Avsnitt
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Get caught up on the current best practices and guidelines in venous interventions. Dr. Adam Raskin covers this and more, with host Dr. Sabeen Dhand in this discussion of DVT and PE treatments. Dr. Raskin is an interventional cardiologist, medical director of Cardiac ICU, and Co-Director of the PERT program at Mercy Health in Cincinnati, Ohio.
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CHECK OUT OUR SPONSOR
Imperative Care
https://imperativecare.com/vascular/
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SYNPOSIS
Dr. Raskin shares his comprehensive approach for treating patients with DVT and PE, highlighting recent advancements in thrombectomy systems, as well as underscoring the need for more randomized trials to further build on current venous disease treatment guidelines. The doctors also touch on the significance of accurate diagnostic tools and thorough follow-up to improve patient outcomes.
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TIMESTAMPS
00:00 - Introduction
10:58 - Approaching DVT & PE Patients
19:04 - Thrombectomy Advancements
24:02 - Iliofemoral Interventions & Standard Practices
26:32 - Accessing Tibial Veins & Clearing Clots
38:59 - Follow-Up & Data Collection
41:09 - Future of Venous Interventions
---
RESOURCES
The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II
Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine:
https://www.jvsvenous.org/article/S2213-333X(23)00322-0/fulltext -
In a society where discussions about medical malpractice are often concealed from the public eye, this episode of BackTable shines a spotlight on the powerful documentary ‘A World of Hurt: How Medical Malpractice Fails Everyone,’ produced by Viknesh Kasthuri, a fourth-year medical student at Brown University. Released earlier this year, the film explores how the American medical malpractice system harms and disconnects patients and providers through three compelling case studies.
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CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
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SYNPOSIS
We delve into Viknesh’s motivations and the process behind creating the documentary, discussing the need for improved provider education on lawsuits, effective communication with patients and legal teams, and strategies for coping mentally and emotionally throughout this intensive process.
Additionally, Viknesh provides a behind-the-scenes look at documentary production, including filming during the COVID pandemic, creating environments for patients and providers to share their stories, and submitting the documentary to film festivals.
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TIMESTAMPS
00:00 - Introduction
02:40 - Inspiration Behind the Documentary
06:10 - Technical and Legal Aspects of Documentary Production
14:34 - Releasing the Documentary
17:04 - Physician and Patient Responses to Medical Errors
20:27 - Highlighting Communication Resolution Programs
23:04 - Educational Gaps in Medical Training
26:43 - Exploring Systemic Solutions to Management of Medical Errors
30:16 - Final Thoughts and Future Projects
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RESOURCES
A World of Hurt Documentary:
https://www.youtube.com/watch?v=09IVcL6pACU
BackTable VI Ep. 77- Doctors and Litigation: The L Word, with Dr. Gita Pensa:
https://www.backtable.com/shows/vi/podcasts/177/doctors-litigation-the-l-word
The L Word Podcast with Dr. Gita Pensa:
https://doctorsandlitigation.com/podcast-2
BackTable ENT Ep. 90- Coaching Physicians Through the Stress of Malpractice Litigation, with Dr. Gita Pensa:
https://www.backtable.com/shows/ent/podcasts/90/coaching-physicians-through-the-stress-of-malpractice-litigation
Michigan Model Communication and Resolution Program:
https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs -
Saknas det avsnitt?
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Are you interested in starting an ASC or converting your OBL into an ASC, but aren’t sure where to start? We’ve got you covered with this comprehensive overview. Attorney Jason Greis joins guest host and ASC founder Dr. Krishna Mannava to explore the operational, financial, and legal intricacies of starting an ASC. Jason is a Partner of Benesch, Friedlander, Coplan & Aronoff LLP, outside co-counsel to the Renal Physicians Association and OEIS Society, and recognized faculty member of SIR Business Institute.
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CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
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SYNPOSIS
Jason and Dr. Mannava discuss crucial factors such as structural modifications, financial considerations, legal requirements, Certificate of Need (CON) states, and credentialing processes. The conversation also delves into strategic partnerships with hospitals, the role of ASC management companies, and the involvement of non-physician owners. Additionally, they explain the implications of non-compete clauses, operational challenges, investment structures, and exit strategies.
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TIMESTAMPS
00:00 - Introduction
03:11 - OBL to ASC Conversion
06:08 - Financial and Regulatory Aspects
15:35 - Ownership and Investment Strategies
29:41 - Non-Competes and Legal Risks
34:21 - Specialized Legal Advice and Conclusion
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RESOURCES
Vive Vascular:
https://www.vivevascular.com/
SIR Business Center:
https://irbc.sirweb.org/ -
What’s needed to build a successful lymphangiography practice? Dr. Bill Majdalany joins host Dr. Chris Beck to answer this question and to discuss advancements in lymphangiography over the past decade. Dr. Majdalany is the Chief and Vice Chair of Research of Interventional Radiology at University of Vermont.
