BackTable Vascular & Interventional

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

Get caught up on prostate artery embolization (PAE) best practices and learn the ins-and-outs of building a PAE program in 2024. Dr. Jason Hoffmann covers this and more, with host Dr. Michael Barraza. Dr. Hoffmann is an interventional radiologist and educator at NYU Langone Health. --- CHECK OUT OUR SPONSOR Merit Embolotherapy https://www.merit.com/solutions/embolotherapy/ --- SYNPOSIS The doctors delve into strategies for developing expertise within a practice, coordinating with urologists, and effectively managing patient expectations. Dr. Hoffmann shares insights on leveraging different imaging techniques, equipment choices, and best practices for ensuring post-procedure patient satisfaction. The discussion also touches on the evolution of PAE guidelines, insurance challenges, and the importance of longitudinal care in interventional radiology. --- TIMESTAMPS 00:00 - Introduction 04:12 - Building a BPH Program and PAE Practice 06:28 - Referrals and Relationship with Urology 15:27 - Patient Workup and Setting Expectations 27:10 - SwiftNinja Study: Initial Impressions and Findings 31:43 - Patient Management and Post-Procedure Care 35:37 - Building a Successful PAE Practice 42:19 - Conclusion --- RESOURCES BackTable VI Podcast Episode #445 - Inside the IR Suite: A Clinician's Own Battle with Portal Vein Thrombosis with Dr. Jason Hoffmann: https://www.backtable.com/shows/vi/podcasts/445/inside-the-ir-suite-a-clinicians-own-battle-with-portal-vein-thrombosis AUA Guidelines on Benign Prostatic Hyperplasia (Updated 2023): https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966367/

24 Sep 202449min

Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice. --- This podcast is supported by an educational grant from Guerbet. --- SYNPOSIS Dr. Ahmed, an interventional radiologist at the University of Chicago, shares details about the procedure, his journey in adopting it, and his thoughts on the current landscape of GAE. Topics include procedural techniques, patient selection, anatomical considerations, potential complications, and the importance of ongoing research in this field. --- TIMESTAMPS 00:00 - Introduction 04:43 - Knee Osteoarthritis and Current Treatments 07:54 - Building a GAE Practice 13:23 - Tools and Procedure: Step-by-Step 25:05 - Post-Procedure Care and Complications 30:26 - Future of GAE and Other Applications 34:03 - Conclusion and Contact Information --- RESOURCES BackTable INN Ep. 46- New Innovations in Treatment of PE: The Flow Medical Story with Founders Dr. Osman Ahmed and Dr. Jonathan Paul: https://www.backtable.com/shows/innovation/podcasts/46/new-innovations-in-treatment-of-pe-the-flow-medical-story BackTable VI Ep. 429- Tackling Upper GI Bleeds: Techniques and Tools with Dr. Osman Ahmed: https://www.backtable.com/shows/vi/podcasts/429/tackling-upper-gi-bleeds-techniques-tools BackTable VI Ep. 447- Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little: https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes GEST MSK Conference 2025 (Paris): https://www.gestmsk.com/ Okuno Y et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis (2014): https://pubmed.ncbi.nlm.nih.gov/24993956/ Little MW et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS 1) Using Permanent Microspheres: Interim Analysis (2021): https://pubmed.ncbi.nlm.nih.gov/33474601/ Little MW et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial (2023): https://pubmed.ncbi.nlm.nih.gov/37337060/ Correa MP et al.GAUCHO - Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial (2022): https://pubmed.ncbi.nlm.nih.gov/35304614/ Sapoval M et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial (2024): https://pubmed.ncbi.nlm.nih.gov/38102013/

