Ep. 328 Adrenal Vein Sampling with Dr, Fritz Angle

Ep. 328 Adrenal Vein Sampling with Dr, Fritz Angle

In this episode, host Dr. Aparna Baheti interviews Dr. Fritz Angle about adrenal vein sampling, including indications, workup, and his technique for accessing the right adrenal vein. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Dr. Fritz Angle is the Director of Interventional Radiology at the University of Virginia. He frequently performs adrenal vein sampling for primary hyperaldosteronism, and has developed a specific technique. The patient is usually referred from an endocrinologist or primary care doctor. The IR should review the labs to verify the aldosterone-to-renin ratio is greater than 20. Additionally, it is important to review medications and stop all potassium sparing diuretics at least two weeks before the procedure. If they haven’t had a CT scan, the IR should order one to assess the position of the right adrenal vein, the hardest to access due to its variable anatomy. The morning of the procedure, Dr. Angle always checks a potassium level to know whether to give potassium supplements. He gets dual femoral access, so that he can obtain both non-stimulated and ACTH-stimulated samples. He obtains the sample from the left adrenal vein first. For the right side, he starts with a C2 catheter, to which he adds side holes using a biopsy needle. The left adrenal vein is almost always one vertebral body above the right renal vein, so he begins here, with the catheter pointing directly posterior. He searches around the entire back wall of the IVC by puffing contrast and rotating the catheter. He moves up and down by half a vertebral level. If he still cannot locate it, he begins looking to the left and right. When injecting, it is important to be gentle. To do this, he inserts an 014 wire through his catheter, then does a dry scan to see if the vein is pointing toward the liver or the right adrenal gland. If the vein is injected too hard, it can cause a venous infarct and adrenal insufficiency. The right adrenal vein forms an upside down Y shape. Dr. Angle draws two sets each from the right and left adrenal veins and two peripheral samples. To interpret results, look for a cortisol of 2-3x greater (3-4x greater in stimulated samples) compared to the peripheral blood to confirm correct placement in the adrenal veins. Once you correct aldosterone levels to cortisol levels, the aldosterone-to-cortisol ratio should be about 5x greater on one side (compared to the other side) to confirm the diagnosis and lateralize the hyperaldosteronism to one side. About 2 ⁄ 3 cases lateralize, but Dr. Angle has found many patients’ symptoms are actually due to bilateral adrenal hyperplasia. Finally, Dr. Angle emphasizes that this is an easy, safe procedure that all IRs should offer.

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Ep. 89 Online Education in Vascular Medicine: do we have the best format? with Dr. Theodosios Bisdas

Ep. 89 Online Education in Vascular Medicine: do we have the best format? with Dr. Theodosios Bisdas

In this episode, Dr. Theodosios Bisdas joins Dr. Aaron Fritts to discuss online education and his e-learning platform, Vascupedia. Dr. Bisdas talks about how he started the platform and the three main parts of the website: main arena, polling station, and exhibition area. We talk about how social media has helped expand his platform to American audiences and how to collaborate with companies and medical societies to present new devices. We go over some of the main challenges of e-learning and why it is important for physicians to have time to watch webinars. Dr. Bisdas emphasizes the value of virtual learning, having forums for international conversation, and he speaks about his hopes for the future of Vascupedia. We discuss the benefits of on-demand, high quality online content and the importance of platforms created by physicians for physicians. Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/jGVeCR RESOURCES MENTIONED: Vascupedia https://vascupedia.com/ This website contains the online learning platform mentioned by Dr. Bisdas.

