BackTable Vascular & Interventional

Interventional Radiologist Sabeen Dhand talks with Vascular Surgeon Frank Arko about endovascular treatment of Type B Aortic Dissections (TBAD), including patient selection, appropriate sizing, and complications to avoid. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Hv2gx0 --- SHOW NOTES In this episode, vascular surgeon Dr. Frank Arko and our host Dr. Sabeen Dhand give an overview of type B aortic dissections, which includes different methods of classifying dissections, workup and imaging, thoracic endovascular aortic repair (TEVAR), potential complications, and timeline for follow up care. Dr. Arko starts the episode by defining vocabulary terms related to aortic dissections. He describes the Stanford and DeBakey classification systems that are used to signify the location of the dissection and the method of treatment (medical management or surgical/endovascular repair). He also distinguishes between complicated/uncomplicated dissections, as well as acute/subacute/chronic dissections. When Dr. Arko discusses TEVAR, he mentions three important complications to be aware of: retrograde type A dissection, stroke, and spinal cord ischemia. He emphasizes that in the debate between optimal medical therapy and early TEVAR, more research on how to minimize these complications is needed before recommending widespread use of early TEVAR. During his walk through of the procedure, Dr. Arko also gives his insight on adjunct techniques such as PETTICOAT. Finally, the doctors discuss special considerations for patients with pleural effusion, chronic hypertension, type II thoracoabdominal aneurysms, and connective tissue disorders. --- RESOURCES INSTEAD-XL Trial- https://pubmed.ncbi.nlm.nih.gov/23922146/

16 Heinä 202149min

Dr. Eric Therasse discusses the results of a randomized clinical trial demonstrating benefit of drug eluting balloon (DEB) over balloon angioplasty alone in treatment of Dysfunctional Hemodialysis Access. --- SHOW NOTES In this episode, Dr. Eric Therasse, an author of the recent JVIR article titled “Safety and Efficacy of Paclitaxel-Eluting Balloon Angioplasty for Dysfunctional Hemodialysis Access,” and our host Dr. Christopher Beck discuss the study design, outcomes, and implications for further research in the use of drug eluting balloons (DEBs) for hemodialysis access. In this study, the control group received “plain old balloon angioplasty” (POBA), while the treatment group received angioplasty with Biotronik’s Passeo 18-Lux DEB. Dr. Therasse describes the angiographic endpoints, with primary endpoint as late lumen loss (to measure the degree of restenosis), and secondary endpoints as hemodialysis access failure and mortality at 12 months. He emphasizes that the clinical endpoints of this study were more significant than the angiographic endpoints because they showed that when treating dysfunctional hemodialysis access, there is decreased incidence and severity of restenosis with DEB compared with POBA. Additionally, the doctors walk through obstacles that arose during the study, which included coordination of data collection across multiple centers, low patient enrollment rate, strict exclusion criteria, and the need for re-intervention prior to the standardized follow up date. Dr. Therasse comments on the increasing use of DEBs in clinical practices and their future cost-effectiveness. He also references other helpful articles for interested listeners (linked below). --- RESOURCES Safety and Efficacy of Paclitaxel-Eluting Balloon Angioplasty for Dysfunctional Hemodialysis Access: https://www.jvir.org/article/S1051-0443(20)30961-1/fulltext Drug-Coated Balloons for Dysfunctional Dialysis Arteriovenous Fistulas: https://www.nejm.org/doi/10.1056/NEJMoa1914617?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed The Lutonix AV Randomized Trial of Paclitaxel-Coated Balloons in Arteriovenous Fistula Stenosis: https://www.jvir.org/article/S1051-0443(19)30817-6/fulltext

12 Heinä 202152min

Bryan Hartley talks with physician entrepreneur Dr. Mahmood Razavi about the essential elements of successfully starting a medtech company, as well as pitfalls to avoid. --- SHOW NOTES In this episode, serial entrepreneur Dr. Mahmood Razavi and our host Dr. Bryan Hartley discuss factors to consider when starting a medical technology company, steps of the innovation process, and fundraising strategies. Dr. Razavi recounts his path into entrepreneurship, emphasizing the importance of finding innovative mentors. He advises listeners to go beyond merely observing other successful innovators and instead, actively engaging and asking them questions. The doctors bring up the concept of filing a provisional patent in the early stages of product development, which can allow an entrepreneur to protect their intellectual property as they seek guidance from others. A critical decision point arises when an entrepreneur must decide whether or not they should establish a new product for an existing company or establish a completely new company. If the product is a different iteration of a design that already exists it might be worthwhile to innovate within the structure of an existing company. If you are creating a completely new device class that addresses a new clinical need or disease, there could be potential to start a company. The startup process requires entrepreneurs to recruit team members and raise funds. Dr. Razavi uses equity as a recruiting tool to bring business and engineering experts into the company. He also describes various methods of funding, including venture capital and strategic partnerships and the pros and cons of each.

