BackTable Vascular & Interventional

Bringing more interventional radiology to rural America would benefit many patients who currently do not have access to minimally invasive, image guided medicine. In today's episode, Dr. Frederick Johnson, an interventional radiologist practicing in Thomasville, Georgia joins us to discuss the unique dynamics and challenges of setting up and maintaining a successful rural IR practice. --- CHECK OUT OUR SPONSOR Medtronic ClosureFast https://www.medtronic.com/us-en/c/cardiovascular/closurefast-rfa-system.html --- SYNPOSIS Dr. Johnson provides insights into the professional service agreement (PSA) model that allows his practice to maintain autonomy while collaborating with the local hospital. The episode explores the complexities of recruiting to a rural setting, maintaining a broad case mix, ensuring financial stability, and fostering professional satisfaction. The conversation highlights the importance of redefining independence and the benefits of integrating collaboration into IR practices. --- TIMESTAMPS 00:00 - Introduction 02:29 - Dr. Johnson’s Background and Journey 11:46 - Professional Service Agreement (PSA) Explained 18:48 - Daily Operations and Structure 24:19 - Teamwork in Rural Healthcare 30:35 - Recruitment and Growth 33:33 - Compensation and Financial Incentives 42:05 - Benefits of Small Town Living 44:34 - Advice for Aspiring Rural Healthcare Practitioners --- RESOURCES Vita Surgery/Vascular Website: https://vitadr.org/

26 Jul 202449min

Ever wonder what it’s like to practice interventional radiology down under? Dr. Chris Rogan joins us on the BackTable Podcast this week to tell us about his IR practice in Australia, with special emphasis on healthcare system and interventional practice model differences between our two countries. --- SYNPOSIS We cover a wide range of topics, including the differences in IR training pathways between Australia and the U.S., the impact of healthcare models on IR practice, and the cooperation between public and private healthcare. We also highlight the urgent need for more IR specialists in Australia. Additionally, the doctors explore the challenges of public awareness, interdisciplinary and global collaboration, and the ongoing efforts by the Interventional Radiology Society of Australasia (IRSA) to promote IR through public outreach and educational strategies. --- TIMESTAMPS 00:00 - Introduction 04:08 - Australia vs. US Healthcare Systems 08:21 - Compensation and Career Mobility 16:52 - IR Public Awareness and Marketing 25:56 - Global Collaboration and Conferences 30:53 - Travel Tips for Australia --- RESOURCES Dr. Chris Rogan’s practice: https://drrogan.com/ Interventional Radiology Society of Australasia (IRSA): https://irsa.com.au/ IRSA 2024 Annual Meeting: https://irsa.com.au/education-events/irsa-annual-scientific-meeting-2024/

23 Jul 202437min

Superficial venous disease can pose significant management challenges, particularly after patients have exhausted conservative and invasive therapies. This week, our host, Dr. Sabeen Dhand, interviews Dr. Ali Golshan, an interventional radiologist and the founder of SOLVEIN. Dr. Golshan discusses the latest advancements in treating superficial venous disease, highlighting both the benefits and complexities of thermal and non-thermal ablation techniques. --- CHECK OUT OUR SPONSOR BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html --- SYNPOSIS Dr. Golshin introduces SOLVEIN, his innovative medical device designed to address these challenges. The conversation also includes practical tips for managing patients with venous insufficiencies, along with insights into the entrepreneurial journey involved in developing a new medical device. --- TIMESTAMPS 00:00 - Introduction 02:02 - Defining Superficial Venous Disease 05:43 - Diagnostic Techniques and Imaging 08:29 - Current Treatment Options for Venous Insufficiency 20:07 - Introducing SOLVEIN 29:42 - FDA Approval Pathway 33:37 - Advice for Aspiring Medical Entrepreneurs --- RESOURCES Dr. Ali Golshan’s Practice: https://www.beachwellnessmd.com/

