BackTable Vascular & Interventional

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Osman Ahmed about treatment algorithms and new technologies for upper gastrointestinal (GI) bleed embolization. Dr. Ahmed is an interventional radiologist at the University of Chicago. The doctors dive into various embolization techniques, microcatheters, and embolic materials that are ideal for managing upper GI bleeds. Dr. Ahmed highlights the importance of understanding the etiology of bleeding, differences between arterial vs. venous bleeding, and first-line therapies such as endoscopy. Dr. Ahmed also discusses the utilization of new embolic materials like Obsidio Embolic, which is designed specifically for peripheral use, and its advantages in achieving rapid and complete vessel occlusion. Additionally, the doctors cover pre-procedural imaging, procedural techniques, and operator preferences for microcatheters and embolic devices. They emphasize the procedural nuances, operator comfort, and evolving technologies in the management of GI bleeds. --- CHECK OUT OUR SPONSOR Boston Scientific Obsidio Embolics https://www.bostonscientific.com/obsidio --- SHOW NOTES 00:00 - Introduction 03:29 - Discussion on Upper GI Bleeds 06:35 - Pre-Procedure Imaging for Upper GI Bleeds 11:16 - Procedure Walkthrough for Upper GI Embolization 19:51 - Understanding Mesenteric Anatomy 22:50 - Embolization Devices: Coils and More 25:31 - Exploring Obsidio: A New Embolic 32:55 - Post-Procedure Care 34:17 - Case Discussions and Final Thoughts --- RESOURCES Navigating Early Cases with the Obsidio™ Conformable Embolic - GEST 2023 Webinar with Dr. Ahmed: https://thegestgroup.com/webinar-featuring-obsidio/ BackTable VI Episode #179 - Happiness is a Warm Coil: Treating GI Bleeds with Dr. Donald Garbett: https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds BackTable VI Episode #216 - Stick It: Glue Embo with Dr. Ziv Haskal: https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo BackTable VI Episode #321 - New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler: https://www.backtable.com/shows/vi/podcasts/321/new-innovations-in-lower-gi-bleed-embolization Obsidio - Conformable Embolic: https://www.bostonscientific.com/obsidio

26 Mars 202437min

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Marcelo Guimaraes about the advantages and implementation of radial access in interventional radiology. Dr. Guimaraes is a vascular and interventional radiologist from the Medical University of South Carolina (MUSC). Dr. Guimaraes shares insights on the adoption of radial access over femoral access, emphasizing its simplicity, safety, and the clear benefits recognized by younger interventionalists. He elaborates on the importance of education, partnership with the industry, and following a standard protocol to build a successful radial access program. The doctors also cover specific topics like the RAVI Registry outcomes, patient preferences for radial access based on a study, the cost-benefit analysis, and handling various challenges such as artery spasms and loops. Dr. Guimaraes advocates for radial access as the default method for embolization therapies, highlighting its efficacy across a range of procedures and patient conditions. --- CHECK OUT OUR SPONSOR Medtronic Concerto https://mobile.twitter.com/mdtvascular --- SHOW NOTES 00:00 - Introduction 02:56 - Insights into MUSC’s Interventional Radiology Program 04:44 - Emergence of Radial Access in Interventional Procedures 07:04 - Challenges and Solutions in Setting Up a Radial Access Program 10:14 - Essential Equipment for Radial Access 22:20 - Addressing Spasm Challenges in Radial Access 30:11 - Patient Preference: Radial vs Femoral Access 32:46 - Safety and Efficacy of Radial Access: The Data 41:11 - Post-procedure Hemostasis Protocol 43:51 - Optimal Radial Artery Access Point and Best Practices --- RESOURCES How To Do The Barbeau Test - BackTable Demo: https://www.backtable.com/shows/vi/demos/how-to-do-the-barbeau-test Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis: https://pubmed.ncbi.nlm.nih.gov/27037544/ Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: Randomized Trial to Assess Patient Satisfaction (Dr. Guimaraes paper): https://pubmed.ncbi.nlm.nih.gov/29150395/ An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association: https://www.ahajournals.org/doi/full/10.1161/HCV.0000000000000035 The RAVI registry: prospective, multicenter study of radial access in embolization procedures – 30 days follow up: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10828405/

