Ep. 590 Deep Venous Arterialization: Techniques & Outcomes with Dr. Miguel Montero Baker and Dr. Lucas M Ferrer Cardona

In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. Dr. Levey is an interventional radiologist at the Memorial Hermann Health System in Houston, TX. The doctors discuss how cryoneurolysis differs from radiofrequency (RF) ablation, highlighting the increased precision and gentleness to surrounding tissues. Dr. Levey describes the specifics of stellate ganglion procedures and cryoneurolysis techniques. They delve into the importance of research and collaboration in advancing the field, as well as the necessity of being patient-centered. They also address the need for financial discussions in medicine and the prospect for cryoneurolysis as desmoid tumor treatments. Additionally, Dr. Levey shares her journey in building a career as a female in a male-dominated space and emphasizes the importance of physician availability to patients and colleagues. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SHOW NOTES 00:00 - Introduction to RF Ablation and Cryoneurolysis 03:20 - Dr. Alexa Levey’s Journey and Inspiration 07:00 - Building a Pain Practice 14:03 - Advantages of Cryoneurolysis over RF 21:09 - Patient Selection and Planning for Cryoneurolysis 32:02 - Understanding Patient’s Condition and Treatment Options 36:21 - Role of Stellate Ganglion Procedures in PTSD and Anxiety Management 37:48 - Challenges and Impact of Long COVID 41:34 - The Future of Cryoneurolysis in Medical Practice 54:55 - Future of Cryo Treatment in Medical Practice --- RESOURCES Safety and Effectiveness of Stellate Ganglion Cryoablation in Complex Regional Pain Syndrome: https://doi.org/10.1016/j.jvir.2023.09.030 Treating phantom limb pain: cryoablation of the posterior tibial nerve: https://pubmed.ncbi.nlm.nih.gov/35801126/ Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664306/ The Efficacy of the Stellate Ganglion Block as a Treatment Modality for Posttraumatic Stress Disorder Among Active Duty Combat Veterans: A Pilot Program Evaluation: https://pubmed.ncbi.nlm.nih.gov/33242072/ Stellate Ganglion Block in the Treatment of Post-traumatic Stress Disorder: A Review of Historical and Recent Literature: https://pubmed.ncbi.nlm.nih.gov/27739175/ Stellate ganglion block reduces symptoms of Long COVID: A case series: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406/ Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498998/

18 Dec 20231h 3min

In this episode of the BackTable Podcast, host Dr. Ally Baheti and Dr. Daniel Sheeran discuss the management and treatment of peripartum and postpartum hemorrhage. Dr. Sheeran highlights the importance of imaging-based diagnostics, particularly with MRI, to identify the source of bleeding and guide therapy. He also explains the need to employ a variety of techniques tailored towards each individual situation, which may involve utilizing different types of catheters, occlusion balloons, and embolics. He underlines the necessity to balance effective treatment with the preservation of uterine health, especially for women who may wish to have future pregnancies. In severe cases, he mentions the possibility of temporary aortic occlusion. As a final point, Dr. Sheeran argues that Interventional Radiology can play a crucial role in managing these types of cases and potentially avoiding hysterectomies. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:00 - Breakdown of Types of Hemorrhages 03:26 - Understanding Peripartum Hemorrhage 04:05 - Discussion on Postpartum Hemorrhage 07:52 - Technical Details of Balloon Occlusion 08:00 - Procedure for Peripartum Hemorrhage 21:15 - Blood Loss in Medical Procedures 22:48 - Uterine Artery Embolization 27:10 - Post-Procedure Follow Up and Fertility Concerns 30:05 - Technical Points for Newcomers in the Field 36:12 - The Role of REBOA in Treating Postpartum Hemorrhage --- RESOURCES The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276355/ Magnetic Resonance Imaging of Placenta Accreta Spectrum: A Step-by-Step Approach: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817633/ Role of interventional radiology in placenta accreta spectrum (PAS) disorders: https://www.sciencedirect.com/science/article/pii/S1521693421000146 Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta: https://pubmed.ncbi.nlm.nih.gov/21598085/ Aberrant Ovarian and Uterine Feeding from the Renal Artery at the End of Gestation: Two Cases: https://www.jvir.org/article/S1051-0443(10)00863-8/fulltext Uterine Fundal Blood Supply from an Aberrant Left Ovarian Artery Originating from the Inferior Mesenteric Artery: Implications for Uterine Artery Embolization: https://www.jvir.org/article/S1051-0443(10)00191-0/fulltext Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948071/ Uterine artery embolisation: fertility, adenomyosis and size – what is the evidence?: https://cvirendovasc.springeropen.com/articles/10.1186/s42155-023-00353-2 Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Proximal Aortic Control in Patients With Severe Hemorrhage and Arrest: https://pubmed.ncbi.nlm.nih.gov/28973104/ Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): https://prytimemedical.com/clinical/reboa/ Resuscitative endovascular balloon occlusion of the aorta (REBOA) for life-threatening postpartum hemorrhage: A nationwide observational study in Japan: https://pubmed.ncbi.nlm.nih.gov/35444149/ Efficacy of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhage control in patients with abnormally invasive placenta: a historical cohort study: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05649-8 An elective hybrid suite approach to the management of placenta accreta-associated postpartum hemorrhage (PPH): https://www.jvir.org/article/S1051-0443(13)00311-4/fulltext The role of interventional radiology in primary postpartum hemorrhage: https://www.jstage.jst.go.jp/article/jsshp/4/2/4_HRP2015-016/_article