19 Jul 202437min

Dr. Venkatesh Krishnasamy shares techniques and specific cases for challenging lung biopsies, his insights on mentorship, importance of multidisciplinary tumor boards, and the evolution of lung biopsy practices. Dr. Krishnasamy is an interventional radiologist and Director of Interventional Oncology at the University of Alabama Birmingham. --- CHECK OUT OUR SPONSOR Merit Biopsy Solutions https://www.merit.com/solutions/biopsy-solutions/ --- SYNPOSIS The doctors cover practical advice on handling complications like pneumothorax and hemoptysis, and share strategies for optimizing workflows to improve patient outcomes. Dr. Krishnasamy encourages listeners to leverage mentor experience and partake in continued learning to advance their practice. --- TIMESTAMPS 00:00 - Introduction 05:16 - Lung Biopsy Referrals and Multidisciplinary Approach 12:03 - Complex Lung Biopsies 25:43 - Needle Position Verification 27:29 - Importance of Cytopathologist Presence 28:51 - Blood Patching vs. Plug Technique 33:54 - Post-Procedure Protocols 36:15 - Advanced Techniques and Mentorship 44:26 - Handling Hemoptysis During Biopsies 47:50 - Encouragement for Trainees --- RESOURCES Society of Interventional Oncology: https://www.sio-central.org/ BackTable VI Podcast Episode #278 - Minimizing Complications for Lung Biopsies with Dr. Robert Suh: https://www.backtable.com/shows/vi/podcasts/278/minimizing-complications-for-lung-biopsies BackTable VI Podcast Episode #156 - Percutaneous Lung Biopsies: The Basics with Dr. Fred Lee (Part 1 of 2): https://www.backtable.com/shows/vi/podcasts/156/percutaneous-lung-biopsies-the-basics BackTable VI Podcast Episode #157 - Percutaneous Lung Biopsies: Pleural & Parenchymal Blood Patching with Dr. Fred Lee (Part 2 of 2): https://www.backtable.com/shows/vi/podcasts/157/percutaneous-lung-biopsies-pleural-parenchymal-blood-patching

16 Jul 202440min

In this episode, Dr. Alexander Vezeridis discusses advanced biliary interventions; covering stone removal procedures, technical success rates, and practical tips for using Spyglass cholangioscopy, laser lithotripsy, and endobiliary ablation. Dr. Vezeridis is an interventional radiologist, physician-scientist, and Assistant Professor of Radiology at Stanford. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Vezeridis highlights the importance of continuous learning, collaboration with other specialties, and shares his experiences and tips for optimizing patient outcomes. The doctors also touch on innovative approaches such as photodynamic therapy and the use of various tools in managing benign and malignant biliary diseases. --- TIMESTAMPS 00:00 - Introduction 03:25 - Setting Up Spyglass in Your Practice 10:50 - Patient Selection and Procedure Details 24:27 - Stone Fragmentation Techniques 27:35 - Success Rates and Patient Outcomes 35:06 - Endobiliary Ablation Techniques 47:35 - Laser Treatment for Biliary Obstructions 49:18 - Future Innovations --- RESOURCES BackTable VI Podcast Episode #146 - Spyglass Interventions with Dr. Jeffrey Chick and Dr. Ravi Srinivasa: https://www.backtable.com/shows/vi/podcasts/146/spyglass-interventions Spyglass - Boston Scientific: https://www.bostonscientific.com/en-US/medical-specialties/gastroenterology/advancements-cholangioscopy.html Percutaneous Gallstone Removal: Long-term Follow-up (Dr. Hovsepian Paper): https://www.jvir.org/article/S1051-0443(96)70766-2/pdf SIR’s Percutaneous Cholangiopancreatoscopy (PCPS) registry: https://clinicaltrials.gov/study/NCT05210322 StarMed Endoscopic RFA Clinical Articles: https://www.starmedacademy.com/endoscopic-rfa-clinical-articles-elra Habib Endobiliary Ablation Catheter: https://www.bostonscientific.com/en-US/products/rf-ablation/habib-endohpb-bipolar-radiofrequency-catheter.html Interventional Radiology-Operated Choledochoscopic-Guided Radiofrequency Wire and Holmium Laser Ablations May Facilitate Treatment and Long-Term Patency of Benign Biliary Strictures: https://www.jvir.org/article/S1051-0443(18)31535-5/abstract Percutaneous Cholangioscope-Assisted Laser Incision of Severe Benign Hepaticojejunostomy Stenoses: https://pubmed.ncbi.nlm.nih.gov/35504434/ Percutaneous Endoluminal Benign Biliary Laser (PEBBL) (Clinical Trial): https://clinicaltrials.gov/study/NCT05567003

