Ep. 592 Comparing Thermal Ablation Techniques for Liver Lesions with Dr. Jason Hoffmann

In this episode of the BackTable Podcast, vascular surgeon Dr. Nicolas Mouawad and interventional radiologist Dr. Raja Ramaswamy share their insights on the changing landscape of deep vein thrombosis (DVT) management, steps of mechanical thrombectomy, and current research on DVT interventions. --- CHECK OUT OUR SPONSOR Inari Medical https://www.inarimedical.com/ --- SYNPOSIS The guests start by describing their typical referral patterns, noting that most cases come through the emergency department. In terms of workup, it is important to distinguish between acute and chronic DVTs and classify the thrombosis location as either proximal (femoral vein or higher) or distal. Anticoagulation, usually with direct oral anticoagulants, is always started, with efficacy largely determined by patient compliance. Regarding endovascular intervention, thrombolysis may be an effective adjunctive treatment if the clot occurred within a two-week timespan, but it carries a bleeding risk and requires ICU monitoring. On the other hand, mechanical thrombectomy is an option for both acute and chronic clots, allows for intervention in patients with high bleeding risk, and does not require post-procedural hospitalization. Both physicians emphasize that interventions should be employed if there are long-term benefits of avoiding post-thrombotic syndrome and pulmonary embolism. The physicians walk through a typical mechanical thrombectomy procedure, which involves the thrombectomy device, venogram, intravascular ultrasound, and possible stent placement. Finally, they discuss recent data, including the ATTRACT Trial for thrombolytics and the CLOUT Registry and Trial for ClotTriever use. Notably, they mention the DEFIANCE Trial as a current prospective randomized clinical trial for ClotTriever use in the iliofemoral region. --- TIMESTAMPS 00:00 - Introduction 03:48 - DVT Referral Patterns and Treatment Algorithms 08:55 - Choosing an Anticoagulation Regimen 11:01 - DVT Interventions 13:54 - Patient Scenarios and Treatment Decisions 22:29 - Post-Thrombotic Syndrome 26:16 - Mechanical Thrombectomy Technique 35:45 - Postoperative Care 39:09 - The Evolution of Mechanical Thrombectomy 43:38 - ATTRACT Trial 46:20 - CLOUT Trial --- RESOURCES Inari ClotTriever System: https://www.inarimedical.com/clottriever-system ATTRACT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1615066 CLOUT Trial: https://pubmed.ncbi.nlm.nih.gov/35218955/ DEFIANCE Trial: https://evtoday.com/news/inari-medical-begins-defiance-randomized-clinical-trial-of-clottriever-system-in-dvt

4 Jun 202458min

Trigger warning: This episode contains discussions about suicide. In this episode of the BackTable podcast, interventional radiologist Dr. Jenanan Vairavamurthy shares about the tragic loss of his physician brother to suicide and discusses his own mental health journey. He highlights the immense pressures and challenges that medical training and practice impose on providers. --- SYNPOSIS The discussion emphasizes the need for mental health awareness and the importance of creating supportive environments within the medical community. He advocates for open conversations about mental health struggles and urges those in leadership positions to prioritize the well-being of colleagues and trainees. This powerful conversation aims to destigmatize mental health issues in the medical field and encourages medical providers to seek and provide support for each other. --- TIMESTAMPS 00:00 Introduction 04:11 Assessing Personal Mental Health 06:31 Personal Tragedy and Mindset Shift 11:49 The Realities of Wellness in Medicine 21:59 Creating Supportive Environments Within Medicine 25:58 Navigating Personal and Professional Challenges 35:15 Building and Leading Supportive Networks --- RESOURCES Physician Supp​​ort Line: https://www.physiciansupportline.com/