15 Dec 202340min

In this episode of the BackTable Podcast, host Dr. Ally Baheti and Dr. Paramjit “Romi” Chopra discuss the processes involved in successful interventional radiology practice management. Dr. Chopra is an interventional radiologist practicing in Chicago, IL. He is the founder and CEO of Midwest Institute for Minimally Invasive Therapies. Dr. Chopra advises young IRs against going solo, and he suggests finding people who’ve done it before, to avoid “reinventing the wheel.” Dr. Chopra emphasizes the importance of adopting a patient-centered approach, building systems, developing business sense, and understanding risk. He shares his own experiences of building systems using Salesforce and explains the concept of ‘omni-channel healthcare delivery’. He particularly discusses the importance of patient, provider, and payer relationships, and he offers solutions for dealing with inherent complications. The episode also covers identifying the right electronic health record and developing an effective inventory management system. --- CHECK OUT OUR SPONSORS Medtronic IN.PACT 018 DCB https://www.medtronic.com/018 Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 05:41 - Shift from Academic Medicine to Entrepreneurship 09:40 - Patient-Centered Care in Interventional Radiology 11:13 - Challenges of Starting an Independent Practice 17:49 - Role of Electronic Health Records (EHRs) in Modern Healthcare 26:15 - Challenges of Implementing EHRs in Interventional Radiology 35:30 - Misconceptions about Outpatient Based Labs (OBLs) 37:01 - Understanding the Payer System 38:19 - Challenge of Insurance Coverage 51:43 - Practice Management Companies --- RESOURCES MIMIT Healthcare: https://mimithealth.com/physicians-executives The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It by Michael E. Gerber: https://a.co/d/2TuGpTn AdvancedMD Cloud Based EMR: https://www.googleadservices.com/pagead/aclk Athena Cloud Based EMR: https://www.athenahealth.com/landing/athenaclinicals CIMSS Management Services Organization (MSO): https://www.cimss.com/ Salesforce: https://www.salesforce.com/

11 Dec 20231h 2min

In this episode, Dr. Aaron Fritts and Dr. Jose Silva invite interventional radiologist Dr. Jamil Muasher to highlight the potential that interventional radiologists possess in offering prostate biopsy work alongside Urology colleagues. Given the advancement in MRI guidance, the discussion addresses the opportunity for radiologists to step in and provide crucial expertise to optimize patient outcomes. Dr. Muasher talks about his approach of using an MR imaging to guide the biopsy procedure. He further expresses importance in understanding the grading, reading, interpreting systems like Prostate Imaging-Reporting and Data System (PI-RADS) and significant experience needed for accurate results. The doctors also explain various biopsy procedures, details about post-procedure care and follow-ups, and observations about billing for the services. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 07:29 - Learning to Read Prostate MRI 09:43 - The Role of Radiologists and Grading Systems in Prostate Biopsies 24:00 - Techniques in Prostate Biopsy 31:16 - The Role of Antibiotics in Biopsy 32:34 - The Debate Between Transperineal and Transrectal Biopsy 40:36 - Post-Procedure Care and Follow-Up 45:49 - The Future of Biopsy --- RESOURCES Decipher Prostate Genomic Classifier by Veracyte: https://decipherbio.com/

