BackTable Vascular & Interventional

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Brian Holly about different surgical scenarios relating to biliary interventions. Dr. Holly is a practicing interventional radiologist and Assistant Professor of Radiology and Radiological Sciences at Johns Hopkins University. The doctors delve into various techniques including the usage of ultrasound, managing non-dilated and dilated systems, as well as handling specific clinical scenarios such as malignant obstructions, benign biliary strictures, and postoperative bile leaks. The podcast also briefly discusses the controversial topic of placing internal biliary stents and the challenges faced with managing biliary strictures and leaks. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 01:53 - Discussion on IR Training at Johns Hopkins 04:09 - Overview of Biliary Interventions 08:31 - Challenges and Techniques in Biliary Access 19:28 - Approach to Non-Dilated Collecting System 28:07 - Dealing with Dilated Systems and Obstructions 32:56 - Biopsy Techniques for Malignant CBD Strictures 39:30 - Approach to Benign Biliary Strictures 41:48 - Use of Internal Stents in Biliary Procedures 44:51 - Managing Bleeding in Biliary Procedures --- RESOURCES The Hepaticojejunostomy Technique with Intra-Anastomotic Stent in Biliary Diseases and Its Evolution throughout the Years: A Technical Analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846744/ Percutaneous Transhepatic Cholangiography and Intraductal Radiofrequency Ablation Combined with Biliary Stent Placement for Malignant Biliary Obstruction: https://www.jvir.org/article/S1051-0443(15)00166-9/abstract

1 Maalis 202450min

In this episode of the Backtable Podcast, host Dr. Chris Beck interviews guests Dr. Omar Chohan and Dr. Harris Chengazi about dialysis fistula declot procedures and their own experiences with various devices and strategies, including usage of pre-procedure ultrasound, heparinization, and closure techniques. Both Dr. Chohan and Dr. Chengazi are interventional radiologists at Great Lakes Medical Imaging in Buffalo, New York. The doctors dive into treatment of anastomosis stenosis, stressing the importance of technique refinement, physical examination, and thoughtful pre-procedure planning. The discussion concludes with an invitation for listeners to share their experiences with the ‘bottle-cap’ hemostasis trick. --- CHECK OUT OUR SPONSOR Argon Cleaner Rotational Thrombectomy System https://www.argonmedical.com/cleaner --- SHOW NOTES 00:00 - Introduction 05:59 - Importance of Problem Solving in Declot Procedures 07:27 - Role of Pre-Procedure Ultrasound 12:00 - Process of Declot Procedures 28:27 - Moving to the Arterial Side: Access and Treatment 32:37 - Wire Management and the Risk of Rupture 41:59 - Art of Closure: Techniques and Considerations 45:53 - When to Quit: Evaluating the Need for Revision or Alternative Treatment 50:24 - Experience and Planning in Successful Fistula Treatment --- RESOURCES BackTable Declot Guide: https://www.backtable.com/shows/vi/topics/procedure/declot BackTable VI Episode #25 - Declots with the Argon Cleaner Device with Dr. Sabeen Dhand: https://www.backtable.com/shows/vi/podcasts/25/declots-with-the-argon-cleaner-device BackTable VI Episode #117 - Successful (and Quick!) Declots for AV Access with Dr. Neghae Mawla: https://www.backtable.com/shows/vi/podcasts/117/successful-quick-declots-for-av-access BackTable VI Episode #139 - AV Fistula & Graft Maintenance with Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/139/av-fistula-graft-maintenance BackTable VI Episode #141 - DEB vs. Balloon Angioplasty Alone for Dysfunctional Hemodialysis Access with Dr. Eric Therasse: https://www.backtable.com/shows/vi/podcasts/141/deb-vs-balloon-angioplasty-alone-for-dysfunctional-hemodialysis-access BackTable VI Episode #292 - Dialysis Interventions with Drug-Coated Balloons, Covered Stents and More Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/292/dialysis-interventions-with-drug-coated-balloons-covered-stents-more

27 Helmi 202456min

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ilan Rzadkowolsky-Raoli about his experience of being diagnosed with a large saddle embolus and subsequently being treated by his best friend, Dr. Ripal Gandhi. Dr. Rzadkowolsky-Raoli is an interventional radiologist at Palmetto General Hospital in Miami, Florida. Dr. Rzadkowolsky-Raoli discusses the impact of his diagnosis on his practice, how it has changed the way he approaches and speaks to his patients, and his advice for clinicians. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions Medtronic ClosureFast https://www.medtronic.com/closurefast6f --- SHOW NOTES 00:00 - Introduction 06:18 - Dr. Rzadkowolsky-Raoli’s Personal Journey 09:41 - Diagnosis and Treatment Process 12:18 - Post-Treatment Recovery and Reflections 24:18 - Impact on Practice and Patient Care 31:45 - Final Thoughts and Appreciation --- RESOURCES Pulmonary Embolism Response Team (PERT) Consortium: https://pertconsortium.org/ Inari FlowTriever: https://www.inarimedical.com/flowtriever/

