Ep. 321 New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler

Ep. 321 New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler

In this episode, host Dr. Aaron Fritts and interventional radiologist Dr. Kevin Henseler discuss his treatment algorithm and new technologies for embolization of GI bleeds. --- CHECK OUT OUR SPONSOR Boston Scientific Obsidio Embolic https://www.bostonscientific.com/obsidio --- SHOW NOTES Dr. Henseler starts by differentiating between lower and upper GI bleeds. Upper GI bleeds tend to be more life-threatening and are most commonly caused by esophageal varices or duodenal ulcers, and many of these consults come from the endoscopy suite. These upper GI bleeds also have a higher risk of recurrence. On the other hand, lower GI bleeds can be more indolent. CTA is the most efficient way to assess the source of GI bleeding. It provides valuable information about the vascular territory, including localization of bleeding, planning where to inject during angiography, and variant anatomy. If CTA is negative for bleeding, Dr. Henseler does not move onto angiography. He monitors the patient for further signs of intermittent bleeding and may re-image or intervene the following day. If CTA does show bleeding, Dr. Henseler moves onto angiography and embolization. He finds that there are few contraindications to angiography. Relative contraindications include renal insufficiency, which is a small tradeoff for a lifesaving procedure, and contrast allergy, which can be addressed with a preprocedural steroid dose. When it comes to methods of embolization, detachable coils have been a mainstay. While they are more expensive than pushable coils, detachable coils allow for more exact placement and increased safety and more IRs are being trained to use these now. Dr. Henseler also discusses the use of embolic particles, which carry risks of end-organ damage and ischemia, as well as embolic glue, which can be difficult to use if the operator does not have sufficient training. Then, we shift gears to discuss Obsidio, a new injectable solid that is soon to be commercially available. It exists as a liquid when it is in its pressurized form within the microcatheter; however, it immediately solidifies in the vessel as soon as the injection ceases. Obsidio is made of radio-opaque tantalum so it is visible on CT, stays permanently in the vessel, and can be used in conjunction with coils if desired. Additionally, its cohesive properties decrease the risk of abdominal extravasation and it can be used with any catheter. --- RESOURCES Dr. Kevin Henseler LinkedIn: https://www.linkedin.com/in/kevin-henseler-364832231/ CTA for Lower GI Bleeds: https://www.youtube.com/watch?v=UWEf_sAUGKU Ep. 179- Happiness is a Warm Coil: Treating GI Bleeds: https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds Ep. 216- Stick It: Glue Embo: https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo

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Ep. 74 The Role of IR in Stroke Interventions (Part 1) with Dr. David Sacks and Dr. Martin Radvany

Ep. 74 The Role of IR in Stroke Interventions (Part 1) with Dr. David Sacks and Dr. Martin Radvany

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/yS6TGL Dr. Martin Radvany and Dr. David Sacks discuss the role of Interventional Radiologists in the treatment of acute ischemic stroke, including training requirements, the multidisciplinary team approach, and ways to improve patient access to high quality care.

2 Aug 202057min

Ep. 73 Iliocaval Stenting with Dr. Gerry O'Sullivan

Ep. 73 Iliocaval Stenting with Dr. Gerry O'Sullivan

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/TFABaN Interventional Radiologist Dr. Gerry O'Sullivan shares his experiences with Iliocaval stenting in post-thrombotic patients, including pearls and pitfalls and the "Aiming for the bottom corner" technique.

27 Juli 202048min

Ep. 72 Uterine Fibroid Embolizations in the OBL with Dr. John Lipman

Ep. 72 Uterine Fibroid Embolizations in the OBL with Dr. John Lipman

John Lipman, MD discusses UFE practice building, patient workup, and embolization technique in his dedicated Women's interventional practice, Atlanta Interventional Institute. --- CHECK OUT OUR SPONSORS RADPAD® Radiation Protection https://www.radpad.com/ Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/10vK6b

20 Juli 202052min

Ep. 71 Building a MedEd platform with Dr. Sarel Gaur

Ep. 71 Building a MedEd platform with Dr. Sarel Gaur

We talk with Interventional Radiologist Sarel Gaur about what inspired his #medEd #YouTube channel, where his topics come from, and tips for success for others.

13 Juli 202028min

Ep. 70 CO2 Angiography with Dr. James Caridi

Ep. 70 CO2 Angiography with Dr. James Caridi

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/F6p0sz In this episode, Dr. James Caridi joins Dr. Christopher Beck to discuss the benefits of using CO2 for an angiography as well as some important tips for proper use. Dr. Caridi mentions some of the reasons for choosing CO2 rather than contrast, including its solubility, low viscosity, and buoyancy. He also speaks about CO2 angiography approaches for imaging difficult to access vasculature. Dr. Caridi also speaks to specific uses of CO2 angiography for use for mesenteric angiography and how CO2 angiography can improve the sensitivity for detection and localization of GI bleeds. Dr. Caridi and Dr. Beck also discuss some non-vascular uses for CO2 angiography as well as a technique for imaging with CO2 without having to give up wire access. We talk through safely preparing a delivery system and gently injecting CO2 to prevent/reduce reflux in the patient if needed. Finally, we go into some notes concerning dialysis, contrast induced nephropathy, and some instances when CO2 angiography should not be used. Resources mentioned: CO2 Angiography Society http://www.co2angio.org/index.php This website features over 100 pieces of literature related to CO2 angiography, information about the newest developments, and access to membership in the society. Dr. Jim Caridi explains CO2mmander and AngiAssist https://www.youtube.com/watch?v=MjsnHWmRZQI This video explains the portable delivery system and the gas management system.

6 Juli 202051min

Ep. 69 Retrograde Pedal Access with Dr. Jim Melton and Dr. Blake Parsons

Ep. 69 Retrograde Pedal Access with Dr. Jim Melton and Dr. Blake Parsons

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/wS9UCY Dr. Jim Melton and Dr. Blake Parsons discuss the benefits of retrograde pedal access in the treatment of PAD, as well as the team approach of their outpatient CardioVascular Health Clinic , which includes Vascular Surgery, Interventional Radiology, and Interventional Cardiology working together as partners for better patient care.

22 Juni 202052min

Ep. 68 RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla

Ep. 68 RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla

Dr. Jason Levy and Dr. Sandeep Bagla discuss palliative treatment of bone metastases with radiofrequency ablation, as well as recent results from the OPuS One trial.

15 Juni 202040min

Ep. 67 Locoregional Therapies for Bridging to Transplant in HCC with Dr. Alex Kim

Ep. 67 Locoregional Therapies for Bridging to Transplant in HCC with Dr. Alex Kim

Interventional Radiologist Dr. Alex Kim and Dr. Christopher Beck discuss the utility of different locoregional liver therapies in bridging HCC patients to transplant.

8 Juni 202047min

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