8 Dec 202351min

In this episode of the BackTable Podcast, host Dr. Chris Beck discusses atherectomy, laser technologies, and their use in vessel treatment with Dr. Tony Das, an interventional cardiologist practicing in Dallas, TX and one of the founding members of the VIVA Vascular Education Course in Las Vegas. Dr. Das shares insights on the PATHFINDER registry, which is a prospective non-randomized, multicenter study to evaluate the performance and outcome of the Auryon laser atherectomy system. Their conversation explores the role of atherectomy in reducing stent usage, decreasing embolization likelihood, enhancing thrombus removal, and uncovering lesions. Dr. Das further provides recommendations for building a successful atherectomy program, utilizing laser technologies, and the importance of having ablative technology in outpatient labs. The doctors forecast future applications for artificial intelligence and remote monitoring. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SHOW NOTES 00:00 - Introduction 03:38 - Discussion about Connected Cardiovascular Care Associates 05:09 - Deep Dive into Atherectomy 14:06 - Understanding Laser Atherectomy 23:23 - Discussion on the PATHFINDER Study 34:52 - Advice for Building an Atherectomy Program 38:49 - Future Topics and Closing Remarks --- RESOURCES Connected Cardiovascular Care Associates: https://www.texasc3.com/ Pathfinder Registry Trial: https://www.clinicaltrials.gov/study/NCT04229563#publications Pathfinder Registry Trial Introduction: https://evtoday.com/articles/2021-sept/introduction-to-the-pathfinder-registry-and-complex-endovascular-cases-with-the-auryon-atherectomy-system Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial: https://pubmed.ncbi.nlm.nih.gov/16445313/ Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis): https://pubmed.ncbi.nlm.nih.gov/25499305/ Cryoplasty Versus Conventional Balloon Angioplasty of the Femoropopliteal Artery in Diabetic Patients: Long-Term Results from a Prospective Randomized Single-Center Controlled Trial: https://link.springer.com/article/10.1007/s00270-010-9915-x#Abs1 Cryoplasty for the treatment of femoropopliteal arterial disease: results of a prospective, multicenter registry: https://pubmed.ncbi.nlm.nih.gov/16105918/ Auryon Laser from AngioDynamics: https://www.angiodynamics.com/product/auryon/ Philips Laser System: https://www.usa.philips.com/healthcare/product/HCIGTDPHLLSRSYSTM/laser-system-hcigtdphllsrsystm Atherectomy plus drug-coated balloon versus drug-coated balloon only for treatment of femoropopliteal artery lesions: A systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/33478353/ Laser in Infrapopliteal and Popliteal Stenosis 2 Study (LIPS2): Long-Term Outcomes of Laser-Assisted Balloon Angioplasty Versus Balloon Angioplasty for Below Knee Peripheral Arterial Disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407062/ Distal embolization during lower extremity endovascular interventions: https://pubmed.ncbi.nlm.nih.gov/28366300/ Shockwave™ Lithoplasty in Combination With Atherectomy in Treating Severe Calcified Femoropopliteal and Iliac Artery Disease: A Single-Center Experience: https://pubmed.ncbi.nlm.nih.gov/32563711/

