Ep. 328 Adrenal Vein Sampling with Dr, Fritz Angle

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Neil Khilnani about the management of pelvic venous disorders, focusing on embolization practices for treating conditions such as chronic pelvic pain and pelvic venous syndrome. Dr. Khilnani is an interventional radiologist at Weill Cornell Medicine in New York Presbyterian Hospital. --- CHECK OUT OUR SPONSOR Cook Medical Embolization https://www.cookmedical.com/embobacktable --- SYNPOSIS Dr. Khilnani discusses the significance of identifying and treating venous disorders in patients with chronic pelvic pain. He emphasizes the need for a comprehensive approach that includes detailed patient history, physical exams, and imaging techniques such as ultrasound, CT, and MRI for accurate diagnosis. The doctors also cover the evolution of embolization techniques, including the use of balloon occlusion and sclerosants and they underscore the importance of addressing underlying venous insufficiencies for effective pain management. Additionally, Dr. Khilnani highlights the interconnectedness of various pelvic symptoms and the potential for embolization to alleviate not just pelvic pain, but also related conditions such as painful bladder syndrome and orthostatic hypotension. The doctors acknowledge the ongoing research and the need for collaboration across specialties to improve patient outcomes in pelvic venous disorder. --- TIMESTAMPS 00:00 - Introduction 04:44 - Pelvic Venous Disease 09:20 - Prevalence of Pelvic Venous Disease 13:54 - Challenges in Communication with Referring Doctors 18:32 - Workup and Diagnosis of Pelvic Venous Disorders 30:08 - Treatment Options and Patient Education 36:19 - Role of Social Media in Patient Support Networks 37:04 - Procedure: From Planning to Execution to Post-Intervention 54:07 - Navigating Difficult Anatomy and Potential Complications 01:02:34 - Future of Pelvic Venous Disorders Treatment: Research and Trials --- RESOURCES BackTable VI Episode 389 - Pelvic PT: An Introduction for Interventionalists with Ingrid Harm-Ernandes, PT: https://www.backtable.com/shows/vi/podcasts/389/pelvic-pt-an-introduction-for-interventionalists BackTable VI Episode 337 - Management of Vulvar Varices with Dr. Brooke Spencer: https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 1: Diagnosis and Planning with Dr. Mark Meissner and Dr. Michael Cumming: https://www.backtable.com/shows/vi/podcasts/101/pelvic-congestion-syndrome-part-1-diagnosis-planning BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 2: Technique and Follow-Up with Dr. Mark Meissner and Dr. Michael Cumming: https://www.backtable.com/shows/vi/podcasts/102/pelvic-congestion-syndrome-part-2-technique-follow-up A standardized ultrasound approach to pelvic congestion syndrome (Labropoulos et al): https://pubmed.ncbi.nlm.nih.gov/27799418/ Comparison of Fibered versus Nonfibered Coils for Venous Embolization in an Ovine Model (White et al): https://pubmed.ncbi.nlm.nih.gov/37105664/ Pelvic Venous Disorders in Women due to Pelvic Varices: Treatment by Embolization: Experience in 520 Patients (De Gregorio et al): https://www.jvir.org/article/S1051-0443(20)30534-0/abstract Improvement in chronic pelvic pain, orthostatic intolerance and interstitial cystitis symptoms after treatment of pelvic vein insufficiency (Smith et al): https://journals.sagepub.com/doi/abs/10.1177/02683555231219737 The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders: https://www.jvsvenous.org/article/S2213-333X(21)00071-8/fulltext Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel: https://pubmed.ncbi.nlm.nih.gov/30857986/ Find this episode on BackTable.com for the full list of resources.

19 Mar 20241h 9min

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ramsey Al-Hakim about the inception and journey of Auxetics, a med-tech company innovating in the vein stent market. Dr. Al-Hakim is the co-founder of Auxetics and the Section Chief of the Division of Interventional Radiology at Scripps Hospital in San Diego, CA. Dr. Al-Hakim covers the initial challenges of understanding the market and securing capital, the clinical significance of addressing stent-adjacent stenosis, and the process of developing a stent with a negative Poisson effect to counteract it. Dr. Al-Hakim highlights Auxetics' approach to combining cutting-edge interventional technologies with world-class imaging tools for enhanced procedural efficiency in venous interventions. The company’s progress through benchtop work, animal testing, and plans for first-in-human studies outside the U.S., aiming for commercialization within the next four to five years, is also outlined. Contributions from key figures in the vascular community and the role of mentorship and perseverance in navigating the complexities of medical device innovation are discussed as well. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:11 - The Market and Problem Solving 12:13 - Journey of Creating a Stent 22:28 - Birth of Auxetics 26:53 - Learning Process and Support from the University 29:16 - Building the Dream Team 33:01 - Starting a Company 36:42 - Challenges and Triumphs of Fundraising 37:44 - Current Status and Future Plans 45:32 - Importance of Community and Mentorship --- RESOURCES Auxetics: https://www.auxeticsinc.com In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction: https://pubmed.ncbi.nlm.nih.gov/34174500/ Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation: https://pubmed.ncbi.nlm.nih.gov/30717966/ The Messy Middle: Finding Your Way Through the Hardest and Most Crucial Part of Any Bold Venture: https://www.amazon.com/Messy-Middle-Finding-Through-Hardest/dp/0735218072