5 Heinä 202155min

We talk with Vascular Access Surgeon Ari Kramer about AV Fistula and Graft Maintenance in dialysis patients from creation to long-term care, as well as tips and tricks for treating stenoses. --- SHOW NOTES In this episode, vascular access surgeon Dr. Ari Kramer and our host Dr. Chris Beck discuss the creation, management, and salvage of AV fistulas and grafts. Dr. Kramer describes the referral patterns that lead dialysis patients to his practice, citing the need to coordinate dialysis care around a common surgical practice. He works closely with nephrologists and dialysis centers to ensure quality of care and streamlined patient management. During an initial workup, Dr. Kramer includes a physical assessment and an echocardiogram to establish a baseline. The doctors discuss the pros and cons of using AV fistulas versus grafts. While AV fistulas are autogenic and carry a lower risk of infection, there is a risk that these may not mature. On the other hand, AV grafts are fully matured but they carry a higher risk of infection and require a higher intervention rate. Dr. Kramer emphasizes the importance of understanding a patient’s cardiac performance and history before selecting a method of AV access. He also schedules periodic follow-up appointments to ensure that the access site reaches maturity, which is evaluated by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. Dr. Kramer walks us through devices and procedures for angioplasty, stent placement, and drug coated balloon placement. Finally, he addresses strategies for managing re-stenosis and considerations for patient preferences regarding surgical revision. --- RESOURCES Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Vascular Access: 2019 Update: https://www.ajkd.org/article/S0272-6386(19)31137-0/fulltext#secsectitle0720 American Society of Diagnostic and Interventional Nephrology (ASDIN): https://www.asdin.org/page/A2 Kidney Academy (use code “backtable21” for free access): https://www.kidneyacademy.com/

2 Heinä 202159min

Dr. Sabeen Dhand talks with Dr. Lorenzo Patrone about how to be your best at giving an amazing, engaging presentation. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rN9SC1 --- SHOW NOTES In this episode, interventional radiologists Dr. Lorenzo Patrone and Dr. Sabeen Dhand discuss their best tips for creating and delivering quality presentations. Due to the highly visual nature of interventional radiology, both doctors agree that PowerPoints are a great way to communicate information to audiences. Dr. Patrone recommends learning how to fully utilize PowerPoint functionalities such as embedded videos, animations, and transitions. Specifically, looped videos can help show blood flow. Interspersing dynamic presentation features can better illustrate important points; however, overuse of these can be distracting and unprofessional. As for presentation delivery, both doctors agree that showing authentic personality can engage audiences. They advise listeners to embrace talking about complications and posing questions to the audience. Finally, they discuss considerations to keep in mind for different types of presentation formats, such as online webinars, industry-sponsored events, and debates. Overall, Dr. Patrone advises doctors to only speak on behalf of products that they truly believe in. --- RESOURCES Vascupedia: https://vascupedia.com/ Envato Presentation Templates: https://elements.envato.com/presentation-templates

25 Kesä 202135min

Dr. Rakesh Ahuja walks us through the Pathway to Becoming a Y-90 Authorized user as a Resident, as well as the standard post-training pathway. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/2JujFM --- SHOW NOTES In this episode, interventional radiologist Dr. Rakesh Ahuja and our host Dr. Michael Barraza continue the BackTable Trainee Series by discussing the meaning, benefits, and pathway for residents to become Y90 Authorized Users (AU). The doctors discuss what it means to be an AU in interventional oncology, a rapidly growing field. The major benefit of Y90 licensing is that AUs can have the freedom to independently prescribe and administer customized doses to patients. Additionally, AU status can make a physician more marketable to private practices and it can allow them to perform cases on their own schedule. AU status is transferable to different sites and states, and it does not expire. Dr. Ahuja speaks about eligibility requirements and emphasizes that trainees do not have to be board certified in radiology to start Y90 training. Supervised clinical training throughout an IR/DR residency will make most PGY-5 residents eligible to start the Authorized User training process. While this alternate pathway of Y90 Authorization can be faster than the traditional pathway (waiting until after board certification from the American Board of Radiology), it is important to work with local radiation safety officers to ensure that all eligibility and training criteria are met. --- RESOURCES US Nuclear Regulatory Commission Y90 Licensing Guidance- https://www.nrc.gov/docs/ML1920/ML19204A272.pdf