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CHECK OUT OUR SPONSOR
Guerbet
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SYNPOSIS
The doctors provide insights on various lymphatic procedures such as thoracic duct embolization, stenting, and recanalization. They also discuss the evolving significance of lymphatic medicine in interventional radiology and its potential applications in treating conditions like ascites and variceal bleeding. The conversation underscores the interconnected nature of the lymphatic system throughout the body, emphasizing the revolutionary potential of lymphangiography in modern medicine.
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TIMESTAMPS
00:00 - Introduction
04:23 - Building a Lymphangiography Practice
08:36 - The Lymphatic Revolution
17:42 - Practical Tips and Equipment for Lymphangiography
30:09 - Advanced Interventions and Tools
48:45 - Future of Lymphatic Interventions
51:23 - Conclusion and Resources
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RESOURCES
BackTable VI Podcast Episode #135 - IR Residency Pathways & Getting In! (Part 1)
with Dr. Jeff Bodner and Dr. Bill Majdalany:
https://www.backtable.com/shows/vi/contributors/dr-bill-majdalany
Seminars in Interventional Radiology - Lymphatics:
https://www.thieme-connect.com/products/ejournals/issue/10.1055/s-010-49075
Lymphatic Anatomy:
https://www.techvir.com/article/S1089-2516(16)30042-7/abstract -
What is the final frontier of interventional radiology? Dominic Tanzillo and Dr. Richard Moon believe it could be space. Dominic is a 3rd year medical student at Duke University interested in interventional radiology (IR) and space medicine, and Dr. Moon is a Professor at Duke University and an expert in hyperbaric and aerospace medicine.
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CHECK OUT OUR SPONSOR
Medtronic DCB
https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/drug-coated-balloons.html
---
SYNPOSIS
Dominic and Dr. Moon cover the potential for IR in deep space missions, focusing on the unique challenges astronauts face, such as altered blood flow, increased clotting risks, and the impacts of microgravity on the human body. The episode dives into NASA’s investments in portable medical technologies, the practicalities of emergency medical procedures in space, and the need for minimally invasive interventions. The significance of IR in diagnosing and managing vascular issues in space is discussed, as well as the broader implications for future Mars missions and long-term space travel.
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TIMESTAMPS
00:00 - Introduction
02:36 - IR in Space
20:04 - Medical Issues Astronauts Face
26:27 - Remote Surgery and Telesurgery
30:45 - Emergency Evacuations in Space
32:32 - More on Space Medicine
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RESOURCES
Aerospace Medicine Association:
https://www.asma.org/about-asma/careers/aerospace-medicine
Translational Research Institute for Space Health:
https://www.bcm.edu/academic-centers/space-medicine/translational-research-institute
Space Medicine Coursera:
https://www.coursera.org/learn/space-medicine-duke
What Space Medicine Taught Me About Science Communication | Dominic Tanzillo | TEDxDuke:
https://www.youtube.com/watch?v=PBkdvSByneM
Dominic Tanzillo:
https://dominictanzillo.github.io/ -
While GLP-1 agonists continue to gain popularity in the medical management of diabetes and obesity, Dr. Cliff Weiss is exploring bariatric arterial embolization (BAE) as an adjunctive therapy to help patients sustain weight loss. Dr. Weiss, the Director of IR Research at Johns Hopkins, joins the show to discuss the techniques and impacts of BAE for obesity treatment.
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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SYNPOSIS
Dr. Weiss outlines his initial research interest in gastric embolization of the fundus to reduce ghrelin production. He began by studying the use of sclerosants for embolization but later shifted to using embolic spheres. BAE involves the targeted embolization of the left gastric artery, with or without the left gastroepiploic artery, using 300-500 micron embolic spheres. Dr. Weiss also employs a dilute mixture of spheres and a vasodilator to achieve distal arterial penetration.
He describes the role of BAE in conjunction with existing surgical and pharmaceutical treatments. According to his experience, patients undergoing BAE achieve maximum weight loss 6-9 months after the procedure and can maintain this weight when they follow up in a weight management clinic. Additionally, Dr. Weiss reviews data from BAE studies, including the BEAT Obesity Trial and the recent BEATLES Trial.