22 Mars 202451min

In this episode of BackTable Podcast, host Dr. Sabeen Dhand interviews guest Dr. Aaron Fischman about the TREAT Symposium and its evolution into TREAT Live, a platform for broadcasting live endovascular cases. Dr. Fischman is a vascular and interventional radiologist at Mount Sinai in New York. Dr. Fischman details the journey from TREAT’s inception as a conference focused on radial interventions to its current form, which includes a monthly live case streaming setup aimed at providing continuous medical education. The discussion covers the strategic shift from annual conferences to monthly live streams due to the pandemic, the logistical challenges and solutions for setting up live broadcasts, and the educational benefits of showcasing live cases, including the potential for offering CME credits. Dr. Fischman also shares insights into the selection of cases and operators, emphasizing the diversity of cases and the future direction of the program. The doctors also underscore the importance of innovation in medical education and the potential of live case broadcasts to enhance learning and improve patient care. --- CHECK OUT OUR SPONSOR Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ --- SHOW NOTES 00:00 - Introduction 01:53 - Meet Dr. Aaron Fischman: A Pioneer in Transradial Interventions 02:19 - Evolution of TREAT Symposium: From Concept to Live Cases 06:06 - TREAT Live’s Monthly Case Broadcasts 10:28 - Future of Medical Education: Live Cases and CME Credits 16:32 - Impact and Expansion of TREAT Live --- RESOURCES TREAT Live: https://treatsymposium.com/ BackTable VI Episode #30 - Transradial Access: Basic to Advanced with Dr. Aaron Fischman: https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced

20 Mars 202420min

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Neil Khilnani about the management of pelvic venous disorders, focusing on embolization practices for treating conditions such as chronic pelvic pain and pelvic venous syndrome. Dr. Khilnani is an interventional radiologist at Weill Cornell Medicine in New York Presbyterian Hospital. --- CHECK OUT OUR SPONSOR Cook Medical Embolization https://www.cookmedical.com/embobacktable --- SYNPOSIS Dr. Khilnani discusses the significance of identifying and treating venous disorders in patients with chronic pelvic pain. He emphasizes the need for a comprehensive approach that includes detailed patient history, physical exams, and imaging techniques such as ultrasound, CT, and MRI for accurate diagnosis. The doctors also cover the evolution of embolization techniques, including the use of balloon occlusion and sclerosants and they underscore the importance of addressing underlying venous insufficiencies for effective pain management. Additionally, Dr. Khilnani highlights the interconnectedness of various pelvic symptoms and the potential for embolization to alleviate not just pelvic pain, but also related conditions such as painful bladder syndrome and orthostatic hypotension. The doctors acknowledge the ongoing research and the need for collaboration across specialties to improve patient outcomes in pelvic venous disorder. --- TIMESTAMPS 00:00 - Introduction 04:44 - Pelvic Venous Disease 09:20 - Prevalence of Pelvic Venous Disease 13:54 - Challenges in Communication with Referring Doctors 18:32 - Workup and Diagnosis of Pelvic Venous Disorders 30:08 - Treatment Options and Patient Education 36:19 - Role of Social Media in Patient Support Networks 37:04 - Procedure: From Planning to Execution to Post-Intervention 54:07 - Navigating Difficult Anatomy and Potential Complications 01:02:34 - Future of Pelvic Venous Disorders Treatment: Research and Trials --- RESOURCES BackTable VI Episode 389 - Pelvic PT: An Introduction for Interventionalists with Ingrid Harm-Ernandes, PT: https://www.backtable.com/shows/vi/podcasts/389/pelvic-pt-an-introduction-for-interventionalists BackTable VI Episode 337 - Management of Vulvar Varices with Dr. Brooke Spencer: https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 1: Diagnosis and Planning with Dr. Mark Meissner and Dr. Michael Cumming: https://www.backtable.com/shows/vi/podcasts/101/pelvic-congestion-syndrome-part-1-diagnosis-planning BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 2: Technique and Follow-Up with Dr. Mark Meissner and Dr. Michael Cumming: https://www.backtable.com/shows/vi/podcasts/102/pelvic-congestion-syndrome-part-2-technique-follow-up A standardized ultrasound approach to pelvic congestion syndrome (Labropoulos et al): https://pubmed.ncbi.nlm.nih.gov/27799418/ Comparison of Fibered versus Nonfibered Coils for Venous Embolization in an Ovine Model (White et al): https://pubmed.ncbi.nlm.nih.gov/37105664/ Pelvic Venous Disorders in Women due to Pelvic Varices: Treatment by Embolization: Experience in 520 Patients (De Gregorio et al): https://www.jvir.org/article/S1051-0443(20)30534-0/abstract Improvement in chronic pelvic pain, orthostatic intolerance and interstitial cystitis symptoms after treatment of pelvic vein insufficiency (Smith et al): https://journals.sagepub.com/doi/abs/10.1177/02683555231219737 The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders: https://www.jvsvenous.org/article/S2213-333X(21)00071-8/fulltext Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel: https://pubmed.ncbi.nlm.nih.gov/30857986/ Find this episode on BackTable.com for the full list of resources.

