BackTable Vascular & Interventional

Get a second opinion on your uterine fibroid embolization (UFE) technique. Dr. Gary Siskin joins host Dr. Chris Beck for an in-depth discussion on his approach to uterine fibroid embolization, detailing techniques, tools, and embolic agents. Dr. Siskin is an experienced UFE practitioner, professor, and Chair of the Department of Radiology and Chief of the Division of Vascular & Interventional Radiology at Albany Med Health System in New York. --- This podcast is supported by: Merit Embolotherapy https://www.merit.com/solutions/embolotherapy/ --- SYNPOSIS Dr. Siskin shares his journey and evolution of his specialization in GYN-related interventional radiology procedures. The doctors cover various aspects of fibroid embolization, including its effectiveness compared to surgical options like myomectomy and hysterectomy, the referral and evaluation process, and considerations for fertility preservation. Pain management strategies and postoperative care are also explored, emphasizing the importance of patient education and interdisciplinary collaboration to promote less invasive treatments. --- TIMESTAMPS 00:00 - Introduction 04:45 - Building a Fibroid Practice 08:35 - Workup and Consultation 17:01 - Recurrence and Re-Embolization 20:27 - Pre-Procedural Workup and Technique 30:18 - Embolization Endpoint 36:07 - Accessing the Correct Uterine Artery 48:49 - Post-Procedure Patient Care --- RESOURCES List of Publications by Dr. James B. Spies (PubMed): https://pubmed.ncbi.nlm.nih.gov/?sort=jour&term=Spies+JB&cauthor_id=24436560

22 Okt 202457min

Historically, public recognition and understanding of IR has been limited, with a significant portion of patients unaware of interventional procedures and the field as a whole. How can we improve awareness of IR and minimally invasive treatment options? Dr. Mina Makary discusses this and his recent study on public perceptions of IR, with host Dr. Michael Barraza. Dr. Makary is a vascular and interventional radiologist and an Associate Professor of Radiology at The Ohio State University. --- This podcast is supported by: PearsonRavitz https://pearsonravitz.com/backtable --- SYNPOSIS Dr. Makary states that less than half of the public believes IRs are physicians, highlighting a knowledge gap with potentially significant implications for patient care and treatment decisions. The doctors delve into possible solutions to address this issue, including educational interventions targeting both the public and healthcare providers, the potential impact of name recognition on public perception, and methods to enhance IR awareness through media and direct engagement with primary care providers. The episode also emphasizes the need for ongoing research and efforts to improve understanding and recognition of IR to ensure patients have informed medical options. --- TIMESTAMPS 00:00 - Introduction 03:23 - Study Methodology and Findings 08:13 - Challenges and Solutions in IR Awareness 10:23 - Impact of IR Procedures on Public Perception 15:16 - Future Research and Awareness Efforts 23:40 - Conclusions --- RESOURCES 2023 Paper - Public Awareness of Interventional Radiology: Population-Based Analysis of the Current State of and Pathways for Improvement: https://pubmed.ncbi.nlm.nih.gov/36764444/ 2019 Paper - Primary Care Provider Awareness of IR: A Single-Center Analysis: https://pubmed.ncbi.nlm.nih.gov/31235412/ 2024 Paper - Impact of Educational Videos on Patient Understanding of Interventional Radiology Procedures: https://pubmed.ncbi.nlm.nih.gov/39198139/ BackTable VI Podcast Episode #454 - Moral Injury in Interventional Radiology with Dr. Mina Makary and Dr. Jeffrey Chick: https://www.backtable.com/shows/vi/podcasts/454/moral-injury-in-interventional-radiology BackTable VI Podcast Episode #195 - Disclosures of Conflicts of Interest with Dr. Mina Makary: https://www.backtable.com/shows/vi/podcasts/195/disclosures-of-conflicts-of-interest BackTable VI Podcast Episode #62 - Protect Yourself Before You Wreck Yourself with Dr. Mina Makary: https://www.backtable.com/shows/vi/podcasts/62/protect-yourself-before-you-wreck-yourself