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TIMESTAMPS
00:00 - Introduction
03:21 - Early Research and Development of BAE
07:39 - Potential Role of BAE in Obesity Treatment
16:03 - Procedure Details
25:28 - Post-Procedure Care and Patient Management
28:06 - Insights from the BEAT Obesity Trial
33:38 - BEATLES Trial
37:38 - Combination Therapy for Obesity
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RESOURCES
BEAT Obesity Trial:
https://pubs.rsna.org/doi/full/10.1148/radiol.2019182354
LC Bead/Bead Block:
https://www.bostonscientific.com/en-US/products/embolization/lc-bead.html
EmboSpheres:
https://www.merit.com/product/embosphere-microspheres/
EMBIO Trial:
https://bmjopen.bmj.com/content/13/9/e072327
BEATLES Trial:
https://www.jvir.org/article/S1051-0443(23)01155-7/fulltext -
How can physicians and industry partners collaborate effectively to enhance patient care? Dr. Adam Tanious, Assistant Professor of Vascular Surgery at the Medical University of South Carolina, joins host Dr. Aaron Fritts to explore strategies for navigating physician-industry relationships.
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SYNPOSIS
The doctors share their experiences in partnering with the medical device industry. The conversation covers the benefits of industry partnerships, the challenges of avoiding conflicts of interest, and the critical role of education in preparing new physicians for these interactions. Dr. Tanious also delves into his thought-provoking TED Talk on big business in surgery, and discusses the value of business education for physicians.
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TIMESTAMPS
00:00 - Introduction
02:12 - Medicine and Business
05:01 - Business Knowledge for Physicians
15:05 - Physician-Industry Relationships
27:26 - Industry Relationships in Medical Training
33:08 - Ethical Considerations and Influence in the OR
35:00 - Leveraging Industry Resources for Better Training
43:24 - Future of Medical Technology and Collaboration
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RESOURCES
Big Business and Surgery: Who Belongs in Your Operating Room?:
https://youtu.be/kksVjF0fI_w?si=LADwqrbXPz3VsFm4
Quantic MBA Program:
https://quantic.edu/blog/category/fields-of-study/accounting/
The price of a cup of coffee:
https://vascularspecialistonline.com/the-price-of-a-cup-of-coffee/ -
The management of portal hypertension has drastically evolved over the years. What are the current best practices? And what’s coming next? Dr. Tom Leventhal and Dr. Siobahn Flanagan from University of Minnesota Medical School join us for an interdisciplinary discussion. Dr. Leventhal is an Associate Professor of Transplant Hepatology and Dr. Siobhan is an Associate Professor of Interventional Radiology.
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CHECK OUT OUR SPONSOR
Cook Medical Embolization
https://www.cookmedical.com/interventional-radiology/coils-home/cook-products/?utm_source=backtable&utm_medium=digital&utm_campaign=vasc_ir_p_awa_embolization_2024_amer
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SYNPOSIS
The doctors discuss current collaborative approaches that are improving portal hypertension patient care, the impact of contemporary clinical practices in transplant hepatology and IR, and the imminent future of portal hypertension treatments. Dr. Leventhal also gives his insight on what could be on the horizon, touching on in-vitro organ creation, xenotransplants, and stem cells phasing out immunosuppression.
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TIMESTAMPS
00:00 - Introduction
06:10 - Managing Portal Hypertension
07:51 - Current Collaborative Practices
10:38 - Patient Referral and Management
15:25 - Initial Workup for Portal Hypertension
19:27 - Role of Biopsy in Diagnosis
24:02 - Patient Scenarios for TIPS Referral
32:04 - Ultrasound and Intracardiac Echocardiography (ICE) in TIPS
38:09 - Clinical Management
52:48 - Future of Transplant and Organ Growth -
We are back with Part 2 of All Things Enteral Access with Dr. Peter Bream! We discuss various aspects of enteric access and management of complications with G and GJ-tubes.
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SYNPOSIS
Dr. Bream provides detailed advice on troubleshooting common issues such as leaking tubes, infections, and clogs. He emphasizes the importance of a multidisciplinary approach in managing special populations, such as patients with ALS and head and neck cancer, and offers guidance for safe and effective procedures. The conversation is rich with practical tips, tricks, and valuable insights that cater to both new and experienced practitioners.
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TIMESTAMPS
00:00 - Introduction
01:47 - Special Populations
07:21 - ALS Patients
09:57 - Head and Neck Cancer Patients
14:05 - Techniques for Gastric Bypass and Altered Anatomy
18:11 - Addressing G-Tube Issues
27:16 - Converting G to GJ-Tubes
31:11 - Advanced Tips and Tricks
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RESOURCES
Weighted Tip Extensions Result in Fewer Gastrojejunostomy Tube Migrations and Increase Tube Lifespan:
https://www.jvir.org/article/S1051-0443(22)01243-X/abstract -
Do you have questions about enteral access? Dr. Peter Bream’s got you covered! In this episode Dr. Bream, former Professor at UNC Chapel Hill School of Medicine and current private practice interventional radiologist, shares his extensive knowledge on enteral access.