23 Helmi 202434min

In this episode, host Dr. Sabeen Dhand interviews Dr. Charles Bailey about Limb Alert, a hospital protocol devised to expedite the diagnosis and treatment of patients presenting with acute limb ischemia. Dr. Bailey is a vascular surgeon and the Director of Peripheral Artery Disease (PAD) and Limb Salvage at the University of South Florida. Dr. Bailey explains how the Limb Alert program standardizes the care pathway, rapidly alerts necessary personnel, initiates labs, and prepares the Penumbra Lightning Bolt 7 System for endovascular thrombectomy. The incorporated protocol significantly streamlines patient management, resulting in encouraging survival rates. Dr. Bailey further emphasizes the necessity for modern endovascular trials in acute limb ischemia and proposes a multicenter randomized trial to provide evidence for endovascular treatment. --- CHECK OUT OUR SPONSOR Penumbra Lightning Flash https://www.penumbrainc.com/products/lightning-flash/ --- SHOW NOTES 00:00 - Introduction 02:43 - Dr. Bailey’s Journey to Florida and His Practice 06:43 - Importance of Timely Intervention in Acute Limb Ischemia 21:29 - Role of Debulking in Acute Limb Ischemia 28:20 - Tips and Tricks for Successful Outcomes 31:17 - Impact of the Limb Alert Program 41:19 - Future of Acute Limb Ischemia Treatment 47:40 - The Need for New Randomized Trials --- RESOURCES Acute Limb Ischemia: An Update on Diagnosis and Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723825/ Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia - STRIDE Study: https://www.jvascsurg.org/article/S0741-5214(23)02196-1/fulltext

20 Helmi 202451min

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Thomas Sullivan about the findings from a recent survey exploring the reasons behind professional job changes among interventional radiologists. Dr. Sullivan is the Assistant Program Director of Diagnostic and Integrated Interventional Radiology Residency programs at Wake Forest University. Dr. Sullivan highlights the importance of mentorship during residency and notes the huge impact of geography and financial compensation in determining job satisfaction and longevity in a role. He also discusses some surprising insights about trainee expectations of future practice settings, the need for a variety in practice caseload, and the desire for about 80% of clinical time to be spent on dedicated IR activities. The conversation also delves into the challenges of equipping residents for rural practice and the potential value of developing a procedural radiology curriculum. Dr. Sullivan anticipates that the survey results will help improve and adapt training paradigms to better align with the evolving landscape of interventional radiology practice. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 02:50 - Discussion on IR Training and Practice 04:51 - Survey Discussion and Key Findings 16:47 - Importance of Diagnostic Skills in IR 19:01 - Deciding Factors for First Job After Training 21:04 - Need for Medical Services in Rural Settings 25:23 - Role of Mentorship in Job Seeking 28:21 - Importance of Networking in Career Development 32:37 - Future of IR Training and Practice 38:23 - Role of BackTable in IR Training --- RESOURCES SIR 2024 Monday Session (3:27 PM - 3:36 PM MT): Trainee perceptions of current IR workforce: Are we setting our residents up for failure? With Dr. Thomas Sullivan: https://www.sirmeeting.org/fsPopup.asp?PresentationID=1348792&mode=presInfo

16 Helmi 202443min

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Charles Nutting about prostatic artery embolization (PAE) in the outpatient-based lab (OBL) setting. Dr. Nutting is an interventional radiologist at Endovascular Consultants in Lone Tree, Colorado. The doctors discuss procedure techniques, patient selection, follow-up care, and benefits of the OBL environment over the hospital. Dr. Nutting emphasizes that it is important to learn PAE in a hospital setting before transitioning to the OBL. He recommends using consistent equipment to help with the learning process. Dr. Nutting also shares his experience with radiopaque beads in PAE and describes the advantages of seeing the deposition of the beads into the gland. The doctors discuss the potential impact of the 2023 American Urological Association (AUA) Guidelines, which for the first time recognizes PAE for the treatment of symptomatic benign prostatic hyperplasia (BPH), and what this might mean for patient volume and interventional radiology training. --- CHECK OUT OUR SPONSOR Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions --- SHOW NOTES 00:00 - Introduction 03:03 - Impact of New AUA Guidelines on PAE 04:48 - Benefits of PAE for Patients 06:37 - Role of Primary Care Physicians in PAE 08:18 - Practice of PAE in the OBL 19:08 - Role of Urodynamic Studies 22:23 - Challenges of Treating Small Glands 26:11 - Procedure Steps and Techniques 34:19 - Post-Procedure Care and Follow-up 38:33 - The Future of Prostate Embolization --- RESOURCES Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023: https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study): https://pubmed.ncbi.nlm.nih.gov/29645352/ NICE - Prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia: https://www.nice.org.uk/guidance/ipg611 Yttrium-90 Radioembolization in the Office-Based Lab: https://pubmed.ncbi.nlm.nih.gov/32800662/ Role of Urodynamic Studies in Management of Benign Prostatic Obstruction: A Guide for Interventional Radiologists: https://www.jvir.org/article/S1051-0443(16)30520-6/fulltext International Prostate Symptom Score (IPSS): https://www.urologygroup.com/wp-content/uploads/2019/07/IPSS-Form-Before-Tx-_-BPH.pdf