18 Okt 202428min

Acetabular lesions present unique challenges for interventionalists due to their location within the pelvis. In this episode of the BackTable Podcast, host Dr. Jacob Fleming interviews Dr. Jason Levy, an experienced practitioner in musculoskeletal interventional oncology based in Atlanta, Georgia, about techniques for ablating acetabular lesions. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS The doctors discuss the unique considerations involved in treating the acetabulum, including its susceptibility to various axial loading, shear, and torsion forces. Dr. Levy prefers to use radiofrequency ablation combined with cement augmentation to enhance joint stability. He outlines the procedural steps and shares his preferred imaging methods. Additionally, he addresses potential complications, such as instability from inadequate cement delivery, cement leakage into the hip joint space, and avascular necrosis. Throughout the episode, the doctors emphasize the importance of collaboration with orthopedic oncologists and staying updated on current research in musculoskeletal interventional oncology.\ --- TIMESTAMPS 00:00 - Introduction 05:11 - Unique Considerations for Acetabular Lesions 09:06 - Collaboration with Orthopedic Oncologists 13:10 - Anatomy and Procedural Steps 24:40 - Preventing Complications 35:25 - Concluding Thoughts --- RESOURCES BackTable MSK Ep. 17- Multidisciplinary Approach to Treating Spinal Metastases with Dr. Jason Levy and Dr. Amir Lavaf: https://www.backtable.com/shows/msk/podcasts/17/multidisciplinary-approach-to-treating-spinal-metastases BackTable VI Ep. 68- RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla: https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases BackTable MSK Ep. 12- Ortho/IR Collaboration in Private Practice: https://www.backtable.com/shows/msk/podcasts/12/ortho-ir-collaboration-in-private-practice Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study): https://pubmed.ncbi.nlm.nih.gov/33129427/ Hip Joint Distraction Technique during Cryoablation of Acetabular Bone Tumor to Prevent Femoral Head Osteonecrosis: https://www.jvir.org/article/S1051-0443(22)01119-8/fulltext

15 Okt 202444min

Tumor embolization is a versatile procedure that can provide symptomatic and long-term benefits for patients. In this episode of BackTable MSK, host Dr. Michael Barraza discusses musculoskeletal tumor embolizations with Dr. Gina Landinez from the Miami Cardiac and Vascular Institute, where she is helping to grow the MSK interventions program. --- This podcast is supported by: Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ --- SYNPOSIS Dr. Landinez explains that the main indications for embolization are preoperative tumor shrinkage and pain palliation. Embolization decreases hemorrhagic risk and procedure time during surgical resection and leads to better surgical margins. Pain palliation can also be achieved due to tumor size reduction and decreased pressure on surrounding nerves and tissue. Dr. Landinez explains that lesions well-suited embolization are hypervascular, large, not sensitive to radiation, and painful. She also describes the risks of off-target skin and muscle embolization and the importance of exercising caution with vertebral tumors. Finally, Dr. Landinez shares valuable practice-building tips about developing relationships with orthopedic surgeons and providing adequate follow up care. --- TIMESTAMPS 00:00 - Introduction 03:51 - Indications for Embolization 08:08 - Building Referral Networks 13:45 - Preoperative Planning 18:34 - Technical Aspects of Embolization 27:25 - Challenges and Considerations 31:23 - Importance of Outpatient Follow Up

11 Okt 202436min

Is your practice profitable? The success of a private medical practice often hinges on effective revenue cycle management (RCM). In this episode of the BackTable Podcast, private practice consultant Teri Yates and host Dr. Ally Baheti share best practices in revenue cycle management for physicians. Teri Yates is the CEO of Accountable Physician Advisors and President of DocCentric. --- This podcast is supported by:S Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Teri explains the importance of understanding payer rules, the benefits of using professional coders, and managing front desk staff efficiently. The episode includes real-world examples of RCM challenges and solutions, the impact of insurance policies, and the role of cybersecurity. Teri also provides actionable tips for improving collections and navigating recent changes in healthcare reimbursement, especially for outpatient-based labs (OBLs) and ambulatory surgery centers (ASCs). --- TIMESTAMPS 00:00 - Introduction 09:17 - Revenue Cycle Management: Case Scenarios 19:55 - In-House vs. Outsourced Billing 31:51 - Winning Strategies for Physicians 40:55 - Healthcare Cybersecurity 43:52 - Proposed Reimbursement Changes for 2025 48:32 - Telehealth and Legislative Concerns 55:25 - Conclusion --- RESOURCES BackTable VI Podcast - Episode #366 Navigating OBL & ASC Business, Pitfalls to Avoid with Teri Yates: https://www.backtable.com/shows/vi/podcasts/366/navigating-obl-asc-business-pitfalls-to-avoid BackTable VI Podcast - Episode #431 OBL or ASC for Your Private Practice? How to Decide with Teri Yates: https://www.backtable.com/shows/vi/podcasts/431/obl-or-asc-for-your-private-practice-how-to-decide Accountable Physician Advisors: http://www.accountablephysicianadvisors.com/services DocCentric: https://doccentricasc.com/ G2211 Add-on Code: What It Is and When To Use It: https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management/G2211-what-it-is-and-how-to-use-it.html