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CHECK OUT OUR SPONSOR
Medtronic Concerto
https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/concerto.html
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SYNPOSIS
The discussion covers various insertion techniques, the use of different types of tubes including NG, G, and GJ tubes, and specialized methods like the Balloon-Assisted Gastrostomy (BAG) and Percutaneous Transesophageal Gastrostomy (PTEG). Dr. Bream also provides valuable insights on handling complications, patient preparation, and post-procedure care, making this episode a comprehensive guide for all things enteral access. Be sure to check out Part 2 next.
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TIMESTAMPS
00:00 - Introduction
03:00 - Tubes for Enteral Access
15:48 - Techniques and Personal Experiences
29:59 - Limitations and Techniques for Stroke Patients
30:45 - Patient Comfort and Sedation
37:16 - Complications and Safety Measures
39:14 - Palliative Techniques and Special Cases
49:49 - Post-Procedure Care and Maintenance
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RESOURCES
Percutaneous gastrostomy:
https://pubmed.ncbi.nlm.nih.gov/6414043/
Retrospective comparison of outcomes and associated complications between large bore radiologically inserted gastrostomy tube types:
https://pubmed.ncbi.nlm.nih.gov/30073401/
Single-Step Method for Pull-Type Gastrostomy Tube Placement:
https://pubmed.ncbi.nlm.nih.gov/31542269/
Balloon Assisted Gastrostomy (BAG) YouTube Video:
https://youtu.be/GuF7BYW2Hm0?si=6xUIDQaQV-ywX1ua
IR Playbook: A Comprehensive Introduction to Interventional Radiology (1st edition):
https://link.springer.com/book/10.1007/978-3-319-71300-7
IR Playbook: A Comprehensive Introduction to Interventional Radiology Second Edition 2024:
https://link.springer.com/book/10.1007/978-3-031-52546-9
Pediatric gastrostomy tubes and techniques: making safer and cleaner choices:
https://pubmed.ncbi.nlm.nih.gov/29180216/ -
The use of drug-coated balloons (DCBs) for peripheral arterial disease has been controversial in the past. However, new data and updated FDA guidance have helped these devices regain popularity. In this episode of the BackTable Podcast, Dr. Ally Baheti hosts a discussion with Dr. Sahil Parikh, an interventional cardiologist in New York City, and Dr. John Park, a vascular surgeon in Omaha.
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CHECK OUT OUR SPONSOR
BD Lutonix
https://www.bd.com/en-us/products-and-solutions/products/product-families/lutonix-drug-coated-balloon-pta-catheters
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SYNPOSIS
They review the historical controversy surrounding the potential late-mortality risks associated with Paclitaxel-coated devices, discuss more recent literature on the safety and efficacy of DCBs, and examine the implications of the FDA’s updated guidance in 2023. This update was made possible through collaborative efforts across specialties and regulatory bodies to establish best practices for vascular interventions. They also delve into patient selection criteria, lesion characteristics, and practical considerations for choosing between DCBs and other revascularization options. Each provider shares their treatment algorithm for DCB use in peripheral arterial disease.
Dr. Park uses DCBs as a first-line treatment for patients with complete occlusions, CLTI symptoms, or lifestyle-limiting claudication, with adjunctive stenting sometimes required afterwards. In his experience, DCBs work best in lesions shorter than 100 mm and are preferable in locations where stenting is not feasible, such as across the knee joint.
Dr. Parikh similarly prefers DCBs over plain balloon angioplasty and places stents in longer lesions. He notes that Hunter’s canal is a challenging area to treat with DCBs alone and may require atherectomy or intravascular lithotripsy. He recommends considering drug-eluting stents as a proactive measure to prevent more costly interventions for future restenosis.
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TIMESTAMPS
00:00 - Introduction
02:14 - History of DCB and Controversy
07:46 - Updated Research and 2023 FDA Guidelines
16:44 - Importance of Collaboration and Patient Preference
26:34 - DCB Treatment Algorithms
33:31 - Drug-Eluting Stents
35:46 - Approach for Patients with Claudication
37:22 - DCB Sizing and Dose
---
RESOURCES
Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (2018):
https://www.ahajournals.org/doi/10.1161/JAHA.118.011245
FDA- Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality–Letter to Health Care Providers (2018):
www.fda.gov/medical-devices/letters-health-care-providers/update-treatment-peripheral-arterial-disease-paclitaxel-coated-balloons-and-paclitaxel-eluting
FDA- Paclitaxel-Coated Devices to Treat Peripheral Arterial Disease Unlikely to Increase Risk of Mortality - Letter to Health Care Providers (2023): https://www.fda.gov/medical-devices/letters-health-care-providers/update-paclitaxel-coated-devices-treat-peripheral-arterial-disease-unlikely-increase-risk-mortality
Mortality in randomised controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis (2023):
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02189-X/abstract -
Creating an ambulatory surgery center (ASC) with transparent, affordable pricing is possible and can go a long way in protecting our patients’ health, pockets, and futures. Dr. Keith Smith, founder of Oklahoma Surgery Center and the Free Market Medical Association, joins us to explain how to do it.
