Ep. 412 Intervencionismo Pediátrico: No Kits For Peds with Dr. Fernando Gómez Muñoz

In this episode, host Dr. Aaron Fritts interviews interventional radiologists Dr. Kumar Madassery and Dr. Shelly Bhanot about catheter shapes and when to use each type in basic and challenging cases. --- CHECK OUT OUR SPONSOR Cook Medical https://www.cookmedical.com/vascularaccessbacktable --- SHOW NOTES Kumar serves as an Associate Professor and Director of Peripheral Vascular Interventions/Critical Limb Ischemia and Shelly is a PGY-6 IR resident at Rush University Medical Center in Chicago, IL. Kumar and Shelly walk us through a number of different catheters and techniques, along with tips that they have learned from their experiences in the cath lab. They pair complex and challenging anatomy with catheter types, and they describe their reasoning behind different approaches. After going through case-based examples, both Kumar and Shelly share advice on how trainees can become more familiar with tools on the back table. These include observing supply shelves, asking questions, and learning from IR techs and device representatives. We conclude the episode by emphasizing the power of teaching and how experience is a big factor in becoming more and more familiar with all the catheters that are available to our specialty. Disclaimer: The content, information, opinions and viewpoints contained in this presentation are for educational purposes only. Some opinions expressed may represent those of the speaker and are based on their own clinical experience in their practice. This information is not meant or intended to serve as a substitute for a healthcare professional’s clinical training, experience or judgment. Guest speakers are paid consultants of Cook Medical. Always refer to the Instructions for Use for complete prescribing information including indications for use, warnings, precautions, adverse events and deployment/use instructions.

4 Sep 20231h

In this episode, our host Michael Barazza interviews Dr. Jafar Golzarian, interventional radiologist at the University of Minnesota, about intra-arterial and percutaneous treatment of giant hepatic hemangiomas. --- SHOW NOTES We start this episode off by highlighting the Global Embolization Symposium and Technologies (GEST) initiative that Jafar co-founded in 2007. Over time, GEST has evolved into a highly acclaimed conference, drawing an international audience of thousands of participants for its webinars. We then dive into cutting edge treatments of liver hemangiomas. Jafar discussed how he was introduced to a novel approach in 2014 when one of his friends, Dr. Shahram Akhlaghpoor, sent him a paper with his results from using transarterial bleomycin-lipiodol embolization (B/LE) to treat symptomatic giant hepatic hemangiomas. Another friend of Jafar’s shared an inventive approach in shifting perspectives to view hepatic hemangiomas as low-grade venous malformations and using percutaneous injections for treatment. Then, Jafar discusses the specifics of his approach to hepatic hemangiomas and how he usually only treats hemangiomas that are large, cause pain and discomfort, or exert pressure on vital structures such as the portal vein or bile duct. Jafar notes that the patient demographic that presents with hemangiomas are typically women aged 30 to 50, and they can be self-referred or referred by hepatobiliary surgeons. In regards to treatment, Jafar prefers either 30, 45, or 60 units of bleomycin, favoring the latter for hemangiomas exceeding 10 cm. He prefers percutaneous access if feasible, but he resorts to chemoembolization in cases when insurance coverage presents issues. Minor post-treatment symptoms post-treatment include abdominal pain and occasional nausea, with extremely rare compilations being pulmonary fibrosis or allergic reactions to the bleomycin. Jafar notes that imaging at 1, 3, and 6 months post-treatment guides assessment of treatment effectiveness of, with substantial change best evaluated at the 6-month mark. Jafar’s treatment has garnered high patient satisfaction, with very few patients requiring return for further therapy after the 6 months. He notes that when surgeons are shown the before and after imaging of the treatment of hemangiomas, they become big advocates of these procedures. --- RESOURCES Transarterial Bleomycin–Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma: https://pubmed.ncbi.nlm.nih.gov/29922860/