19 Mars 20241h 9min

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ramsey Al-Hakim about the inception and journey of Auxetics, a med-tech company innovating in the vein stent market. Dr. Al-Hakim is the co-founder of Auxetics and the Section Chief of the Division of Interventional Radiology at Scripps Hospital in San Diego, CA. Dr. Al-Hakim covers the initial challenges of understanding the market and securing capital, the clinical significance of addressing stent-adjacent stenosis, and the process of developing a stent with a negative Poisson effect to counteract it. Dr. Al-Hakim highlights Auxetics' approach to combining cutting-edge interventional technologies with world-class imaging tools for enhanced procedural efficiency in venous interventions. The company’s progress through benchtop work, animal testing, and plans for first-in-human studies outside the U.S., aiming for commercialization within the next four to five years, is also outlined. Contributions from key figures in the vascular community and the role of mentorship and perseverance in navigating the complexities of medical device innovation are discussed as well. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:11 - The Market and Problem Solving 12:13 - Journey of Creating a Stent 22:28 - Birth of Auxetics 26:53 - Learning Process and Support from the University 29:16 - Building the Dream Team 33:01 - Starting a Company 36:42 - Challenges and Triumphs of Fundraising 37:44 - Current Status and Future Plans 45:32 - Importance of Community and Mentorship --- RESOURCES Auxetics: https://www.auxeticsinc.com In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction: https://pubmed.ncbi.nlm.nih.gov/34174500/ Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation: https://pubmed.ncbi.nlm.nih.gov/30717966/ The Messy Middle: Finding Your Way Through the Hardest and Most Crucial Part of Any Bold Venture: https://www.amazon.com/Messy-Middle-Finding-Through-Hardest/dp/0735218072

15 Mars 202454min

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Dean Ferrera about treating acute limb ischemia with mechanical thrombectomy. Dr. Ferrera is an interventional cardiologist at Community Care Network in northwestern Indiana. Dr. Ferrera emphasizes the importance of interdisciplinary collaboration, early detection, and selection of appropriate intervention techniques. He also discusses threading issues, bleeding complications, use of lysis, and understanding the nature of clots. He recommends thrombectomy systems such as the Pounce Thrombectomy System for removing thrombus and embolus. Furthermore, Dr. Ferrera highlights the significance of continued learning and mentorship in managing these complex conditions. --- CHECK OUT OUR SPONSOR Surmodics Pounce Thrombectomy https://pouncesystem.com/ --- SHOW NOTES 00:00 - Introduction 04:21 - Patient Presentation and Workup 09:23 - Treatment Options for Acute Limb Ischemia 17:48 - Crossing the Clot and Treatment Options 25:18 - Device Capabilities and Limitations 28:43 - Procedure Steps and Reusability 31:26 - Device Selection and Aspiration Devices 37:07 - Post-Procedure Considerations and Follow-Up 43:16 - Complications and Risk Management --- RESOURCES Pounce Thrombectomy System: https://pouncesystem.com/ Thrombus Structural Composition in Cardiovascular Disease: https://pubmed.ncbi.nlm.nih.gov/34261330/