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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SYNPOSIS
Dr. Smith shares his journey of creating transparent and affordable healthcare pricing, the challenges faced due to government regulations and insurance companies, and the rapid growth of self-funded companies seeking value in medical services. He highlights the importance of simple, honest pricing and the impact of the Free Market Medical Association in connecting buyers and sellers. Dr. Smith also discusses the expansion of his model beyond Oklahoma and into new surgical centers, emphasizing the need for price transparency in healthcare.
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TIMESTAMPS
00:00 - Introduction
05:06 - Challenges & Growth
14:18 - Self-Funding & Price Transparency
16:47 - Free Market Medical Association
21:44 - Government & Price Transparency
26:19 - Expansion & Future Plans
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RESOURCES
Oklahoma Surgery Center:
https://surgerycenterok.com/
Free Market Medical Association:
https://fmma.org/ -
How has Laser Atherectomy advanced over the years to treat patients with coronary and peripheral artery disease? Dr. On Topaz, renowned specialist in laser atherectomy, answers exactly that and much more in this week’s episode the BackTable Podcast. Dr. Topaz is an interventional cardiologist and a professor of medicine at Duke University.
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CHECK OUT OUR SPONSOR
AngioDynamics Auryon System
https://www.auryon-system.com/
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SYNPOSIS
The doctors begin their discussion by comparing traditional Excimer laser and new Auryon laser technologies. The conversation also covers thrombus management, use of lasers in complex plaques, the latest research studies on laser atherectomy, and future developments in laser technology for varied medical applications.
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TIMESTAMPS
00:00 - Introduction
10:01 - Laser Atherectomy & Thrombus Management
21:59 - Laser Applications in Peripheral Arterial Disease
28:12 - Laser in Interventional Cardiology
41:17 - New Laser Technologies
47:50 - Research Findings and Clinical Trials
59:09 - Future Prospects and Applications
---
RESOURCES
Book by Dr. On Topaz - Debulking in Cardiovascular Interventions and Revascularization Strategies:
https://www.sciencedirect.com/book/9780128214510/debulking-in-cardiovascular-interventions-and-revascularization-strategies
Book by Dr. On Topaz - Lasers in Cardiovascular Interventions:
https://link.springer.com/content/pdf/10.1007/978-1-4471-5220-0.pdf
Book by Dr. On Topaz - Cardiovascular Thrombus: From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions:
https://www.sciencedirect.com/book/9780128126158/cardiovascular-thrombus
Paper from Dr. Giancarlo Biamino - The excimer laser: science fiction fantasy or practical tool?:
https://pubmed.ncbi.nlm.nih.gov/15760264/
Clinical Trial from Dr. John Bittl - Predictors of outcome of percutaneous excimer laser coronary angioplasty of saphenous vein bypass graft lesions. The Percutaneous Excimer Laser Coronary Angioplasty Registry:
https://pubmed.ncbi.nlm.nih.gov/8023778/
Paper from Dr. Warren S. Grundfest - https://journals.lww.com/coronary-artery/citation/1990/07000/laser_angioplasty.4.aspx
Paper from Dr. George S. Abela - Abrupt Closure After Pulsed Laser Angioplasty: Spasm or A “Mille-Feuilles” Effect?:
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1540-8183.1992.tb00830.x
Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry:
https://pubmed.ncbi.nlm.nih.gov/38566525/ -
Bringing more interventional radiology to rural America would benefit many patients who currently do not have access to minimally invasive, image guided medicine. In today's episode, Dr. Frederick Johnson, an interventional radiologist practicing in Thomasville, Georgia joins us to discuss the unique dynamics and challenges of setting up and maintaining a successful rural IR practice.
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CHECK OUT OUR SPONSOR
Medtronic ClosureFast
https://www.medtronic.com/us-en/c/cardiovascular/closurefast-rfa-system.html
---
SYNPOSIS
Dr. Johnson provides insights into the professional service agreement (PSA) model that allows his practice to maintain autonomy while collaborating with the local hospital. The episode explores the complexities of recruiting to a rural setting, maintaining a broad case mix, ensuring financial stability, and fostering professional satisfaction. The conversation highlights the importance of redefining independence and the benefits of integrating collaboration into IR practices.
