BackTable Vascular & Interventional

Dr. Sameh Sayfo discusses advanced techniques in radial to peripheral (R2P) interventions, the importance of having multiple techniques, the role of different devices, troubleshooting tips, and the evolving landscape of R2P interventions. Dr. Sayfo is an interventional cardiologist at the Baylor Heart Hospital, and serves as program director for the endovascular fellowship and pulmonary embolism response team (PERT) program. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SYNPOSIS Dr. Sayfo shares his experience and insights on using various devices, such as the new Auryon laser, for treating peripheral arterial disease (PAD).Additionally, the doctors address the benefits of radial access over traditional femoral approaches, patient selection, and procedural planning. Listeners are encouraged to adopt a flexible approach and learn from each other’s experiences to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 05:24 - Incorporating Radial into Peripheral Practice 11:19 - Right vs. Left Radial Access 20:01 - Room Setup and Procedure Planning 25:13 - Radial vs. Femoral Access 33:01 - Advancements in Laser Atherectomy 41:33 - Laser Atherectomy Tips 45:52 - Advantages of Radial Access in Specific Cases 51:33 - Post-Op Care and Best Practices --- RESOURCES BackTable VI Podcast Episode #30 - Transradial Access Basic to Advanced with Dr. Aaron Fischman: https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced BackTable VI Podcast Episode #148 - Radial vs. Femoral for Prostate Artery Embolization with Dr. Blake Parsons: https://www.backtable.com/shows/vi/podcasts/148/radial-vs-femoral-for-prostate-artery-embolization BackTable VI Podcast Episode #342 - Radial Access for PAD with Dr. Rami Tadros: https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad BackTable VI Podcast Episode #395 - Radial to Peripheral Tools & Technique with Dr. Sameh Sayfo: https://www.backtable.com/shows/vi/podcasts/395/radial-to-peripheral-tools-technique BackTable VI Podcast Episode #443 - Innovative Approaches in Radial to Peripheral Interventions with Dr. Amit Srivastava: https://www.backtable.com/shows/vi/podcasts/443/innovative-approaches-in-radial-to-peripheral-interventions BackTable VI Podcast Episode #390 - Laser Atherectomy: An Overview of the Pathfinder Registry with Dr. Tony Das: https://www.backtable.com/shows/vi/podcasts/390/laser-atherectomy-an-overview-of-the-pathfinder-registry BackTable VI Podcast Episode #408 - Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas: https://www.backtable.com/shows/vi/podcasts/408/laser-btk-study-insights-navigating-complex-lesions Safety and efficacy of radial artery access for peripheral vascular intervention: a single center experience: https://www.ajconline.org/article/S0002-9149(24)00461-2/abstract Comparative Outcomes of Interventions for Femoropopliteal Chronic Total Occlusion Versus Non-Chronic Total Occlusion Lesions From the Multicenter XLPAD Registry: https://pubmed.ncbi.nlm.nih.gov/37318023/ Prospective, Multi-center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries in Patients With Chronic Limb-Threatening Ischemia: 30-Day Results of the Auryon BTK: https://pubmed.ncbi.nlm.nih.gov/38458581/ Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions: https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry: https://pubmed.ncbi.nlm.nih.gov/38566525/ SCAI Expert Consensus Statement Update on Best Practices for Transradial Angiography and Intervention: https://scai.org/publications/clinical-documents/scai-expert-consensus-statement-update-best-practices-transradial

2 Heinä 202458min

Dr. Ally Baheti interviews interventional radiologist Dr. Steven Smith about his insights into venous orthostatic flow dysfunction and its association with multisystem disorders. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Smith details his clinical career and his surprising findings that connect pelvic congestion syndrome with a range of other conditions, such as postural orthostatic tachycardia syndrome (POTS), chronic fatigue syndrome, Ehlers-Danlos syndrome, irritable bowel syndrome (IBS), vulvodynia, interstitial cystitis, and fibromyalgia. For patients with venous manifestations, he pursues treatment with stents or embolization, taking a proactive approach to targeting any abnormal vasculature that he identifies. Additionally, the podcast delves into the physiological basis of POTS and related disorders, which mainly stems from blood pooling in the lower body, leading to sympathetic overactivation. Overall, Dr. Smith emphasizes the significance of collaborating with specialists across different disciplines to advance understanding and treatment of these complex syndromes. --- TIMESTAMPS 00:00 - Introduction 03:11 - Symptom Constellation of Venous Orthostatic Flow Syndrome 12:08 - Pelvic Vein Treatment Algorithm 21:08 - Physiology of Orthostatic Intolerance and Sympathetic Overdrive 27:11 - Patient Selection 33:27 - Need for Research and Collaboration 36:07 - Advocacy for Patients --- RESOURCES BackTable VI Ep. 337- Management of Vulvar Varices with Dr. Brooke Spencer https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices BackTable VI Ep. 33- Building a Comprehensive Vein Practice with Dr. Brooke Spencer & Dr. Isabel Newton https://www.backtable.com/shows/vi/podcasts/33/building-a-comprehensive-vein-practice An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes (Smith et al, 2022): https://journals.sagepub.com/doi/abs/10.1177/02683555221112567 Distension of central great vein decreases sympathetic outflow in humans (Cui et al, 2013): https://journals.physiology.org/doi/full/10.1152/ajpheart.00019.2013 Orthostatic intolerance and chronic fatigue syndrome: New light on an old problem (Rowe, 2002): https://www.jpeds.com/article/S0022-3476(02)53209-1/fulltext