8 Okt 20241h 1min

Are you up-to-date on microwave ablation for hepatocellular carcinoma (HCC) treatment? Dr. Zachary Berman and host Dr. Michael Barraza discuss this treatment modality. They cover the spectrum of pre-procedure imaging and planning, procedure steps, and tips for navigating difficult cases. Dr. Berman is a hepatobiliary interventional oncologist and Associate Clinical Professor of Radiology at UC San Diego School of Medicine. --- This podcast is supported by an educational grant from Varian, a Siemens Healthineers company. --- SYNPOSIS Dr. Berman highlights the importance of a multidisciplinary approach, referral pathways, and the role of tumor boards in decision-making. The doctors also cover various ablation technologies, pre-procedure embolization, hydrodissection, biopsy considerations, and the incorporation of immunotherapy in ongoing research. Finally, Dr. Berman emphasizes the importance of ultrasound skills and presents some cases. --- TIMESTAMPS 00:00 - Introduction 10:09 - Techniques and Technologies 17:26 - Planning and Performing Ablations 21:35 - Tumor Size and Margins 25:09 - Navigational Software and Skills 30:47 - Hydrodissection Techniques 33:20 - Post-Ablation Imaging and Follow-Up 35:52 - Future of Ablation in IR and Cases --- RESOURCES Liver Imaging Reporting & Data System (LI-RADS®): https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS Liver Cancer Stages (BCLC): https://www.cancer.gov/types/liver/what-is-liver-cancer/stages Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795153/ Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698169/ Prospective double-blinded randomized controlled trial of Microwave versus RadioFrequency Ablation for hepatocellular carcinoma (McRFA trial): https://www.hpbonline.org/article/S1365-182X(20)30023-X/fulltext Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: a randomized controlled trial: https://jgo.amegroups.org/article/view/26929/html Surgical microwave ablation for the treatment of hepatocellular carcinoma in 791 operations: https://www.sciencedirect.com/science/article/abs/pii/S1365182X23020002 Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial: https://meetings.asco.org/abstracts-presentations/234189 One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach: https://pubmed.ncbi.nlm.nih.gov/23732261/

4 Okt 202439min

Is your critical limb ischemia (CLI) toolbox up to date? Dr. Kevin Herman and host Dr. Sabeen Dhand discuss treating CLI in the outpatient based lab (OBL) and ambulatory surgery center (ASC) settings. Dr. Herman is an interventional radiologist at American Endovascular and Holy Name Hospital in New Jersey. --- This podcast is supported by: Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Herman discusses the evolution of vascular interventions over the past 15 years, the role of advanced devices like the Wingman catheter and IVUS, and the nuances of tackling complex cases in both hospital and outpatient settings. Additionally, Dr. Herman highlights the business challenges of OBL practices, effective marketing strategies, and the integration of innovative tools such as live-streaming cases for real-time education and consultations. The episode concludes with a detailed case study showcasing a successful treatment of CLI, underscoring the application of advanced techniques and collaborative efforts in management. --- TIMESTAMPS 00:00 - Introduction 06:57 - Balancing Hospital and OBL Work 13:48 - Educational Initiatives and Innovations 17:12 - Strategic Planning and Treatments 26:25 - Crossing Devices and Techniques 32:04 - DEEPER REVEAL Trial 39:33 - Case Presentation: Non-Healing Wound 50:09 - Conclusion --- RESOURCES A Prospective Single-Arm Multicenter StuDy of the BarE TEmporary SPur StEnt System foR the tREatment of Vascular Lesions Located in the infrapoplitEal Arteries beLow the Knee (DEEPER REVEAL) (DEEPER REVEAL): https://clinicaltrials.gov/study/NCT05358353 Wingman Catheter: https://www.reflowmedical.com/wingman/

1 Okt 202441min

Surgical arteriovenous fistula (AVF) creation has been a mainstay of dialysis care for multiple decades. What does it take to break into such an established space with a new endovascular medical device? In this episode of the BackTable Podcast, Dr. Jeffrey Hull discusses the challenging journey of developing the Ellipsys system for endovascular AVF creation. --- CHECK OUT OUR SPONSOR Medtronic ClosureFast https://www.medtronic.com/closurefast6f --- SYNPOSIS We trace Dr. Hull’s path from the device's initial conception in 2006, through the first-in-human cases in 2013, to regulatory approval and acquisition by Medtronic in 2020. Dr. Hull highlights the roles of key business mentors, the importance of multidisciplinary collaboration with vascular surgery and nephrology, and the impact of investment. He also shares valuable insights on the benefits of having competitors and selecting a well-thought-out exit strategy. Additionally, we explore deep vein arterialization (DVA) as another application of endovascular AVF creation in the context of peripheral arterial disease. --- TIMESTAMPS 00:00 - Introduction 03:05 - The Birth of the Percutaneous AV Fistula Creation 15:04 - First-in-Human Cases 17:58 - Navigating the Startup Journey 21:52 - Identifying Mentors and Investors 27:33 - Competition and Criticism 36:43 - Regulatory Hurdles 44:45 - Acquisition by Medtronic 49:14 - Deep Vein Arterialization for Peripheral Arterial Disease 54:40 - Final Thoughts and Advice --- RESOURCES Avenu Medical: https://avenumedical.com/ Gracz KC et al. Proximal forearm fistula for maintenance hemodialysis (1977): https://pubmed.ncbi.nlm.nih.gov/839655/ Hull JE et al. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access (2018): https://pubmed.ncbi.nlm.nih.gov/29275056/ Endovascular Today- Update on Percutaneous AV Fistula Creation (2015): https://evtoday.com/articles/2015-june/update-on-percutaneous-av-fistula-creation Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art (2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353338/

27 Sep 202458min