Ep. 315 Arterial Thrombectomy with Dr. Alexander Ushinsky

Do you have questions about enteral access? Dr. Peter Bream’s got you covered! In this episode Dr. Bream, former Professor at UNC Chapel Hill School of Medicine and current private practice interventional radiologist, shares his extensive knowledge on enteral access. --- CHECK OUT OUR SPONSOR Medtronic Concerto https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/concerto.html --- SYNPOSIS The discussion covers various insertion techniques, the use of different types of tubes including NG, G, and GJ tubes, and specialized methods like the Balloon-Assisted Gastrostomy (BAG) and Percutaneous Transesophageal Gastrostomy (PTEG). Dr. Bream also provides valuable insights on handling complications, patient preparation, and post-procedure care, making this episode a comprehensive guide for all things enteral access. Be sure to check out Part 2 next. --- TIMESTAMPS 00:00 - Introduction 03:00 - Tubes for Enteral Access 15:48 - Techniques and Personal Experiences 29:59 - Limitations and Techniques for Stroke Patients 30:45 - Patient Comfort and Sedation 37:16 - Complications and Safety Measures 39:14 - Palliative Techniques and Special Cases 49:49 - Post-Procedure Care and Maintenance --- RESOURCES Percutaneous gastrostomy: https://pubmed.ncbi.nlm.nih.gov/6414043/ Retrospective comparison of outcomes and associated complications between large bore radiologically inserted gastrostomy tube types: https://pubmed.ncbi.nlm.nih.gov/30073401/ Single-Step Method for Pull-Type Gastrostomy Tube Placement: https://pubmed.ncbi.nlm.nih.gov/31542269/ Balloon Assisted Gastrostomy (BAG) YouTube Video: https://youtu.be/GuF7BYW2Hm0?si=6xUIDQaQV-ywX1ua IR Playbook: A Comprehensive Introduction to Interventional Radiology (1st edition): https://link.springer.com/book/10.1007/978-3-319-71300-7 IR Playbook: A Comprehensive Introduction to Interventional Radiology Second Edition 2024: https://link.springer.com/book/10.1007/978-3-031-52546-9 Pediatric gastrostomy tubes and techniques: making safer and cleaner choices: https://pubmed.ncbi.nlm.nih.gov/29180216/

8 Aug 202458min

The use of drug-coated balloons (DCBs) for peripheral arterial disease has been controversial in the past. However, new data and updated FDA guidance have helped these devices regain popularity. In this episode of the BackTable Podcast, Dr. Ally Baheti hosts a discussion with Dr. Sahil Parikh, an interventional cardiologist in New York City, and Dr. John Park, a vascular surgeon in Omaha. --- CHECK OUT OUR SPONSOR BD Lutonix https://www.bd.com/en-us/products-and-solutions/products/product-families/lutonix-drug-coated-balloon-pta-catheters --- SYNPOSIS They review the historical controversy surrounding the potential late-mortality risks associated with Paclitaxel-coated devices, discuss more recent literature on the safety and efficacy of DCBs, and examine the implications of the FDA’s updated guidance in 2023. This update was made possible through collaborative efforts across specialties and regulatory bodies to establish best practices for vascular interventions. They also delve into patient selection criteria, lesion characteristics, and practical considerations for choosing between DCBs and other revascularization options. Each provider shares their treatment algorithm for DCB use in peripheral arterial disease. Dr. Park uses DCBs as a first-line treatment for patients with complete occlusions, CLTI symptoms, or lifestyle-limiting claudication, with adjunctive stenting sometimes required afterwards. In his experience, DCBs work best in lesions shorter than 100 mm and are preferable in locations where stenting is not feasible, such as across the knee joint. Dr. Parikh similarly prefers DCBs over plain balloon angioplasty and places stents in longer lesions. He notes that Hunter’s canal is a challenging area to treat with DCBs alone and may require atherectomy or intravascular lithotripsy. He recommends considering drug-eluting stents as a proactive measure to prevent more costly interventions for future restenosis. --- TIMESTAMPS 00:00 - Introduction 02:14 - History of DCB and Controversy 07:46 - Updated Research and 2023 FDA Guidelines 16:44 - Importance of Collaboration and Patient Preference 26:34 - DCB Treatment Algorithms 33:31 - Drug-Eluting Stents 35:46 - Approach for Patients with Claudication 37:22 - DCB Sizing and Dose --- RESOURCES Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (2018): https://www.ahajournals.org/doi/10.1161/JAHA.118.011245 FDA- Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality–Letter to Health Care Providers (2018): www.fda.gov/medical-devices/letters-health-care-providers/update-treatment-peripheral-arterial-disease-paclitaxel-coated-balloons-and-paclitaxel-eluting FDA- Paclitaxel-Coated Devices to Treat Peripheral Arterial Disease Unlikely to Increase Risk of Mortality - Letter to Health Care Providers (2023): https://www.fda.gov/medical-devices/letters-health-care-providers/update-paclitaxel-coated-devices-treat-peripheral-arterial-disease-unlikely-increase-risk-mortality Mortality in randomised controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis (2023): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02189-X/abstract