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TIMESTAMPS
00:00 - Introduction
02:29 - Dr. Johnson’s Background and Journey
11:46 - Professional Service Agreement (PSA) Explained
18:48 - Daily Operations and Structure
24:19 - Teamwork in Rural Healthcare
30:35 - Recruitment and Growth
33:33 - Compensation and Financial Incentives
42:05 - Benefits of Small Town Living
44:34 - Advice for Aspiring Rural Healthcare Practitioners
---
RESOURCES
Vita Surgery/Vascular Website:
https://vitadr.org/ -
Ever wonder what it’s like to practice interventional radiology down under? Dr. Chris Rogan joins us on the BackTable Podcast this week to tell us about his IR practice in Australia, with special emphasis on healthcare system and interventional practice model differences between our two countries.
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SYNPOSIS
We cover a wide range of topics, including the differences in IR training pathways between Australia and the U.S., the impact of healthcare models on IR practice, and the cooperation between public and private healthcare. We also highlight the urgent need for more IR specialists in Australia. Additionally, the doctors explore the challenges of public awareness, interdisciplinary and global collaboration, and the ongoing efforts by the Interventional Radiology Society of Australasia (IRSA) to promote IR through public outreach and educational strategies.
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TIMESTAMPS
00:00 - Introduction
04:08 - Australia vs. US Healthcare Systems
08:21 - Compensation and Career Mobility
16:52 - IR Public Awareness and Marketing
25:56 - Global Collaboration and Conferences
30:53 - Travel Tips for Australia
---
RESOURCES
Dr. Chris Rogan’s practice:
https://drrogan.com/
Interventional Radiology Society of Australasia (IRSA):
https://irsa.com.au/
IRSA 2024 Annual Meeting:
https://irsa.com.au/education-events/irsa-annual-scientific-meeting-2024/ -
Superficial venous disease can pose significant management challenges, particularly after patients have exhausted conservative and invasive therapies. This week, our host, Dr. Sabeen Dhand, interviews Dr. Ali Golshan, an interventional radiologist and the founder of SOLVEIN. Dr. Golshan discusses the latest advancements in treating superficial venous disease, highlighting both the benefits and complexities of thermal and non-thermal ablation techniques.
---
CHECK OUT OUR SPONSOR
BD Advance Clinical Training & Education Program
https://page.bd.com/Advance-Training-Program_Homepage.html
---
SYNPOSIS
Dr. Golshin introduces SOLVEIN, his innovative medical device designed to address these challenges. The conversation also includes practical tips for managing patients with venous insufficiencies, along with insights into the entrepreneurial journey involved in developing a new medical device.
---
TIMESTAMPS
00:00 - Introduction
02:02 - Defining Superficial Venous Disease
05:43 - Diagnostic Techniques and Imaging
08:29 - Current Treatment Options for Venous Insufficiency
20:07 - Introducing SOLVEIN
29:42 - FDA Approval Pathway
33:37 - Advice for Aspiring Medical Entrepreneurs
---
RESOURCES
Dr. Ali Golshan’s Practice:
https://www.beachwellnessmd.com/ -
Dr. Venkatesh Krishnasamy shares techniques and specific cases for challenging lung biopsies, his insights on mentorship, importance of multidisciplinary tumor boards, and the evolution of lung biopsy practices. Dr. Krishnasamy is an interventional radiologist and Director of Interventional Oncology at the University of Alabama Birmingham.
---
CHECK OUT OUR SPONSOR
Merit Biopsy Solutions
https://www.merit.com/solutions/biopsy-solutions/
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SYNPOSIS
The doctors cover practical advice on handling complications like pneumothorax and hemoptysis, and share strategies for optimizing workflows to improve patient outcomes. Dr. Krishnasamy encourages listeners to leverage mentor experience and partake in continued learning to advance their practice.