31 Mai 202442min

In this episode, interventional cardiologist Dr. Peter Soukas joins us to discuss percutaneous transmural arterial bypass (PTAB) using the DETOUR system, a novel percutaneous treatment for extensive and complex blockages in the superficial femoral artery (SFA). --- CHECK OUT OUR SPONSOR Endologix https://endologix.com/ --- SYNPOSIS Dr. Soukas shares his extensive experience and insights into PTAB development, benefits, patient selection, and procedural details. The idea behind PTAB is to create an SFA-to-popliteal artery bypass through endovascular means, using a system of overlapping stent grafts within the femoral vein as a conduit. When planning the procedure, it is important to consider the location of reentry into the popliteal artery, avoid calcified zones, and meet femoral vein size criteria. Additionally, we explore the advantages of PTAB over other endovascular options and traditional open surgical bypass, which carry a higher likelihood of restenosis and longer recovery times, respectively. We also discuss the types of training and support available for physicians interested in adopting this technique, cost and reimbursement aspects, and the future direction of PTAB, including ongoing post-market studies. --- TIMESTAMPS 00:00 Introduction 02:38 Dr. Soukas’ Career in Vascular Medicine 05:19 Introduction to PTAB 13:00 Landing Zones 19:37 Stent Graft Sizing 23:14 Patient Selection and Adjunctive Medical Therapy 28:04 Procedural Risks 29:18 Navigating PTAB Implementation 32:20 Opportunities for Learning PTAB --- RESOURCES PTAB with the DETOUR System: https://endologix.com/ptab/detour/ Brown Vascular and Endovascular Fellowship: https://brownmedicine.org/3/cardiology-vascular-endovascular-fellowship/ COMPASS Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118 VOYAGER Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2000052 DETOUR 2 Trial: https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext

28 Mai 202439min

In this episode, Dr. Marta Lobato explores advanced endovascular techniques in below the knee (BTK) and below the ankle (BTA) interventions for critical limb ischemia (CLI). She introduces various skills that were developed and used by her team, such as the telescopic needle, buddy needle, balloon-assisted puncture, and vasodilation to prevent artery spasm. Dr. Lobato is a vascular surgeon at Hospital de Cruces in Barakaldo, Spain. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS The discussion covers the importance of visualizing the fifth metatarsal for effective lateral views in X-rays, the intricacies of accessing the lateral and medial plantar arteries, and the significance of starting with easier procedures before attempting more complex interventions. Additionally, Dr. Lobato highlights the role of social media in learning about innovative medical practices. --- TIMESTAMPS 00:00 - Introduction 05:54 - Below the Knee and Ankle Interventions 15:35 - Complexities of Zone 2 and 3 Access 23:12 - Buddy Needle Technique for Calcified Arteries 30:12 - Advanced Techniques for Supporting the Wire 34:13 - Vasodilator Use 37:12 - Balloon-Assisted Techniques 41:02 - Advancing Your Endovascular Skills --- RESOURCES Tips and Tricks for Simple and Complex Below-the-Ankle Punctures: https://pubmed.ncbi.nlm.nih.gov/38441118/ Buddy Needle Technique to Facilitate Retrograde Puncture of Heavily Calcified Tibial Vessels: https://pubmed.ncbi.nlm.nih.gov/28587566/ Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach: https://pubmed.ncbi.nlm.nih.gov/34989276/ Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures: https://pubmed.ncbi.nlm.nih.gov/36415934/ The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia: https://pubmed.ncbi.nlm.nih.gov/38523459/ New antioxidant therapy for hard-to-heal neuroischaemic diabetic foot ulcers with deep exposure: https://pubmed.ncbi.nlm.nih.gov/37029973/ Percutaneous endovascular arteriovenous fistula creation for hemodialysis access using "off-the-shelf" conventional devices: https://pubmed.ncbi.nlm.nih.gov/33251393/

24 Mai 202445min

In this episode, Dr. Mark Little shares his insights about genicular artery embolization (GAE), implications for patients with knee osteoarthritis, possible applications in other MSK interventions, and the importance of research for advancing the field. Dr. Little is a consultant diagnostic and interventional radiologist at Berkshire Imaging and Visiting Professor at the University of Reading in England. --- CHECK OUT OUR SPONSOR Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ --- SYNPOSIS The doctors also discuss challenges and considerations in patient selection, particularly concerning patients with comorbid peripheral arterial disease, and they further emphasize the need for high-quality research and collaboration within the IR community to continue improving MSK embolization practices. --- TIMESTAMPS 00:00 - Introduction 12:28 - Genicular Artery Embolization 24:30 - GENESIS 1 and 2 Studies 41:04 - Future of MSK Embolization --- RESOURCES BackTable VI Episode 27 - Geniculate Artery Embolization for Osteoarthritis with Dr. Sandeep Bagla and Dr. Ari Isaacson: https://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritis 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 GEST MSK Annual Meeting: https://thegestgroup.com/annual-msk-meeting/ GENESIS 1 - Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis: https://pubmed.ncbi.nlm.nih.gov/33474601/ GENESIS 2 - Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial: https://pubmed.ncbi.nlm.nih.gov/37337060/ Dr. Little Genicular Artery Anatomy Paper - Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis: https://pubmed.ncbi.nlm.nih.gov/34657976/ Dr. Sid Padia’s Knee OA Research (UCLA) - Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis: https://pubmed.ncbi.nlm.nih.gov/34703964/ Dr. Lars Lönn from Copenhagen Trial - Genicular Artery Embolization as Pain Treatment of Knee Osteoarthritis (GETKO): https://classic.clinicaltrials.gov/ct2/show/NCT05360329 Dr. Anna Martinez from Spain Shoulder Study - Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment: https://pubmed.ncbi.nlm.nih.gov/33135118/ Dr. Anna Martinez from Spain Shoulder Study - Clinical Outcomes of Transcatheter Arterial Embolization for Secondary Stiff Shoulder: https://pubmed.ncbi.nlm.nih.gov/33478903/