6 Aug 202446min

Creating an ambulatory surgery center (ASC) with transparent, affordable pricing is possible and can go a long way in protecting our patients’ health, pockets, and futures. Dr. Keith Smith, founder of Oklahoma Surgery Center and the Free Market Medical Association, joins us to explain how to do it. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Smith shares his journey of creating transparent and affordable healthcare pricing, the challenges faced due to government regulations and insurance companies, and the rapid growth of self-funded companies seeking value in medical services. He highlights the importance of simple, honest pricing and the impact of the Free Market Medical Association in connecting buyers and sellers. Dr. Smith also discusses the expansion of his model beyond Oklahoma and into new surgical centers, emphasizing the need for price transparency in healthcare. --- TIMESTAMPS 00:00 - Introduction 05:06 - Challenges & Growth 14:18 - Self-Funding & Price Transparency 16:47 - Free Market Medical Association 21:44 - Government & Price Transparency 26:19 - Expansion & Future Plans --- RESOURCES Oklahoma Surgery Center: https://surgerycenterok.com/ Free Market Medical Association: https://fmma.org/

2 Aug 202438min

How has Laser Atherectomy advanced over the years to treat patients with coronary and peripheral artery disease? Dr. On Topaz, renowned specialist in laser atherectomy, answers exactly that and much more in this week’s episode the BackTable Podcast. Dr. Topaz is an interventional cardiologist and a professor of medicine at Duke University. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SYNPOSIS The doctors begin their discussion by comparing traditional Excimer laser and new Auryon laser technologies. The conversation also covers thrombus management, use of lasers in complex plaques, the latest research studies on laser atherectomy, and future developments in laser technology for varied medical applications. --- TIMESTAMPS 00:00 - Introduction 10:01 - Laser Atherectomy & Thrombus Management 21:59 - Laser Applications in Peripheral Arterial Disease 28:12 - Laser in Interventional Cardiology 41:17 - New Laser Technologies 47:50 - Research Findings and Clinical Trials 59:09 - Future Prospects and Applications --- RESOURCES Book by Dr. On Topaz - Debulking in Cardiovascular Interventions and Revascularization Strategies: https://www.sciencedirect.com/book/9780128214510/debulking-in-cardiovascular-interventions-and-revascularization-strategies Book by Dr. On Topaz - Lasers in Cardiovascular Interventions: https://link.springer.com/content/pdf/10.1007/978-1-4471-5220-0.pdf Book by Dr. On Topaz - Cardiovascular Thrombus: From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions: https://www.sciencedirect.com/book/9780128126158/cardiovascular-thrombus Paper from Dr. Giancarlo Biamino - The excimer laser: science fiction fantasy or practical tool?: https://pubmed.ncbi.nlm.nih.gov/15760264/ Clinical Trial from Dr. John Bittl - Predictors of outcome of percutaneous excimer laser coronary angioplasty of saphenous vein bypass graft lesions. The Percutaneous Excimer Laser Coronary Angioplasty Registry: https://pubmed.ncbi.nlm.nih.gov/8023778/ Paper from Dr. Warren S. Grundfest - https://journals.lww.com/coronary-artery/citation/1990/07000/laser_angioplasty.4.aspx Paper from Dr. George S. Abela - Abrupt Closure After Pulsed Laser Angioplasty: Spasm or A “Mille-Feuilles” Effect?: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1540-8183.1992.tb00830.x 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/

30 Juli 20241h 7min

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 Juli 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 Juli 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 Juli 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 Juli 202440min