15 Mar 202454min

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Dean Ferrera about treating acute limb ischemia with mechanical thrombectomy. Dr. Ferrera is an interventional cardiologist at Community Care Network in northwestern Indiana. Dr. Ferrera emphasizes the importance of interdisciplinary collaboration, early detection, and selection of appropriate intervention techniques. He also discusses threading issues, bleeding complications, use of lysis, and understanding the nature of clots. He recommends thrombectomy systems such as the Pounce Thrombectomy System for removing thrombus and embolus. Furthermore, Dr. Ferrera highlights the significance of continued learning and mentorship in managing these complex conditions. --- CHECK OUT OUR SPONSOR Surmodics Pounce Thrombectomy https://pouncesystem.com/ --- SHOW NOTES 00:00 - Introduction 04:21 - Patient Presentation and Workup 09:23 - Treatment Options for Acute Limb Ischemia 17:48 - Crossing the Clot and Treatment Options 25:18 - Device Capabilities and Limitations 28:43 - Procedure Steps and Reusability 31:26 - Device Selection and Aspiration Devices 37:07 - Post-Procedure Considerations and Follow-Up 43:16 - Complications and Risk Management --- RESOURCES Pounce Thrombectomy System: https://pouncesystem.com/ Thrombus Structural Composition in Cardiovascular Disease: https://pubmed.ncbi.nlm.nih.gov/34261330/

12 Mar 202450min

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. John Qiao about exploration of physicians’ role in medical innovation, particularly among interventional radiologists. Dr. Qiao shares insightful information about the origin of RadioClash and details his journey as an entrepreneur. Through this discussion, Dr. Qiao covers the challenges encountered during the startup phase, the invention of a single-probe electroporation device, and the future applications of this novel medical technology. The episode concludes with broader advice on how to manage the demands of professional work, entrepreneurship, and personal life. --- CHECK OUT OUR SPONSORS Reflow Medical https://www.reflowmedical.com/ Medtronic Concerto https://mobile.twitter.com/mdtvascular --- SHOW NOTES 00:00 - Introduction 02:39 - Dr. Qiao’s Journey into Medicine and Entrepreneurship 11:40 - Birth of Radioclash: A Unique Solution for Cancer Treatment 17:58 - Future of RadioClash: Targeting Metastatic Cancer 25:20 - Future of Electroporation Therapy 35:21 - Challenges of Building a Company 44:37 - Path to Market and Future Plans 47:28 - Balancing Clinical Practice and Entrepreneurship --- RESOURCES RadioClash website: https://www.radioclash.co/ News Article on Dr. John Qiao: https://voyagehouston.com/interview/meet-john-qiao-m-d-of-radioclash-ltd-co/ Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086111/ The Abscopal Effect: A Reemerging Field of Interest: https://ascopost.com/issues/november-25-2018/the-abscopal-effect-a-reemerging-field-of-interest/ BackTable VI Episode #402 - Immunotherapy in HCC: Evolving Treatment Paradigms: https://www.backtable.com/shows/vi/podcasts/402/immunotherapy-in-hcc-evolving-treatment-paradigms Tavo and Pembrolizumab in Patients With Stage III/​IV Melanoma Progressing on Either Pembrolizumab or Nivolumab Treatment (Keynote-695): https://clinicaltrials.gov/study/NCT03132675 PANFIRE-3 Trial: Assessing Safety and Efficacy of Irreversible Electroporation (IRE) + Nivolumab + CpG for Metastatic Pancreatic Cancer: https://classic.clinicaltrials.gov/ct2/show/NCT04612530 Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients: https://pubmed.ncbi.nlm.nih.gov/33129427/ The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study (Northwestern study): https://pubmed.ncbi.nlm.nih.gov/21728392/ Irreversible electroporation reverses resistance to immune checkpoint blockade in pancreatic cancer: https://www.nature.com/articles/s41467-019-08782-1

8 Mar 202450min

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Andrew Sholl, who demystifies the ins and outs of percutaneous biopsies and their impact on diagnoses. Dr. Scholl is a pathologist at LCMC Health in New Orleans, Louisiana. Dr. Sholl emphasizes the importance of understanding substantial clinical history, as well as obtaining adequate and correctly processed samples. The doctors discuss the varying scenarios faced in pathology, such as instances when larger samples are beneficial and the nuances of differentiating malignancies in certain organs. They also cover detailed tips for conducting biopsies and the process of how pathologists assess patient samples. The overarching message is the importance of communication and collaboration between interventional radiologists and pathologists to ensure the best patient outcomes. --- CHECK OUT OUR SPONSOR Argon BioPince Ultra https://www.argonmedical.com/product/biopince-ultra-full-core-biopsy-instrument/ --- SHOW NOTES 00:00 - Introduction 02:38 - Understanding Pathology Training and Practice 06:07 - Role of Pathology in Medical Diagnosis 18:57 - Importance of Sample Size and Quality in Pathology 26:34 - Next Gen Sequencing and Molecular Markers 29:44 - Biopsy Devices and Their Impact on Diagnosis 37:21 - Using Clinical History in Pathology 43:16 - Challenges and Considerations in Diagnosing Renal and Hepatic Tumors 50:25 - Importance of Communication Between Pathologists and Interventional Radiologists

5 Mar 202455min

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 Mar 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 Feb 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 Feb 202434min