Ep. 431 OBL or ASC for Your Private Practice? How to Decide with Teri Yates

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

In this episode, Dr. Amit Srivastava discusses the transformation of peripheral interventional practices through radial access techniques, emphasizing reduced complication rates, the extensive range of devices now available, and the option for same-day discharge. --- CHECK OUT OUR SPONSOR Terumo Interventional Systems https://terumois.com/education --- SYNPOSIS Through a series of real-world examples and discussion on the R2P registry, the doctors illustrate the high success rates and low complications of the transradial approach, debunking common misconceptions, and highlighting the significance of team collaboration in executing these procedures efficiently. Additionally, the conversation covers the evolution of devices suited for R2P, including longer length wires, catheters, and novel training methods like immersive virtual reality courses designed to educate and inspire practitioners to adopt radial access in their endovascular practices. --- TIMESTAMPS 00:00 - Introduction 02:19 - Current Role of Radial Access in Peripheral Interventions 15:08 - Future of Radial Access 21:11 - The R2P Registry 28:44 - Educational Opportunities and Community Support --- RESOURCES TERUMO Transradial Training & Education: https://www.terumois.com/education-training/healthcare-provider-education-programs/transradial-courses.html BT Episode 342 - Radial Access for PAD with Dr. Rami Tadros: https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study: https://pubmed.ncbi.nlm.nih.gov/22858390/ Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions (RPI Study): https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext

7 Mai 202438min

In this episode, Dr. Nicole Lamparello discusses the strides and challenges in achieving gender equity in interventional radiology (IR), sharing insights from her research on gender disparities in IR, and revealing how women currently comprise a significantly low percentage of the IR workforce compared to men despite equal numbers of male and female medical students. Dr. Lamparello is an interventional radiologist and serves as the Program Director for Weill Cornell Medicine’s Integrated IR Residency in New York City. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS The doctors cover the importance of workplace culture with flexibility for family and maternity needs, mentorship, visibility of female leaders in IR, and strategies for attracting more women to the field. The conversation also touches on the impact of diverse IR professionals on patient outcomes, and how outsourcing personal tasks can help maintain work-life balance. The necessity of early exposure to IR for medical students and addressing specific hurdles for women in IR, such as work-life balance, radiation exposure fears, and lack of female role models are also explored. --- TIMESTAMPS 00:00 - Introduction 05:40 - Addressing Gender Disparity in IR 13:48 - Importance of Physician Workforce Diversity 18:31 - Challenges and Solutions for Gender Equity in IR 25:28 - Work-Life Balance 38:40 - Concluding Thoughts --- RESOURCES The Gender Gap in Interventional Radiology: Barriers, Opportunities, and the Role of the Integrated IR Residency: https://pubmed.ncbi.nlm.nih.gov/36870809/ The IR Trainee Workforce 10 Years after Becoming a Primary Medical Specialty: https://www.jvir.org/article/S1051-0443(23)00651-6/fulltext Lack of exposure and perceived occupational hazards as barriers to entry into IR for women: a survey of 143 female medical students: https://www.jvir.org/article/S1051-0443(16)31526-3/fulltext Untapped Resources: Attaining Equitable Representation for Women in IR: https://www.jvir.org/article/S1051-0443(18)31645-2/fulltext Gender and racial diversity among plenary session speakers at the Society of Abdominal Radiology Annual Meetings: a five-year assessment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9226100/ Bridging the Gender Gap in the Society of IR: A Benchmark Study: https://www.jvir.org/article/S1051-0443(18)31492-1/pdf

3 Mai 202442min