21 Mai 202451min

En este episodio de nuestro podcast, Dra. Anna Alguersuari Cabiscol, una radióloga intervencionista que dejó su especialidad hace cuatro años, comparte su experiencia personal sobre los desafíos relacionados con la salud mental dentro de la profesión médica. --- SYNPOSIS Expone cómo la insatisfacción profesional, el síndrome del impostor y la falta de bienestar mental la llevaron a tomar la decisión drástica de abandonar el intervencionismo. A través de su relato, se discute la relevancia de crear un entorno positivo en el trabajo, invertir en el bienestar mental, y la importancia de enfrentar y superar el estigma asociado con estos temas en el ámbito médico. El episodio también aborda la necesidad de cambiar la percepción del éxito y cómo el apoyo de la comunidad médica y científica es fundamental para mejorar la situación actual. Finalmente, se destaca el rol crucial de los mentores en todas las etapas de la carrera médica para fomentar un equilibrio entre competencia y confianza, así como promover un entorno laboral saludable y respetuoso. --- TIMESTAMPS 00:00 - Bienvenido al podcast 07:16 - Redefiniendo el éxito 10:20 - Los cuatro pilares de una vida y un trabajo significativos 28:36 - Crecimiento personal y la importancia de la tutoría 32:22 - Pensamientos finales

17 Mai 202434min

In this episode, Dr. Jason Hoffmann shares his harrowing personal experience as a patient with massive portal vein thrombosis - recounting the onset of his symptoms, the subsequent diagnosis, treatment, and recovery, all occurring while he was on-call for his own hospital. Dr. Hoffmann is an interventional radiologist and educator at NYU Langone Health. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Reflecting on how this experience impacted his approach to medicine and patient care, Dr. Hoffmann discusses the importance of empathy, patient education, and building trust. Additionally, he touches upon his personal and family medical history, and how these events have influenced his medical practice and perspective on patient care. --- TIMESTAMPS 00:00 - Introduction 05:55 - Dr. Hoffmann’s IR Practice and Passions 09:23 - Physician’s Experience as a Patient 22:47 - New Perspective on Patient Care 28:53 - Closing Thoughts --- RESOURCES Combating the Health Risks of Sedentary Behavior in the Contemporary Radiology Reading Room: https://pubmed.ncbi.nlm.nih.gov/27057784/

14 Mai 202431min

En este episodio de BackTable la Dra. Maite Velázquez, hemodinamista del Hospital 12 de Octubre de Madrid, aborda el creciente porcentaje de mujeres que ingresan en el campo de la medicina y, en comparación, el escaso porcentaje de mujeres entre los profesionales que trabajan en entornos con radiación ocupacional, como la radiología vascular intervencionista, hemodinámica o cirugía vascular. Además, se analizan los desafíos existentes alrededor del embarazo de estas profesionales, legislación existente y qué medidas protectoras existen en España y Europa, así como los riesgos reales de radiación para el feto basados en evidencia científica. --- SYNPOSIS La Dra. Velázquez disipa mitos, enfatiza la seguridad existente a la hora de mantener la actividad profesional durante el embarazo con las protecciones adecuadas y destaca la brecha de género y el impacto de la escasez de relevo generacional en estas especialidades. La conversación tiene como objetivo informar y reflejar la evidencia científica existente en cuanto al manejo del embarazo mientras se trabaja en ambientes expuestos a la radiación ionizante. --- TIMESTAMPS 00:00 - Introducción 03:11 - Exposición a la radiación durante el embarazo 07:33 – Evidencia científica y legislación 20:19 - Abordar el impacto profesional del embarazo 26:56 - Combatir conceptos erróneos y promover prácticas seguras 34:59 - Comentarios finales

10 Mai 202438min