20 Sep 202437min

Get caught up on the current best practices and guidelines in venous interventions. Dr. Adam Raskin covers this and more, with host Dr. Sabeen Dhand in this discussion of DVT and PE treatments. Dr. Raskin is an interventional cardiologist, medical director of Cardiac ICU, and Co-Director of the PERT program at Mercy Health in Cincinnati, Ohio. --- CHECK OUT OUR SPONSOR Imperative Care https://imperativecare.com/vascular/ --- SYNPOSIS Dr. Raskin shares his comprehensive approach for treating patients with DVT and PE, highlighting recent advancements in thrombectomy systems, as well as underscoring the need for more randomized trials to further build on current venous disease treatment guidelines. The doctors also touch on the significance of accurate diagnostic tools and thorough follow-up to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 10:58 - Approaching DVT & PE Patients 19:04 - Thrombectomy Advancements 24:02 - Iliofemoral Interventions & Standard Practices 26:32 - Accessing Tibial Veins & Clearing Clots 38:59 - Follow-Up & Data Collection 41:09 - Future of Venous Interventions --- RESOURCES The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine: https://www.jvsvenous.org/article/S2213-333X(23)00322-0/fulltext --- DISCLAIMER The Symphony Thrombectomy System is intended for the non-surgical removal of fresh, soft emboli and thrombi from blood vessels. Injection, infusion and/or aspiration of contrast media and other fluids into or from a blood vessel, intended for use in the peripheral vasculature and it is not for use in the pulmonary vasculature. Rx only. Important Safety Information may be found at http://bit.ly/3pAaUlw. Views expressed are those of the speakers and not necessarily those of the sponsor. Certain content in this podcast contains forward-looking statements and no assurance of future results should be relied upon. Brands and trademarks referenced herein are those of their respective owners or holders. Dr. Adam Raskin is a paid consultant of Imperative Care.

17 Sep 202446min

In a society where discussions about medical malpractice are often concealed from the public eye, this episode of BackTable shines a spotlight on the powerful documentary ‘A World of Hurt: How Medical Malpractice Fails Everyone,’ produced by Viknesh Kasthuri, a fourth-year medical student at Brown University. Released earlier this year, the film explores how the American medical malpractice system harms and disconnects patients and providers through three compelling case studies. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS We delve into Viknesh’s motivations and the process behind creating the documentary, discussing the need for improved provider education on lawsuits, effective communication with patients and legal teams, and strategies for coping mentally and emotionally throughout this intensive process. Additionally, Viknesh provides a behind-the-scenes look at documentary production, including filming during the COVID pandemic, creating environments for patients and providers to share their stories, and submitting the documentary to film festivals. --- TIMESTAMPS 00:00 - Introduction 02:40 - Inspiration Behind the Documentary 06:10 - Technical and Legal Aspects of Documentary Production 14:34 - Releasing the Documentary 17:04 - Physician and Patient Responses to Medical Errors 20:27 - Highlighting Communication Resolution Programs 23:04 - Educational Gaps in Medical Training 26:43 - Exploring Systemic Solutions to Management of Medical Errors 30:16 - Final Thoughts and Future Projects --- RESOURCES A World of Hurt Documentary: https://www.youtube.com/watch?v=09IVcL6pACU BackTable VI Ep. 77- Doctors and Litigation: The L Word, with Dr. Gita Pensa: https://www.backtable.com/shows/vi/podcasts/177/doctors-litigation-the-l-word The L Word Podcast with Dr. Gita Pensa: https://doctorsandlitigation.com/podcast-2 BackTable ENT Ep. 90- Coaching Physicians Through the Stress of Malpractice Litigation, with Dr. Gita Pensa: https://www.backtable.com/shows/ent/podcasts/90/coaching-physicians-through-the-stress-of-malpractice-litigation Michigan Model Communication and Resolution Program: https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs

13 Sep 202437min

Are you interested in starting an ASC or converting your OBL into an ASC, but aren’t sure where to start? We’ve got you covered with this comprehensive overview. Attorney Jason Greis joins guest host and ASC founder Dr. Krishna Mannava to explore the operational, financial, and legal intricacies of starting an ASC. Jason is a Partner of Benesch, Friedlander, Coplan & Aronoff LLP, outside co-counsel to the Renal Physicians Association and OEIS Society, and recognized faculty member of SIR Business Institute. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Jason and Dr. Mannava discuss crucial factors such as structural modifications, financial considerations, legal requirements, Certificate of Need (CON) states, and credentialing processes. The conversation also delves into strategic partnerships with hospitals, the role of ASC management companies, and the involvement of non-physician owners. Additionally, they explain the implications of non-compete clauses, operational challenges, investment structures, and exit strategies. --- TIMESTAMPS 00:00 - Introduction 03:11 - OBL to ASC Conversion 06:08 - Financial and Regulatory Aspects 15:35 - Ownership and Investment Strategies 29:41 - Non-Competes and Legal Risks 34:21 - Specialized Legal Advice and Conclusion --- RESOURCES Vive Vascular: https://www.vivevascular.com/ SIR Business Center: https://irbc.sirweb.org/

10 Sep 202446min

What’s needed to build a successful lymphangiography practice? Dr. Bill Majdalany joins host Dr. Chris Beck to answer this question and to discuss advancements in lymphangiography over the past decade. Dr. Majdalany is the Chief and Vice Chair of Research of Interventional Radiology at University of Vermont. --- CHECK OUT OUR SPONSOR Guerbet --- SYNPOSIS The doctors provide insights on various lymphatic procedures such as thoracic duct embolization, stenting, and recanalization. They also discuss the evolving significance of lymphatic medicine in interventional radiology and its potential applications in treating conditions like ascites and variceal bleeding. The conversation underscores the interconnected nature of the lymphatic system throughout the body, emphasizing the revolutionary potential of lymphangiography in modern medicine. --- TIMESTAMPS 00:00 - Introduction 04:23 - Building a Lymphangiography Practice 08:36 - The Lymphatic Revolution 17:42 - Practical Tips and Equipment for Lymphangiography 30:09 - Advanced Interventions and Tools 48:45 - Future of Lymphatic Interventions 51:23 - Conclusion and Resources --- RESOURCES BackTable VI Podcast Episode #135 - IR Residency Pathways & Getting In! (Part 1) with Dr. Jeff Bodner and Dr. Bill Majdalany: https://www.backtable.com/shows/vi/contributors/dr-bill-majdalany Seminars in Interventional Radiology - Lymphatics: https://www.thieme-connect.com/products/ejournals/issue/10.1055/s-010-49075 Lymphatic Anatomy: https://www.techvir.com/article/S1089-2516(16)30042-7/abstract

3 Sep 202454min

What is the final frontier of interventional radiology? Dominic Tanzillo and Dr. Richard Moon believe it could be space. Dominic is a 3rd year medical student at Duke University interested in interventional radiology (IR) and space medicine, and Dr. Moon is a Professor at Duke University and an expert in hyperbaric and aerospace medicine. --- CHECK OUT OUR SPONSOR Medtronic DCB https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/drug-coated-balloons.html --- SYNPOSIS Dominic and Dr. Moon cover the potential for IR in deep space missions, focusing on the unique challenges astronauts face, such as altered blood flow, increased clotting risks, and the impacts of microgravity on the human body. The episode dives into NASA’s investments in portable medical technologies, the practicalities of emergency medical procedures in space, and the need for minimally invasive interventions. The significance of IR in diagnosing and managing vascular issues in space is discussed, as well as the broader implications for future Mars missions and long-term space travel. --- TIMESTAMPS 00:00 - Introduction 02:36 - IR in Space 20:04 - Medical Issues Astronauts Face 26:27 - Remote Surgery and Telesurgery 30:45 - Emergency Evacuations in Space 32:32 - More on Space Medicine --- RESOURCES Aerospace Medicine Association: https://www.asma.org/about-asma/careers/aerospace-medicine Translational Research Institute for Space Health: https://www.bcm.edu/academic-centers/space-medicine/translational-research-institute Space Medicine Coursera: https://www.coursera.org/learn/space-medicine-duke What Space Medicine Taught Me About Science Communication | Dominic Tanzillo | TEDxDuke: https://www.youtube.com/watch?v=PBkdvSByneM Dominic Tanzillo: https://dominictanzillo.github.io/

27 Aug 202437min