---
TIMESTAMPS
00:00 - Introduction
05:16 - Lung Biopsy Referrals and Multidisciplinary Approach
12:03 - Complex Lung Biopsies
25:43 - Needle Position Verification
27:29 - Importance of Cytopathologist Presence
28:51 - Blood Patching vs. Plug Technique
33:54 - Post-Procedure Protocols
36:15 - Advanced Techniques and Mentorship
44:26 - Handling Hemoptysis During Biopsies
47:50 - Encouragement for Trainees
---
RESOURCES
Society of Interventional Oncology:
https://www.sio-central.org/
BackTable VI Podcast Episode #278 - Minimizing Complications for Lung Biopsies with Dr. Robert Suh:
https://www.backtable.com/shows/vi/podcasts/278/minimizing-complications-for-lung-biopsies
BackTable VI Podcast Episode #156 - Percutaneous Lung Biopsies: The Basics with Dr. Fred Lee (Part 1 of 2):
https://www.backtable.com/shows/vi/podcasts/156/percutaneous-lung-biopsies-the-basics
BackTable VI Podcast Episode #157 - Percutaneous Lung Biopsies: Pleural & Parenchymal Blood Patching with Dr. Fred Lee (Part 2 of 2):
https://www.backtable.com/shows/vi/podcasts/157/percutaneous-lung-biopsies-pleural-parenchymal-blood-patching -
In this episode, Dr. Alexander Vezeridis discusses advanced biliary interventions; covering stone removal procedures, technical success rates, and practical tips for using Spyglass cholangioscopy, laser lithotripsy, and endobiliary ablation. Dr. Vezeridis is an interventional radiologist, physician-scientist, and Assistant Professor of Radiology at Stanford.
---
CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
---
SYNPOSIS
Dr. Vezeridis highlights the importance of continuous learning, collaboration with other specialties, and shares his experiences and tips for optimizing patient outcomes. The doctors also touch on innovative approaches such as photodynamic therapy and the use of various tools in managing benign and malignant biliary diseases.
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TIMESTAMPS
00:00 - Introduction
03:25 - Setting Up Spyglass in Your Practice
10:50 - Patient Selection and Procedure Details
24:27 - Stone Fragmentation Techniques
27:35 - Success Rates and Patient Outcomes
35:06 - Endobiliary Ablation Techniques
47:35 - Laser Treatment for Biliary Obstructions
49:18 - Future Innovations
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RESOURCES
BackTable VI Podcast Episode #146 - Spyglass Interventions with Dr. Jeffrey Chick and Dr. Ravi Srinivasa:
https://www.backtable.com/shows/vi/podcasts/146/spyglass-interventions
Spyglass - Boston Scientific:
https://www.bostonscientific.com/en-US/medical-specialties/gastroenterology/advancements-cholangioscopy.html
Percutaneous Gallstone Removal: Long-term Follow-up (Dr. Hovsepian Paper):
https://www.jvir.org/article/S1051-0443(96)70766-2/pdf
SIR’s Percutaneous Cholangiopancreatoscopy (PCPS) registry:
https://clinicaltrials.gov/study/NCT05210322
StarMed Endoscopic RFA Clinical Articles:
https://www.starmedacademy.com/endoscopic-rfa-clinical-articles-elra
Habib Endobiliary Ablation Catheter:
https://www.bostonscientific.com/en-US/products/rf-ablation/habib-endohpb-bipolar-radiofrequency-catheter.html
Interventional Radiology-Operated Choledochoscopic-Guided Radiofrequency Wire and Holmium Laser Ablations May Facilitate Treatment and Long-Term Patency of Benign Biliary Strictures:
https://www.jvir.org/article/S1051-0443(18)31535-5/abstract
Percutaneous Cholangioscope-Assisted Laser Incision of Severe Benign Hepaticojejunostomy Stenoses:
https://pubmed.ncbi.nlm.nih.gov/35504434/
Percutaneous Endoluminal Benign Biliary Laser (PEBBL) (Clinical Trial):
https://clinicaltrials.gov/study/NCT05567003 -
In this episode of the Back Table Podcast, interventional radiologist Dr. Noor Ahmad discusses his algorithm for complex inferior vena cava (IVC) filter retrievals and reviews several cases that utilize various retrieval tools.
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CHECK OUT OUR SPONSOR
Argon Medical
http://www.argonmedical.com/
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SYNPOSIS
Dr. Ahmad emphasizes that most patients are referred by physicians with whom he maintains good relationships, and both specialties jointly monitor patients after IVC filters are placed. Generally, it is ideal to remove IVC filters around the 3-month mark, with filters in place for over 6 months posing a higher risk of requiring complex retrieval. For preoperative evaluation, obtaining a history of the filter type and placement date, along with CT scans (non-contrast and venogram), is crucial. Anticoagulation is typically discontinued two days prior to retrieval.
During the procedure, moderate sedation and internal jugular access are used. However, complex retrievals may necessitate general anesthesia and access through the femoral vein or dual sites. The initial device employed is usually the CloverSnare to hook and extract the IVC filter. If unsuccessful, Dr. Ahmad proceeds with techniques such as the hangman (modified loop snare), endobronchial forceps, and finally the CavaClear laser sheath. He highlights that particularly challenging cases might require collaboration with colleagues, especially when dual access is needed, possibly requiring rescheduling for general anesthesia availability. Patient safety is emphasized in these scenarios. Lastly, Dr. Ahmad presents past cases with imaging to illustrate various retrieval methods.
