard embolization, and details the utility of pressure-enabled drug delivery in lobar radioembolization and larger tumors. They also explore the benefits of both balloon occlusion and microvalve catheters.Real-world cases—including neuroendocrine tumors, segmental HCC, and more—illustrate the thought process around when to use specialized technologies. The episode wraps up with a discussion of the future implications for this technology in other pathologies, cost considerations, and the potential for enhancing drug delivery with innovative approaches.---TIMESTAMPS00:00 - Introduction01:39 - The Tumor Microenvironment06:59 - Pressure-Enabled Drug Delivery Explained09:37 - Technical Aspects of Pressure-Enabled Catheters21:48 - Case 1: Grade 3 Neuroendocrine Tumor34:06 - Case 2: Hepatocellular Carcinoma with Tumor and Vein36:01 - Case 3: TACE for Segmental HCC in Decompensated Cirrhosis38:58 - Case 4: Large Heterogenous Cholangiocarcinoma40:40 - Case 5: Lobar Neuroendocrine Tumor42:38 - Case 6: Segmental HCC with Central Necrosis47:52 - Best Practices and Technical Considerations57:52 - Future Directions in Pressure-Directed Embolotherapy59:48 - Conclusion and Final Thoughts---RESOURCESJVIR 2024 Jaroch et al.:https://pubmed.ncbi.nlm.nih.gov/38969336/

Jaksot(583)

Ep. 55 Transitioning from a Hospital to OBL practice (Part I) with Dr. Yates and Dr.  Patel

Ep. 55 Transitioning from a Hospital to OBL practice (Part I) with Dr. Yates and Dr. Patel

In Part 1 of this 2-part series, Dr. Tim yates and Dr. Lincoln Patel provide insight on how they made their career change decisions, as well as the advantages and disadvantages of a hospital-based vs. outpatient-based endovascular practice. --- 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/vog6G0

11 Helmi 202051min

Ep. 54 Inclusivity in IR with Dr. Barbara Hamilton and Dr. Mary Costantino

Ep. 54 Inclusivity in IR with Dr. Barbara Hamilton and Dr. Mary Costantino

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/o6ecMR Dr. Barbara Hamilton and Dr. Mary Costantino, MD discuss inclusivity in IR, including the importance of mentorship and diversity in medicine.

16 Tammi 202023min

Ep. 53 International Volunteer Work with Dr. Stephen Hunt

Ep. 53 International Volunteer Work with Dr. Stephen Hunt

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/Fh5LxS Dr. Stephen Hunt shares his international volunteer experiences traveling with IR4Nigeria and RAD-AID International. Get involved at www.rad-aid.org.

1 Tammi 202026min

Ep. 52 IVUS for Iliac Vein Compression with Dr. Mark Lessne and Dr. Mike Cumming

Ep. 52 IVUS for Iliac Vein Compression with Dr. Mark Lessne and Dr. Mike Cumming

Dr. Michael Cumming and Dr. Mark Lessne discuss the utility of Intravascular Ultrasound (IVUS) in the diagnosis and treatment of Deep Venous Disease, including patient selection, appropriate assessment of stenoses and assistance with stent placement. Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/ySM6hy

11 Marras 201944min

Ep. 51 Cone Beam CT Technique with Dr. Austin Bourgeois

Ep. 51 Cone Beam CT Technique with Dr. Austin Bourgeois

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/zGhYib Austin Bourgeois and Dr. Christopher Beck discuss ways you can improve your Cone Beam imaging for liver directed therapy, prostate artery embolization and how it can be used to improve safety of other procedures, such as G-tube placement.

30 Loka 201944min

Ep. 50 Practicing IR in India with Dr. Deepa Shree

Ep. 50 Practicing IR in India with Dr. Deepa Shree

Dr. Deepa Shree tells us about the challenges she faced building her IR practice in Chennai, and how she is spreading awareness of the specialty and training new IRs to help serve the need throughout India.

13 Loka 201948min

Ep. 49 Collaboration in the Hybrid OR with Dr. Racadio and Dr. von Allmen

Ep. 49 Collaboration in the Hybrid OR with Dr. Racadio and Dr. von Allmen

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/Ucy8jI Director of IR Innovation Dr. John Racadio and Pediatric Surgeon-in-Chief Dr. Daniel von Allmen of Cincinnati Children’s Hospital discuss their experiences in the Hybrid OR, how they built it, and how cross-specialty collaboration with pulmonary, urology, and orthopedic surgeons has greatly improved patient care.

30 Syys 201929min

Ep. 48 IR and ENT Treatment of Epistaxis with Dr. Ashley Agan and Dr. Sabeen Dhand

Ep. 48 IR and ENT Treatment of Epistaxis with Dr. Ashley Agan and Dr. Sabeen Dhand

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/xQPc7h In this episode, Dr. Ashley Agan and Dr. Sabeen Dhand join Dr. Gopi Shah to discuss IR and ENT treatment of epistaxis. We cover the differences in how epistaxis presents for ENT and IR as well as how epistaxis presents in children and older patients. Dr. Agan tells us about the types of nosebleeds that are common and the general treatment algorithm she follows. We discuss nasal packing and decongestant sprays for treatment and how to know when to take the patient to the OR. Dr. Agan talks about isolating the bleeding spot, how to use a foley for posterior nosebleeds, and SPA litigation. We discuss why ENT might consult IR for an embolization. Dr. Dhand tells us about the contraindications for embolization and the procedure for treating the epistaxis. We review the materials that should be used and why it is important to look out for artery connections and pseudoaneurysms. We discuss the pearls and pitfalls of ENT and IR treatment of epistaxis and how to avoid the risk of stroke.

30 Elo 201933min

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