12 Jul 202453min

In this episode of the Back Table Podcast, interventional radiologist Dr. Noor Ahmad discusses his algorithm for complex inferior vena cava (IVC) filter retrievals and reviews several cases that utilize various retrieval tools. --- CHECK OUT OUR SPONSOR Argon Medical http://www.argonmedical.com/ --- SYNPOSIS Dr. Ahmad emphasizes that most patients are referred by physicians with whom he maintains good relationships, and both specialties jointly monitor patients after IVC filters are placed. Generally, it is ideal to remove IVC filters around the 3-month mark, with filters in place for over 6 months posing a higher risk of requiring complex retrieval. For preoperative evaluation, obtaining a history of the filter type and placement date, along with CT scans (non-contrast and venogram), is crucial. Anticoagulation is typically discontinued two days prior to retrieval. During the procedure, moderate sedation and internal jugular access are used. However, complex retrievals may necessitate general anesthesia and access through the femoral vein or dual sites. The initial device employed is usually the CloverSnare to hook and extract the IVC filter. If unsuccessful, Dr. Ahmad proceeds with techniques such as the hangman (modified loop snare), endobronchial forceps, and finally the CavaClear laser sheath. He highlights that particularly challenging cases might require collaboration with colleagues, especially when dual access is needed, possibly requiring rescheduling for general anesthesia availability. Patient safety is emphasized in these scenarios. Lastly, Dr. Ahmad presents past cases with imaging to illustrate various retrieval methods. --- TIMESTAMPS 00:00 - Introduction 03:29 - Referrals and Tracking for Filter Removal 08:49 - Working Up Complex Cases 13:19 - Patient Selection 20:14 - Procedure Walkthrough 23:22 - Different Strategies for Filter Removal 31:23 - Laser Techniques 34:47 - Sheath Sizing 36:06 - Enhancing Patient Safety 43:34 - Cheat Sheet for IVC Filters and Case Studies --- RESOURCES BackTable Ep. 204- Filter Indications and Filter Tracking: Up Your Game with Dr. Stephen Wang: https://www.backtable.com/shows/vi/podcasts/204/filter-indications-filter-tracking-up-your-game BackTable Ep. 339- The Importance of a Multidisciplinary Filter Retrieval Program with Dr. Robert Ryu, Dr. Warren Clements, and Dr. Premal Trivedi: https://www.backtable.com/shows/vi/podcasts/339/the-importance-of-a-multidisciplinary-filter-retrieval-program