1 Sep 202338min

In this episode, guest host and neurointerventional surgeon Dr. Krishna Amuluru interviews triple-boarded neurointerventional surgeon, neurointensivist, and neurologist Dr. Fawaz Al-Mufti about stroke thrombectomy in special populations. --- CHECK OUT OUR SPONSOR MicroVention FRED X https://www.fred-x.com/ --- SHOW NOTES Fawaz serves as an Associate Professor, Director of Neuroendovascular Surgery Fellowship & Neurocritical-Care Unit, Assistant Dean of GME research, and Vice-Chair of Neurology research at New York Medical College, Westchester Medical Center. First, we define the special populations that have been excluded from stroke thrombectomy randomized controlled trials (RCTs). These populations include octogenarian, nonagenarian, pediatric, and pregnant patients. Fawaz then recaps the landmark trials that have shaped the field of neuroendovascular surgery, beginning with the handful that were published in 2015/2016. Approaching mechanical stroke thrombectomy in patients in their 80s and 90s and the lack of existing RCT literature is also discussed. Switching gears, Fawaz then speaks on caring for pediatric patients with large-vessel occlusion (LVO). Krishna and Fawaz cover the relative rarity of pediatric LVOs, significant differences in adult vs. pediatric stroke, and what literature exists to help guide decision-making in this patient population. Krishna then asks Fawaz about mechanical stroke thrombectomy in pregnant patients. They also cover existing literature, etiologies, and their approaches to intervention. To conclude the episode, Fawaz and Krishna speak on the purposes, applications, extrapolations, and limitations of randomized-controlled trials. --- RESOURCES SVIN 2023 Annual Meeting: https://www.svin.org/i4a/pages/index.cfm?pageid=3625 IMS-III Trial 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214300 Mr. Clean Study: https://www.nejm.org/doi/full/10.1056/nejmoa1411587 REVASCAT Study: https://www.nejm.org/doi/full/10.1056/nejmoa1503780 EXTEND-IA Study: https://www.nejm.org/doi/full/10.1056/nejmoa1414792 ESCAPE Trial: https://www.nejm.org/doi/full/10.1056/nejmoa1414905 SWIFT PRIME Trial: https://www.nejm.org/doi/full/10.1056/nejmoa1415061 HERMES Registry: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00351-2/fulltext?rss%3Dyes Thrombolysis in Pediatric Stroke Study (TIPS): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342311/ Delay to Diagnosis in Acute Pediatric Arterial Ischemic Stroke Study: https://www.ahajournals.org/doi/10.1161/strokeaha.108.519066#:~:text=Analysis%20of%20Delay%20in%20Arterial,and%2020%25%20within%206%20hours. Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke Study: https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.036361 Recanalization Treatments for Pediatric Acute Ischemic Stroke in France (Kids-Clot): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796278 Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study: https://pubmed.ncbi.nlm.nih.gov/31609380/ Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee: https://jnis.bmj.com/content/14/10/1033 O-039 diameters of large vessels in children and compatibility with adult interventional stroke devices: children are not little adults: https://jnis.bmj.com/content/7/Suppl_1/A21.1 Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke: A Multi-Institutional Experience of Technical and Clinical Outcomes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8660626/#bib28 WEB Device from Microvention TERUMO: https://www.microvention.com/products/web-family

