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. 59 Endovascular Treatment of DVT with Dr. Dexter and Dr. Abramowitz

Ep. 59 Endovascular Treatment of DVT with Dr. Dexter and Dr. Abramowitz

Vascular Surgeons David Dexter and Steven Abramowitz discuss endovascular treatment of lower extremity DVT, including patient selection and risks and benefits of catheter-directed therapy (CDT), mechanical thrombectomy, and pharmaco-mechanical thrombolysis.

24 Mars 202059min

Ep. 58 Endovascular Treatment of PE with Dr. Venkat Tummala and Dr. Thomas Tu

Ep. 58 Endovascular Treatment of PE with Dr. Venkat Tummala and Dr. Thomas Tu

Interventional Cardiologist Thomas Tu, MD and Interventional Radiologist Venkat Tummala MD discuss their respective approach to the treatment of Pulmonary Embolism, including risk stratification, treatment options, and endovascular technique.

11 Mars 202045min

Ep. 57 Practicing IR in the UK with Dr. Gregory Makris

Ep. 57 Practicing IR in the UK with Dr. Gregory Makris

Dr. Christopher Beck talks with Dr. Gregory Makris of Guy's and St. Thomas' NHS Foundation Trust in London about IR education and practice in the UK, as well as his involvement with CIRSE and the European Trainee Forum.

5 Mars 202045min

Ep. 56 Transitioning from a Hospital to OBL practice (Part II) with Dr. Yates and Dr. Patel

Ep. 56 Transitioning from a Hospital to OBL practice (Part II) with Dr. Yates and Dr. Patel

In Part 2 of this 2-part series, Dr. Tim yates and Dr. Lincoln Patel provide insight on marketing strategies, as well as the importance of experience and partners in an outpatient based endovascular practice. --- CHECK OUT OUR SPONSORS RADPAD® Radiation Protection https://www.radpad.com/ Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/5UxgxL

23 Feb 202043min

Ep. 55 Transitioning from a Hospital to OBL practice (Part I) with Dr. Yates and Dr.  Patel

Ep. 55 Transitioning from a Hospital to OBL practice (Part I) with Dr. Yates and Dr. Patel

In Part 1 of this 2-part series, Dr. Tim yates and Dr. Lincoln Patel provide insight on how they made their career change decisions, as well as the advantages and disadvantages of a hospital-based vs. outpatient-based endovascular practice. --- 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/vog6G0

11 Feb 202051min

Ep. 54 Inclusivity in IR with Dr. Barbara Hamilton and Dr. Mary Costantino

Ep. 54 Inclusivity in IR with Dr. Barbara Hamilton and Dr. Mary Costantino

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/o6ecMR Dr. Barbara Hamilton and Dr. Mary Costantino, MD discuss inclusivity in IR, including the importance of mentorship and diversity in medicine.

16 Jan 202023min

Ep. 53 International Volunteer Work with Dr. Stephen Hunt

Ep. 53 International Volunteer Work with Dr. Stephen Hunt

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/Fh5LxS Dr. Stephen Hunt shares his international volunteer experiences traveling with IR4Nigeria and RAD-AID International. Get involved at www.rad-aid.org.

1 Jan 202026min

Ep. 52 IVUS for Iliac Vein Compression with Dr. Mark Lessne and Dr. Mike Cumming

Ep. 52 IVUS for Iliac Vein Compression with Dr. Mark Lessne and Dr. Mike Cumming

Dr. Michael Cumming and Dr. Mark Lessne discuss the utility of Intravascular Ultrasound (IVUS) in the diagnosis and treatment of Deep Venous Disease, including patient selection, appropriate assessment of stenoses and assistance with stent placement. Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/ySM6hy

11 Nov 201944min

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