9 Jul 202445min

Dr. Sameh Sayfo discusses advanced techniques in radial to peripheral (R2P) interventions, the importance of having multiple techniques, the role of different devices, troubleshooting tips, and the evolving landscape of R2P interventions. Dr. Sayfo is an interventional cardiologist at the Baylor Heart Hospital, and serves as program director for the endovascular fellowship and pulmonary embolism response team (PERT) program. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SYNPOSIS Dr. Sayfo shares his experience and insights on using various devices, such as the new Auryon laser, for treating peripheral arterial disease (PAD).Additionally, the doctors address the benefits of radial access over traditional femoral approaches, patient selection, and procedural planning. Listeners are encouraged to adopt a flexible approach and learn from each other’s experiences to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 05:24 - Incorporating Radial into Peripheral Practice 11:19 - Right vs. Left Radial Access 20:01 - Room Setup and Procedure Planning 25:13 - Radial vs. Femoral Access 33:01 - Advancements in Laser Atherectomy 41:33 - Laser Atherectomy Tips 45:52 - Advantages of Radial Access in Specific Cases 51:33 - Post-Op Care and Best Practices --- RESOURCES BackTable VI Podcast Episode #30 - Transradial Access Basic to Advanced with Dr. Aaron Fischman: https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced BackTable VI Podcast Episode #148 - Radial vs. Femoral for Prostate Artery Embolization with Dr. Blake Parsons: https://www.backtable.com/shows/vi/podcasts/148/radial-vs-femoral-for-prostate-artery-embolization BackTable VI Podcast Episode #342 - Radial Access for PAD with Dr. Rami Tadros: https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad BackTable VI Podcast Episode #395 - Radial to Peripheral Tools & Technique with Dr. Sameh Sayfo: https://www.backtable.com/shows/vi/podcasts/395/radial-to-peripheral-tools-technique BackTable VI Podcast Episode #443 - Innovative Approaches in Radial to Peripheral Interventions with Dr. Amit Srivastava: https://www.backtable.com/shows/vi/podcasts/443/innovative-approaches-in-radial-to-peripheral-interventions BackTable VI Podcast Episode #390 - Laser Atherectomy: An Overview of the Pathfinder Registry with Dr. Tony Das: https://www.backtable.com/shows/vi/podcasts/390/laser-atherectomy-an-overview-of-the-pathfinder-registry BackTable VI Podcast Episode #408 - Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas: https://www.backtable.com/shows/vi/podcasts/408/laser-btk-study-insights-navigating-complex-lesions Safety and efficacy of radial artery access for peripheral vascular intervention: a single center experience: https://www.ajconline.org/article/S0002-9149(24)00461-2/abstract Comparative Outcomes of Interventions for Femoropopliteal Chronic Total Occlusion Versus Non-Chronic Total Occlusion Lesions From the Multicenter XLPAD Registry: https://pubmed.ncbi.nlm.nih.gov/37318023/ Prospective, Multi-center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries in Patients With Chronic Limb-Threatening Ischemia: 30-Day Results of the Auryon BTK: https://pubmed.ncbi.nlm.nih.gov/38458581/ Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions: https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry: https://pubmed.ncbi.nlm.nih.gov/38566525/ SCAI Expert Consensus Statement Update on Best Practices for Transradial Angiography and Intervention: https://scai.org/publications/clinical-documents/scai-expert-consensus-statement-update-best-practices-transradial

2 Jul 202458min

Dr. Ally Baheti interviews interventional radiologist Dr. Steven Smith about his insights into venous orthostatic flow dysfunction and its association with multisystem disorders. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Smith details his clinical career and his surprising findings that connect pelvic congestion syndrome with a range of other conditions, such as postural orthostatic tachycardia syndrome (POTS), chronic fatigue syndrome, Ehlers-Danlos syndrome, irritable bowel syndrome (IBS), vulvodynia, interstitial cystitis, and fibromyalgia. For patients with venous manifestations, he pursues treatment with stents or embolization, taking a proactive approach to targeting any abnormal vasculature that he identifies. Additionally, the podcast delves into the physiological basis of POTS and related disorders, which mainly stems from blood pooling in the lower body, leading to sympathetic overactivation. Overall, Dr. Smith emphasizes the significance of collaborating with specialists across different disciplines to advance understanding and treatment of these complex syndromes. --- TIMESTAMPS 00:00 - Introduction 03:11 - Symptom Constellation of Venous Orthostatic Flow Syndrome 12:08 - Pelvic Vein Treatment Algorithm 21:08 - Physiology of Orthostatic Intolerance and Sympathetic Overdrive 27:11 - Patient Selection 33:27 - Need for Research and Collaboration 36:07 - Advocacy for Patients --- RESOURCES BackTable VI Ep. 337- Management of Vulvar Varices with Dr. Brooke Spencer https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices BackTable VI Ep. 33- Building a Comprehensive Vein Practice with Dr. Brooke Spencer & Dr. Isabel Newton https://www.backtable.com/shows/vi/podcasts/33/building-a-comprehensive-vein-practice An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes (Smith et al, 2022): https://journals.sagepub.com/doi/abs/10.1177/02683555221112567 Distension of central great vein decreases sympathetic outflow in humans (Cui et al, 2013): https://journals.physiology.org/doi/full/10.1152/ajpheart.00019.2013 Orthostatic intolerance and chronic fatigue syndrome: New light on an old problem (Rowe, 2002): https://www.jpeds.com/article/S0022-3476(02)53209-1/fulltext

28 Jun 202445min