28 Aug 202346min

En este episodio de BackTable, la Dra. Sara Lojo Lendoiro entrevista al Dr. Alberto Alonso, radiólogo intervencionista en la Clínica Universidad de Navarra, sobre la importancia del trabajo multidisciplinar e interdisciplinar en la Radiología intervencionista. --- SHOW NOTES El Dr. Alonso introduce el término de interdisciplinariedad, que ocurre cuando distintas especialidades trabajan de manera combinada para interconectarse y potenciar las ventajas de cada una, con un objetivo común. El Dr Alonso defiende que todas las disciplinas son finitas, y debido a ello, existen puntos ciegos y una ausencia de alternativas si se depende solamente de una especialidad. Fomentar el trabajo en equipo con otras especialidades es importante para los radiólogos intervencionistas porque puede ayudarles, no solo con los procedimientos técnicos, sino también con la parte clínica. En este episodio, se enfatiza la importancia del análisis de los resultados de los procedimientos a corto y largo plazo. Para Alonso, ser autocrítico es importante y recomienda que se elimine la subjetividad en la medida de lo posible. Menciona que los errores y los malosentendidos entre las diferentes especialidades ocurren si no existe comunicación y confianza entre los distintos especialistas: es necesario que nos centremos en el factor humano, más que la reputación o el ego, para construir las relaciones personales, dejando atrás el narcisismo existente en la medicina. Finalmente, se resumen algunos escenarios en los que la interdisciplinariedad puede mejorar el manejo de los pacientes, siendo especialmente importante en pacientes complejos como pacientes pediátricos y oncológicos. El Dr. Alonso termina el episodio animando a los oyentes a fomentar la comunicación con el resto de las especialidades, promover la autocrítica y evaluar los resultados obtenidos, así como impulsar el trabajo interdisciplinar en las diferentes unidades de radiología intervencionista.

25 Aug 202339min

In this episode, guest host and interventional radiologist Dr. Dana Dunleavy interviews neurointerventional radiologist Dr. Wayne Olan about growing neuroIR and IR through a neurosurgery department. Wayne serves as the Director of Interventional and Endovascular Neurosurgery at George Washington University Medical Center. --- CHECK OUT OUR SPONSOR MicroVention FRED X https://www.fred-x.com/ --- SHOW NOTES First, Wayne tells us more about his training, journey in academia, and role in building robust neuroIR and IR service lines through his leadership of the neurosurgery department at his institution. Wayne also shares how powerful being involved in interdisciplinary clinics can be in growing the scale, reach, and impact of minimally-invasive image guided interventions. These collaborations include neuroIR/neurosurgery for neuro clinic and IR/ gynecology for fibroid clinic. Dana and Wayne then discuss how neuroIR and IR has evolved over the years, highlighting watershed moments and key innovations. They discuss sacroiliac joint interventions in detail and how MSK has become one of IR’s newest subspecialties. Wayne shares his history of playing and coaching lacrosse, and he also tells us about the Q-Collar and his role in serving on the company’s board of medical advisors. The device has been shown to protect the athletes’ brains from concussive and subconcussive impacts by increasing internal jugular vein pressure. We conclude the episode with some parting wisdom from Wayne regarding career paths, navigating reimbursements and insurance as a neuroIR or IR, and finding joy and purpose at and outside of work. --- RESOURCES SI-Bone, iFuse TORQ Device: https://si-bone.com/providers/solutions/trauma/ifuse-torq SI-Bone, iFuse Triangle Device: https://si-bone.com/providers/solutions/ifuse Stryker, Spine Jack Device: https://www.stryker.com/us/en/interventional-spine/products/spinejack-system.html Q-Collar Company web-page: https://q30.com/ Q-Collar Studies / Research Briefing: https://q30.com/pages/fda-reviewed Boston University CTE Clinic: https://www.bu.edu/cte/

23 Aug 20231h 11min

In this episode, host Aaron Fritts is joined by Lake Odom and Chas Sanders. Lake is an IR technologist with over a decade of experience, and Chas is the founder and CEO of MARGIN, a company that handles supply chain and outpatient OBLs and ASCs. They focus on the vital role that techs play in maintaining the culture, workflow, and efficiency in an office-based lab (OBL). --- CHECK OUT OUR SPONSOR Siemens Healthineers https://www.siemens-healthineers.com/ --- SHOW NOTES The episode starts with a discussion on what a team lead should be looking for when hiring a IR or cath lab tech. Lake notes that experience and teamwork skills are essential. However, the willingness to learn can also make up for the lack of experience, especially because experience in one office does not always translate to another practice, since every practice has different needs and procedures. Positive work culture and fair compensation are crucial to employee retention. While the physician plays a large role in defining the culture in a practice, it is also important that IR techs are trusted with the responsibility of maintaining the culture, as their roles are very patient-facing and key in practice efficiency. In the discussion of paying techs on a salary versus an hourly system, Lake notes how a salaried tech is more likely to feel like a part of the team and is more invested in the success of the practice. As the discussion shifts to increasing the efficiency and profitability of a practice, Chas discusses how cost awareness is key. It is vital that the physician engages the techs in this conversation, since they are the ones who order tools. The guests wrap up the episode by emphasizing how putting trust in the techs is crucial to the efficiency and profitability of each practice, as they will be the biggest advocates of the practice to the patients.