13 Okt 202028min

Ep. 88 Intro to Structural Heart Disease with Dr. Raj Narayan

Ep. 88 Intro to Structural Heart Disease with Dr. Raj Narayan

In this episode, Dr. Rajeev Narayan joins Dr. Achal Sahai to discuss structural heart disease and the (Transcatheter aortic valve replacement) TAVR procedure. Dr. Narayan talks us through what an average working week looks like and speaks to the importance of having a great referral network. We define structural heart disease and discuss the development of the TAVR procedure for high risk patients and how the process is different from a regular cardiac surgery. We examine what can make a patient with structural heart disease high risk and eligible for TAVR. We talk through how access has changed over the years and some of the more technical aspects of these procedures. Dr. Narayan gives some advice to trainees and emphasizes the importance of learning to face complications on your own. Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/scgy25

10 Okt 202052min

Ep. 87 Deep Dive Into Ascites with Dr. Rajeev Suri

Ep. 87 Deep Dive Into Ascites with Dr. Rajeev Suri

In this episode, Dr. Rajeev Suri joins Dr. Christopher Beck to discuss ascites and paracentesis. Dr. Suri touches on what a potential paracentesis candidate might present with and speaks about why no lab values or blood tests are needed prior to the procedure. We discuss the basic steps for removing ascites, how to find the side with the biggest pocket, and preventing leakage by using a Z pattern. He speaks to the circumstances for using direct US guidance rather than intermittent and when, if ever, to use glue or stitches after paracentesis. We mention the benefits of utilizing the Renova Pump for fluid removal and discuss why Dr. Suri might use a vacuum container bottle rather than a wall suction. Lastly, we examine some methods for managing recurring patients in the ascites clinic. Dr. Suri also discusses how his practice has incorporated a paracentesis clinic to reduce the number of emergency room visits for ascites and how this practice has improved workflow and patient access to an interventional radiologist. RESOURCES MENTIONED: RenovaRP® Paracentesis Management System www.rethinkparas.com This website allows you to download the case study mentioned by Dr. Beck and check out other products from GI Supply. AASLD Guidelines https://www.aasld.org/publications/practice-guidelines This website includes the 2013 guidelines for ascites management. SIR Coagulation Guidelines https://www.jvir.org/article/S1051-0443(19)30407-5/pdf This pdf has recommendations for periprocedural management of thrombotic and bleeding risks in patients. Denver Shunts https://www.ajronline.org/doi/full/10.2214/AJR.12.9203 This article, mentioned by Dr. Suri, discusses the placement and management of Denver shunts for portal hypertensice ascites.

6 Okt 202040min

Ep. 86 Building a PAD practice with Dr. Srini Tummala

Ep. 86 Building a PAD practice with Dr. Srini Tummala

Building a PAD practice with Dr. Srini Tummala by BackTable

3 Okt 202044min

Ep. 85 Genicular Artery Embolization for OA with Dr. Jafar Golzarian

Ep. 85 Genicular Artery Embolization for OA with Dr. Jafar Golzarian

In this episode, Dr. Jafar Golzarian joins Dr. Michael Barraza to discuss genicular artery embolization for osteoarthritis. Dr. Golzarian describes how he worked and collaborated with orthopedic surgeons to offer this procedure for his patients. He also speaks about some potential underlying causes and aggravating factors for osteoarthritis. Dr. Golzarian provides useful tips on taking an academic approach to setting up trials and what makes his trials different from previous studies on genicular artery embolization. We discuss why patients with osteoarthritis can be a challenge for family practitioners and how collaboration with IR can benefit these patients. We go into the differences in the procedure for hemarthrosis and osteoarthritis. We review some ways to find the best angle to identify an arterial origin for embolization, and we discuss some of the challenges in the embolization procedure and how to adapt to different types of patients.

28 Sep 202035min

Ep. 84 An Interview with Dr. Ernie Ring- WAIS Series

Ep. 84 An Interview with Dr. Ernie Ring- WAIS Series

Ep. 84 An Interview with Dr. Ernie Ring- WAIS Series by BackTable

22 Sep 202047min

Ep. 83 An Interview with Dr. David Kumpe- WAIS Series

Ep. 83 An Interview with Dr. David Kumpe- WAIS Series

An Interview with Dr. David Kumpe- WAIS Series by BackTable

21 Sep 20201h 7min

Ep. 82 An Interview with Dr. Dan Sze- WAIS Series

Ep. 82 An Interview with Dr. Dan Sze- WAIS Series

Ep. 82 An Interview with Dr. Dan Sze- WAIS Series by BackTable

20 Sep 202037min

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