4 Dec 202342min

In this episode of the BackTable Podcast, host Dr. Ally Baheti discusses the relationship between pelvic venous disease and physical therapy with Ingrid Harm-Ernandes, a pelvic floor physical therapist, mentor for Duke University’s Women’s Health Physical Therapy Residency Program, and author of The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms. Ingrid gives a detailed walkthrough of a physical therapy session, highlighting the importance of holistic and interdisciplinary treatment approaches, as well as patient communication. She shares perspectives on the need for earlier interventions of physical therapy, misconceptions around the pelvic therapy issues, and the significant role of interventional radiologists as part of the treatment team. She also discusses her book which aims to demystify pelvic floor issues and empower both patients and practitioners in treating them. --- CHECK OUT OUR SPONSORS BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 02:25 - Discussion on Pelvic Venous Disease and Physical Therapy 02:36 - Exploring the Role of Physical Therapy in Treating Pelvic Pain 04:41 - Understanding the Challenges in Treating Pelvic Pain 06:51 - Identifying Symptoms of Pelvic Venous Disease 10:06 - The Role of Pelvic PT in Treating Pelvic Venous Disease 15:49 - Finding a Qualified Pelvic PT 22:13 - Improving Synergy between Interventional Radiologists and Pelvic PT 28:39 - Understanding the Musculoskeletal Mystery in Pelvic Floor Symptoms 33:48 - Final Thoughts and Advice for Treating Patients with Pelvic Venous Disease --- RESOURCES The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms: https://www.pelvicpain.org/resources/marketplace/books/the-musculoskeletal-mystery

1 Dec 202337min

In this episode, host Dr. Aaron Fritts interviews Dr. Rehan Quadri about the impact of intra-procedural arterial monitoring via sheath technology. Dr. Quadri is a practicing interventional radiologist at UT Southwestern in Dallas, Texas. --- CHECK OUT OUR SPONSOR Endophys https://endophys.com/ --- SHOW NOTES Dr. Quadri begins by telling us about a new arterial sheath, the EndoPhys Pressure Sense Arterial Sheath, which enables real-time blood pressure monitoring in a number of different cases and advantages that it offers over arterial lines and cuff monitors. We also discuss specific indications for utilizing this technology, such as trauma, GI bleeds, stroke, fistulas, and other emergent arterial interventions requiring minute-to-minute monitoring. We also breakdown the specs of the sheath, including its setup, calibration, placement, recorded measurements, and the accuracy of the read-outs when compared to those of past technologies. Dr. Quadri speaks on the cost and the overall value of the EndoPhys sheath. He concludes the episode by discussing new advancements in the technology such as improved device warmup times and a radial-specific sheath. --- RESOURCES Endophys Pressure Sense Arterial Sheath: https://endophys.com/

27 Nov 202331min

In this episode of BackTable, host Dr. Michael Barraza is joined by Dr. Nainesh Parikh from Moffitt Cancer Center. Dr. Parikh has worked extensively on prostate artery embolizations (PAE), having performed around 250 PAEs since joining Moffitt in 2017. The conversation delves into the multifaceted applications of PAE, with a specific focus on its role in prostate cancer. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Dr. Parikh outlines the various clinical scenarios where PAE proves beneficial in prostate cancer cases. This includes the potential to shrink the prostate to an optimal size for brachytherapy, decrease volume for operational convenience, and address lower urinary tract symptoms associated with enlarged prostates. Clinical improvement emerges as a major motivator, with Dr. Parikh underscored the importance of ensuring a certain volume reduction before focal therapy, thereby simplifying subsequent treatments. The conversation extends to the role of PAE in managing radiation prostatitis, categorized clinically as chronic prostatitis. While conventional treatments often fall short for this condition, PAE emerges as an effective solution, especially for the 50% of men typically refractory to standard approaches. Dr. Parikh informs patients of the 70-75 percent chance of improvement while acknowledging the challenges in chronic prostatitis patients. The episode explores Dr. Parikh's approach to working up patients for PAE, with most referrals originating from the GU tumor board. Dr. Parikh discusses the gland size threshold for PAE assessment, emphasizing that while larger glands generally ease embolization, he occasionally considers PAE for smaller glands based on clinical context. Challenges associated with chronic prostatitis patients are acknowledged, with a focus on managing expectations due to a lower response rate compared to other PAE patients. Detailed insights into imaging protocols for follow-up are provided. For prostate cancer cases, Dr. Parikh recommends MRI at 6 and 12 weeks post procedure. He notes that there is notable reduction in PSA levels following PAE. Conversely, radiation prostatitis patients do not undergo post-procedural imaging unless PSA levels are detectable. As the episode concludes, Dr. Parikh highlights the future utility of PAE in prostate cancer, particularly in neoadjuvant settings before local or radiation therapy and even post radiation therapy.

24 Nov 202349min