21 Aug 202348min

In this episode, host Dr. Aaron Fritts interviews interventional radiologist Dr. Eric DePopas about digital marketing strategies for physicians. Eric is the Co-Founder and Chief Medical Officer of Helped, a company designed to connect patients to IR physicians. --- CHECK OUT OUR SPONSORS Siemens Healthineers https://www.siemens-healthineers.com/ Medtronic Ellipsys Vascular Access System https://www.medtronic.com/ellipsys --- SHOW NOTES To begin the episode, Eric shares his motivations behind starting Helped and the unique story of sharing this undertaking with his brother and co-founder Kevin DePopas. He discusses his uphill battle of marketing IR services and building a strong patient base. Eric also covers differences between digital versus in-person marketing. He emphasizes that the digital world is not a substitute for boots on the ground, and he underscores the importance of building word of mouth through strong clinical work and regularly interacting with referring physicians. Eric also shares valuable digital marketing takeaways and questions to ask marketing agencies. Then, Eric breaks down paid-search (Google), paid-social (Facebook, Instagram, TikTok), and radio marketing strategies. Aaron and Eric discuss how to approach the bottom of the marketing funnel (where potential patients become treated patients), and how to engage and guide patients with interactive online quizzes. Finally, the doctors examine the value of customer relation management systems (CRMS). Eric explains how CRMS is a high fidelity approach to assessing patient knowledge and how it is a key component in building a truly robust funnel. The episode concludes with Eric giving parting advice and encouragement for physicians in the marketing world. --- RESOURCES Helped Website: https://www.tryhelped.com/patient-home

18 Aug 202356min

In this episode, interventional nephrologist Dr. Neghae Mawla discusses endovascular AV fistula creation with our host Dr. Christopher Beck. --- CHECK OUT OUR SPONSOR BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html --- SHOW NOTES We start off the episode by discussing Neghae’s current practice at Dallas Nephrology Associates, where most of his patient referrals come from his partners. Patients who come to see Neghae receive a standard vein mapping via ultrasound to determine whether they should receive an endovascular or a surgical procedure. If patients’ veins fit certain specifications, such as superficial location (cephalic, median cubital), large enough size (2-2.5 mm) and presence of large perforating veins (2 mm), then they are better candidates for an endovascular approach. However, these rules do not perfectly predict fistula success. Neghae noticed that even if patients fit the above criteria, their fistulas don’t always mature correctly. With experience, he began to take into consideration the brachial vein size as well. While this is not part of the official vein mapping criteria, he has seen that if the brachial vein is significantly larger than the superficial veins, it could have a competitive outflow and hinder the maturation of the fistula. The conversation then shifts to the types of devices used to create the anastomosis for the fistulas, WavelinQ and Ellipsys. Neghae notes that while most patients do well with either device, some patients do better with one over the other. Thus, he suggests that physicians are trained on both devices if possible, to guarantee the best outcomes. To end the episode, Neghae reflects on his previous decade of experience with endovascular AV fistulas and shares wisdom about failures and successes that he has learned from. --- RESOURCES ASDIN White Paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology: https://cdn.ymaws.com/www.asdin.org/resource/resmgr/positionpaper/Cephalic_Arch.pdf ASDIN White Paper: Patient selection, education, and cannulation of percutaneous arteriovenous fistulae: https://cdn.ymaws.com/www.asdin.org/resource/resmgr/positionpaper/ASDIN_EndoAVF.pdf ASDIN Certification ink: https://www.asdin.org/page/pAVFCert

14 Aug 20231h 10min