13 Helmi 202446min

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Gary Tse about the innovative technique of thyroid ablation and its role in treating benign thyroid nodules. Dr. Tse is a practicing interventional radiologist at UCLA Health. Dr. Tse highlights the procedural details, patient experiences, potential complications, and follow-up protocols of thyroid ablation. He emphasizes the importance of consistent communication with patients during these procedures, given that the patients are under minimal anesthesia. He explains how interventional radiologists can benefit from embracing this procedure due to their expertise in ultrasound usage, as it leads to reduction in recovery times and complications for patients. Dr. Tse also briefly discusses the future potential of thyroid embolization for larger goiters. He encourages other IR specialists to consider adopting this procedure, which he believes should become a standard of care. --- CHECK OUT OUR SPONSORS Siemens Healthineers https://www.siemens-healthineers.com/ Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions --- SHOW NOTES 00:00 - Introduction 04:03 - Dr. Tse’s Career Journey and Transition to Academics 06:32 - Discussion on Thyroid Interventions 09:15 - Building Referral Patterns for Thyroid Interventions 11:50 - Thyroid Ablation Procedure Overview 21:23 - Post-Ablation Outcomes and Goals 25:52 - Avoiding Complications 32:55 - Post-Procedure Follow-Up 36:14 - Exploring Thyroid Embolization 42:23 - Final Thoughts and Future Prospects --- RESOURCES 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005940/ Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis: https://pubmed.ncbi.nlm.nih.gov/35311971/ Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation: https://doi.org/10.3803/EnM.2020.35.2.407 Revisiting Rupture of Benign Thyroid Nodules after Radiofrequency Ablation: Various Types and Imaging Features: https://doi.org/10.3803/EnM.2019.34.4.415 Thyroid arterial embolization to treat Graves' disease: https://pubmed.ncbi.nlm.nih.gov/17354140/ Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients: https://www.jvir.org/article/S1051-0443(21)01212-4/fulltext#%20

9 Helmi 202445min

In this episode, host Dr. Chris Beck interviews Dr. Jason Wagner about his experience with using the Hemodialysis Reliable Outflow (HeRO) graft and the Surfacer system for treating patients with end stage renal disease (ESRD) and limited vascular access options. Dr. Wagner is a practicing vascular surgeon in Sarasota, Florida. Dr. Wagner explains the steps to implant a HeRO endovascular graft, how it provides a durable and reliable outflow for hemodialysis patients, and how it can be used and revised based on the patient’s needs. He also discusses the Surfacer system in obtaining central venous access, its advantages, and the necessity of preoperative imaging. Dr. Wagner emphasizes the critical role of continued learning in utilizing and optimizing these advanced dialysis solutions. The suggestions and other information, which may include Merit products, are for the practitioner’s convenience and for general information purposes only. This information does not constitute medical or legal advice. Before using, refer to the Instructions for Use (IFU) for indications, contraindications, warnings, precautions, and directions for use. --- CHECK OUT OUR SPONSOR Merit HeRO Graft https://www.merit.com/product/merit-hero-graft/ --- SHOW NOTES 00:00 - Introduction 02:25 - Dr. Wagner’s Experience in Vascular Surgery 05:49 - Understanding End-Stage Vascular Access 08:52 - Introduction to the HeRO Graft 16:15 - Implantation of the HeRO Graft 28:38 - The Surfacer: A Game Changer in Vascular Access 31:49 - Potential Risks and Precautions with the Surfacer 33:38 - Using Both HeRO Graft and Surfacer 36:31 - Final Thoughts and Resources on Both Devices --- RESOURCES Think Dialysis Access Course from Merit: https://www.merit.com/education/courses/thinkaccess/ HeRO Graft: Indications, Technique, Outcomes, and Secondary Intervention: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8856774/ KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/ The Surfacer: https://bluegrassvascular.com/surfacer-2/

6 Helmi 202445min