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TIMESTAMPS
00:00 - Introduction
03:29 - Referrals and Tracking for Filter Removal
08:49 - Working Up Complex Cases
13:19 - Patient Selection
20:14 - Procedure Walkthrough
23:22 - Different Strategies for Filter Removal
31:23 - Laser Techniques
34:47 - Sheath Sizing
36:06 - Enhancing Patient Safety
43:34 - Cheat Sheet for IVC Filters and Case Studies
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RESOURCES
BackTable Ep. 204- Filter Indications and Filter Tracking: Up Your Game with Dr. Stephen Wang:
https://www.backtable.com/shows/vi/podcasts/204/filter-indications-filter-tracking-up-your-game
BackTable Ep. 339- The Importance of a Multidisciplinary Filter Retrieval Program with Dr. Robert Ryu, Dr. Warren Clements, and Dr. Premal Trivedi:
https://www.backtable.com/shows/vi/podcasts/339/the-importance-of-a-multidisciplinary-filter-retrieval-program -
Dr. Sameh Sayfo discusses advanced techniques in radial to peripheral (R2P) interventions, the importance of having multiple techniques, the role of different devices, troubleshooting tips, and the evolving landscape of R2P interventions. Dr. Sayfo is an interventional cardiologist at the Baylor Heart Hospital, and serves as program director for the endovascular fellowship and pulmonary embolism response team (PERT) program.
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CHECK OUT OUR SPONSOR
AngioDynamics Auryon System
https://www.auryon-system.com/
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SYNPOSIS
Dr. Sayfo shares his experience and insights on using various devices, such as the new Auryon laser, for treating peripheral arterial disease (PAD).Additionally, the doctors address the benefits of radial access over traditional femoral approaches, patient selection, and procedural planning. Listeners are encouraged to adopt a flexible approach and learn from each other’s experiences to improve patient outcomes.
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TIMESTAMPS
00:00 - Introduction
05:24 - Incorporating Radial into Peripheral Practice
11:19 - Right vs. Left Radial Access
20:01 - Room Setup and Procedure Planning
25:13 - Radial vs. Femoral Access
33:01 - Advancements in Laser Atherectomy
41:33 - Laser Atherectomy Tips
45:52 - Advantages of Radial Access in Specific Cases
51:33 - Post-Op Care and Best Practices
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RESOURCES
BackTable VI Podcast Episode #30 - Transradial Access Basic to Advanced with Dr. Aaron Fischman:
https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced
BackTable VI Podcast Episode #148 - Radial vs. Femoral for Prostate Artery Embolization with Dr. Blake Parsons:
https://www.backtable.com/shows/vi/podcasts/148/radial-vs-femoral-for-prostate-artery-embolization
BackTable VI Podcast Episode #342 - Radial Access for PAD with Dr. Rami Tadros:
https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad
BackTable VI Podcast Episode #395 - Radial to Peripheral Tools & Technique with Dr. Sameh Sayfo:
https://www.backtable.com/shows/vi/podcasts/395/radial-to-peripheral-tools-technique
BackTable VI Podcast Episode #443 - Innovative Approaches in Radial to Peripheral Interventions with Dr. Amit Srivastava:
https://www.backtable.com/shows/vi/podcasts/443/innovative-approaches-in-radial-to-peripheral-interventions
BackTable VI Podcast Episode #390 - Laser Atherectomy: An Overview of the Pathfinder Registry with Dr. Tony Das:
https://www.backtable.com/shows/vi/podcasts/390/laser-atherectomy-an-overview-of-the-pathfinder-registry
BackTable VI Podcast Episode #408 - Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas:
https://www.backtable.com/shows/vi/podcasts/408/laser-btk-study-insights-navigating-complex-lesions
Safety and efficacy of radial artery access for peripheral vascular intervention: a single center experience:
https://www.ajconline.org/article/S0002-9149(24)00461-2/abstract
Comparative Outcomes of Interventions for Femoropopliteal Chronic Total Occlusion Versus Non-Chronic Total Occlusion Lesions From the Multicenter XLPAD Registry:
https://pubmed.ncbi.nlm.nih.gov/37318023/
Prospective, Multi-center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries in Patients With Chronic Limb-Threatening Ischemia: 30-Day Results of the Auryon BTK:
https://pubmed.ncbi.nlm.nih.gov/38458581/
Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions:
https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext
Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry:
https://pubmed.ncbi.nlm.nih.gov/38566525/
SCAI Expert Consensus Statement Update on Best Practices for Transradial Angiography and Intervention:
https://scai.org/publications/clinical-documents/scai-expert-consensus-statement-update-best-practices-transradial - Visa fler