28 Kesä 202445min

Dr. Jafar Golzarian shares his experiences with co-founding an outpatient-based lab (OBL), obtaining the right equipment, handling staffing, negotiating with insurance companies, and marketing his new practice. Dr. Golzarian is an interventional radiologist at his OBL in Minneapolis, Minnesota and he is the former Division Head and Program Director for the interventional radiology program at the University of Minnesota. --- CHECK OUT OUR SPONSOR GE Healthcare Allia Image Guided Systems https://www.gehealthcare.com/products/interventional-image-guided-systems/allia --- SYNPOSIS Dr. Golzarian emphasizes the importance of having independence and adopting a patient-centered approach. He also offers practical advice for physicians considering similar moves into the private practice sphere. Additionally, Dr. Golzarian talks about the challenges and rewards of focusing on specific embolization procedures and collaborating with industry partners to build a successful practice. --- TIMESTAMPS 00:00 - Introduction 06:06 - Setting Up a New Practice 14:27 - Tips for Marketing 23:40 - Finding the Right Business Partner 30:44 - OBL vs. ASC Status and Reimbursement 32:59 - Industry Support and Device Costs 37:58 - Staffing and Culture 45:25 - Advice for New Practitioners --- RESOURCES BackTable VI Episode #85 - Genicular Artery Embolization for OA with Dr. Jafar Golzarian: https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa BackTable VI Episode #361 - Intra-Arterial & Percutaneous Treatment of Giant Hepatic Hemangiomas with Dr. Jafar Golzarian: https://www.backtable.com/shows/vi/podcasts/361/intra-arterial-percutaneous-treatment-of-giant-hepatic-hemangiomas BackTable VI Episode #447 - Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little: https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes GEST MSK Annual Meeting: https://www.gestmsk.com/ Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline: https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

25 Kesä 202448min

Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation. --- SYNPOSIS Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis. --- TIMESTAMPS 00:00 - Introduction 06:00 - How ScribeMD AI Works 14:14 - Integration with EMR 20:31 - Legal Considerations with AI Technology 26:34 - Cost Implications of AI Scribes 38:46 - Future of AI in Medical Diagnosis 41:45 - Conclusion and Final Thoughts --- RESOURCES ScribeMD.ai https://www.scribemd.ai/

21 Kesä 202443min

In this episode of the Back Table MSK podcast, Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses. --- TIMESTAMPS 00:00 - Introduction 02:33 - Expanding Sacroplasty Training and Curriculum 04:50 - Walkthrough of Sacroplasty Technique 10:36 - Mechanical Stabilization and Cement Volume 21:41 - Choosing Hardware and Needle Size 27:37 - Industry-Sponsored Trials and Bias 32:47 - Navigating Billing and Reimbursement 38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures --- RESOURCES BackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures: https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fractures Seattle Science Foundation Annual Image Guided Interventional Spine Procedures Course: https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149 Dr. Doug Beall’s Twitter: @dougbeall Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation: https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023): https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext

20 Kesä 202440min

Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI. We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations. --- TIMESTAMPS 00:00 - Introduction 03:01 - Sacral Fractures and Sacroplasty 15:17 - Treatment Options for Sacral Fractures 17:34 - Consequences of Untreated Sacral Fractures 28:32 - Sacroplasty Registry and Current Research 38:08 - Imaging Modalities: CT vs. Fluoroscopy 40:49 - Complications of Sacroplasty: Extravasation 43:21 - Bone Quality and Fracture Healing 45:42 - Growing Awareness of Sacral Fractures and Treatment Options --- RESOURCES Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982): https://pubmed.ncbi.nlm.nih.gov/7097924/ Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000): https://pubmed.ncbi.nlm.nih.gov/11094996/ Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019): https://pubmed.ncbi.nlm.nih.gov/31587952/ Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008): https://pubmed.ncbi.nlm.nih.gov/17981097/ Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017): https://pubmed.ncbi.nlm.nih.gov/29149151/ Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020): https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023): https://pubmed.ncbi.nlm.nih.gov/37207812/ Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019): ​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx

19 Kesä 202451min

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