BackTable Vascular & Interventional

En este episodio de BackTable, la Dra. Sara Lojo Lendoiro entrevista a la Dra. Eva Criado, radióloga intervencionista del Hospital Parc Taulí de Sabadell, Barcelona, sobre el manejo de las estenosis benignas en vía biliar y los stents biodegradables. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/zVailz --- SHOW NOTES En primer lugar la Dra. Criado explica la clasificación de las estenosis biliares y las diferentes etiologías de las estenosis benignas, como causas iatrogénicas, procesos autoinmunes, inflamatorio-infecciosos, isquémicos o post-transplante hepático. Es crucial saber reconocer este tipo de estenosis y diagnosticar su etiología, ya que su no reconocimiento, o su tratamiento inadecuado deriva en complicaciones con riesgo vital para los pacientes. Las pruebas de imagen como la ecografía, el TC o la RM y colangioRM juegan un papel importante para la detección de estenosis biliares, su precisión diagnóstica y por tanto para su manejo y la planificación prequirúrgica A continuación la Dra. Criado resume las diferentes alterativas terapéuticas para la estenosis biliar benigna, como la cirugía y los tratamientos mínimamente invasivos, tanto endoscópicos como percutáneos, como son la dilatación y la colocación de stents. Ella enfatiza que la decisión sobre qué método utilizar debe de ser valorada de manera individualizada en función de la etiología, tipo y localización de la estenosis y factores de riesgo de cada paciente. Ambas doctoras destacan el hecho de que no existen unas guías de consenso entre las distintas sociedades que faciliten el manejo estandarizado con protocolos para el manejo de esta patología, lo cual sería muy Valioso. Adicionalmente, la Dra. Criado explica las posibilidades terapéuticas que ofrece la radiología intervencionista: la bilioplastia percutánea o dilatación, así como sus resultados y complicaciones, como la alta tasa de re-estenosis. Posteriormente pasa a evaluar los distintos tipos de stents, y específicamente los stents biodegradables, comentando las tasas de éxito técnico en su colocación, su permeabilidad primaria y la baja tasa de complicaciones que han demostrado en estudios multicéntricos a largo plazo, uno de los cuales es el registro Biella, un registro multicéntrico en el que han participado 11 centros españoles. También realiza un resumen de los diferentes tipos de stents biodegradables que hay hoy en día en el mercado y comenta las principales características mecánicas de los mismos. La Dra Criado concluye el episodio comentando su experiencia personal en el tratamiento de estenosis biliares benignas con stents biodegradables dando una serie de consejos prácticos para la liberación de estos stents y para prevenir complicaciones, así como las principales contraindicaciones y el tipo de seguimiento recomendado. También destaca la importancia de valorar cada caso individualmente y tomar decisiones bajo el marco de un equipo multidisciplinar. Finalmente comparte sus predicciones para el futuro de los stents biodegradables.

15 Sep 202343min

In this episode, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Sean Lyden about percutaneous transarterial bypass (PTAB) with DETOUR, a new therapy for treating occlusive / stenotic superficial femoral artery (SFA) disease. --- CHECK OUT OUR SPONSOR Endologix https://endologix.com/ --- SHOW NOTES Dr. Sean Lyden serves as the Chairman of Vascular Surgery at Cleveland Clinic. Sean starts off the discussion by conveying the severity of SFA chronic total occlusion (CTO) and walks us through what PTAB therapy is. We then cover the steps and general principles of using the DETOUR technology. Throughout the episode, Sean and Sabeen discuss the structure and key takeaways of both the DETOUR 1 and DETOUR 2 trials, held in Europe and the United States respectively. They also cover major questions, such as DVT and PE risk, patency of femoral vein following DETOUR intervention, and overall device cost. We conclude the episode with future directions of the now FDA-approved DETOUR device, and when and how vascular and interventional physicians can incorporate the new technology into their practice. Sean and Sabeen also contrast prior treatment options with the recent DETOUR trials to highlight how longer calcified / occluded SFA lesions now have a viable, effective, and safe endovascular treatment option. --- RESOURCES PTAB with DETOUR System: https://endologix.com/ptab/detour/ DETOUR 1 Trial: https://pubmed.ncbi.nlm.nih.gov/29327570/ DETOUR 1 Trial, 1 year follow-up results: https://pubmed.ncbi.nlm.nih.gov/32276015/ DETOUR 2 Trial, 12 month results: https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext DETOUR 2 Trial, 24 month results from Vascular Annual Conference Presentation: https://www.dicardiology.com/content/endologix-announces-24-month-results-detour-2-study-2023-vascular-annual-meeting Voyager Trial: https://www.nejm.org/doi/full/10.1056/nejmoa2000052 Compass Trial: https://www.nejm.org/doi/full/10.1056/nejmoa1709118

11 Sep 202334min

In this episode, host Dr. Aaron Fritts is joined by Dr. Pranav Moudgil, a new IR graduate who has just completed his first IR job search. Today’s discussion revolves around the job landscape for recent interventional radiology graduates. --- CHECK OUT OUR SPONSOR Philips Image Guided Therapy Devices Academy https://resource.philipseliiteacademy.com --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/rhaY4i --- SHOW NOTES The episode begins by introducing Pranav, who hails from Michigan and has recently completed his IR training at Beaumont. His discussion on today’s podcast was influenced by the recurring question he faced during his job hunt: “What do candidates like him seek in their careers?” Pranav's job search began in January of his PGY-5 year, 18 months before his graduation. When compared to his initial expectations of a robust job market, reality both did and did not meet these expectations. Pranav found that while there were a lot of job postings online, he was aware that there were just as many, if not more, word-of-mouth job opportunities. During his early training years, Pranav initially thought that he wanted a 100% IR role, but after getting more exposure to DR, he later realized that he wanted a balanced mix of DR and IR. When searching for jobs, Pranav found that many of his interviews came from listings on the ACR job board. However, after seeing the jobs his peers ended up taking, Pranav realized that personal connections played a significant role in job placement for him and his peers. As we delve into the core aspects of Pranav's job search strategy, he emphasizes the importance of being aware of which factors you value most in a job. Pranav also encourages new grads to evaluate job offers in terms of technical staff support and long-term job satisfaction. He advises job seekers to be vigilant for red flags during negotiations and emphasizes the importance of clear communication. The topic of locums tenens work also gets brought up during this discussion, as a means to explore diverse job opportunities before committing to a permanent position. Overalll, for a new IR graduate, Pranav recommends engaging in candid discussions about pay and structural aspects with mentors, understanding personal priorities, and evaluating job offers with a discerning perspective. --- RESOURCES ACR Job Listings: https://jobs.acr.org/

8 Sep 202345min

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