12 Mars 202450min

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. John Qiao about exploration of physicians’ role in medical innovation, particularly among interventional radiologists. Dr. Qiao shares insightful information about the origin of RadioClash and details his journey as an entrepreneur. Through this discussion, Dr. Qiao covers the challenges encountered during the startup phase, the invention of a single-probe electroporation device, and the future applications of this novel medical technology. The episode concludes with broader advice on how to manage the demands of professional work, entrepreneurship, and personal life. --- CHECK OUT OUR SPONSORS Reflow Medical https://www.reflowmedical.com/ Medtronic Concerto https://mobile.twitter.com/mdtvascular --- SHOW NOTES 00:00 - Introduction 02:39 - Dr. Qiao’s Journey into Medicine and Entrepreneurship 11:40 - Birth of Radioclash: A Unique Solution for Cancer Treatment 17:58 - Future of RadioClash: Targeting Metastatic Cancer 25:20 - Future of Electroporation Therapy 35:21 - Challenges of Building a Company 44:37 - Path to Market and Future Plans 47:28 - Balancing Clinical Practice and Entrepreneurship --- RESOURCES RadioClash website: https://www.radioclash.co/ News Article on Dr. John Qiao: https://voyagehouston.com/interview/meet-john-qiao-m-d-of-radioclash-ltd-co/ Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086111/ The Abscopal Effect: A Reemerging Field of Interest: https://ascopost.com/issues/november-25-2018/the-abscopal-effect-a-reemerging-field-of-interest/ BackTable VI Episode #402 - Immunotherapy in HCC: Evolving Treatment Paradigms: https://www.backtable.com/shows/vi/podcasts/402/immunotherapy-in-hcc-evolving-treatment-paradigms Tavo and Pembrolizumab in Patients With Stage III/​IV Melanoma Progressing on Either Pembrolizumab or Nivolumab Treatment (Keynote-695): https://clinicaltrials.gov/study/NCT03132675 PANFIRE-3 Trial: Assessing Safety and Efficacy of Irreversible Electroporation (IRE) + Nivolumab + CpG for Metastatic Pancreatic Cancer: https://classic.clinicaltrials.gov/ct2/show/NCT04612530 Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients: https://pubmed.ncbi.nlm.nih.gov/33129427/ The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study (Northwestern study): https://pubmed.ncbi.nlm.nih.gov/21728392/ Irreversible electroporation reverses resistance to immune checkpoint blockade in pancreatic cancer: https://www.nature.com/articles/s41467-019-08782-1

8 Mars 202450min

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Andrew Sholl, who demystifies the ins and outs of percutaneous biopsies and their impact on diagnoses. Dr. Scholl is a pathologist at LCMC Health in New Orleans, Louisiana. Dr. Sholl emphasizes the importance of understanding substantial clinical history, as well as obtaining adequate and correctly processed samples. The doctors discuss the varying scenarios faced in pathology, such as instances when larger samples are beneficial and the nuances of differentiating malignancies in certain organs. They also cover detailed tips for conducting biopsies and the process of how pathologists assess patient samples. The overarching message is the importance of communication and collaboration between interventional radiologists and pathologists to ensure the best patient outcomes. --- CHECK OUT OUR SPONSOR Argon BioPince Ultra https://www.argonmedical.com/product/biopince-ultra-full-core-biopsy-instrument/ --- SHOW NOTES 00:00 - Introduction 02:38 - Understanding Pathology Training and Practice 06:07 - Role of Pathology in Medical Diagnosis 18:57 - Importance of Sample Size and Quality in Pathology 26:34 - Next Gen Sequencing and Molecular Markers 29:44 - Biopsy Devices and Their Impact on Diagnosis 37:21 - Using Clinical History in Pathology 43:16 - Challenges and Considerations in Diagnosing Renal and Hepatic Tumors 50:25 - Importance of Communication Between Pathologists and Interventional Radiologists

5 Mars 202455min