24 Kesä 202125min

We chat with MedSchoolCoach Founder Dr. Sahil Mehta and 1st Year IR Resident Dr. Elias Farah about what inspired them to go into IR, and advice on getting into the specialty via the existing training pathways. --- SHOW NOTES In this episode, interventional radiologist Dr. Sahil Mehta, integrated DR/IR resident Dr. Elias Farah, and our host Dr. Aaron Fritts continue the BackTable Trainee Series by discussing how they each discovered the field of interventional radiology (IR), recent trends in the IR match process, and the importance of raising awareness of the IR specialty. With the recent shift towards integrated IR residencies, medical students now have the opportunity to experience a mix of diagnostic and interventional radiology training from PGY-2 through PGY-4, and then dedicate time to IR training during PGY-5 and PGY-6. As a recent IR applicant and now a resident, Dr. Farah walks us through his process of applying to residency. He outlines the steps that he took to prepare and the number of programs that he applied to. We also address the fact that IR has grown to be one of the most competitive specialties to match into. Dr. Mehta emphasizes that applicants’ average USMLE scores and number of publications have increased in the last few years, so it is important for applicants to demonstrate their genuine interest in the field and be prepared to speak about this during the interview. The doctors close by discussing why increased awareness of IR can benefit both providers and patients. They highlight organizations that advance this mission, including the Society of Interventional Radiology (SIR) and the Interventional Institute. --- RESOURCES Society of Interventional Radiologists (SIR) Online Education Resources: https://www.sirweb.org/learning-center/rfs-landing-page/medical-student-and-resident-educational-resources/ SIR Residents, Fellows, and Students (SIR RFS): http://rfs.sirweb.org/ The Interventional Initiative: http://www.theii.org/ Beth Israel Deaconess IR Residency: https://www.bidmc.org/medical-education/medical-education-by-department/radiology/residencies-in-radiology/interventional-radiology-integrated-pathway-residency University of Florida IR Residency: https://radiology.med.jax.ufl.edu/interventional-radiology-integrated-residency/ MedSchoolCoach: https://www.medschoolcoach.com/

23 Kesä 202146min

We talk with IR Resident Dr. Jeff Bodner and Emory IR Program Director Dr. Bill Majdalany about the current IR training pathways and what it takes to get in these days! --- SHOW NOTES In this episode, interventional radiology (IR) program director Dr. Bill Majdalany, integrated IR resident Dr. Jeff Bodner, and our host Dr. Chris Beck continue the BackTable Trainee Series by discussing the IR residency application and interview process: different pathways to enter IR, applications that stand out, and interview day tips. As a recent residency applicant, Dr. Bodner walks us through his journey through medical school, applications, and interviews. For students interested in pursuing IR, he recommends demonstrating interest in the field by participating in medical student committees, conferences, and volunteer opportunities. He also advises fourth-year students to apply broadly to both integrated interventional radiology and diagnostic radiology programs, emphasizing that there are multiple pathways to IR. Dr. Majdalany elaborates on these pathways, describing the differences between the Early Specialization in Interventional Radiology (ESIR), the independent IR residency, and the integrated IR residency. He highlights key actions that applicants can take, which include performing well in all clerkships, taking advantage of research opportunities, and composing a personal statement that ties the whole application together. We conclude the episode by offering advice for interview days. Overall, the best practices are to maintain professionalism and come prepared with knowledge about each program. --- RESOURCES Society of Interventional Radiologists (SIR) Online Education Resources: https://www.sirweb.org/learning-center/rfs-landing-page/medical-student-and-resident-educational-resources/ SIR Residents, Fellows, and Students (SIR RFS): http://rfs.sirweb.org/ Emory University IR Residency: https://med.emory.edu/departments/radiology/education/interventional-radiology-residency/index.html

22 Kesä 20211h