Avsnitt
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In this episode, Dr. Paul Lewis discusses best practices for thoracentesis. He shares insights on using image guidance, managing complex effusions, and managing complications such as pneumothorax and hemothorax. Dr. Lewis is an interventional radiologist at the University of Pittsburgh Medical Center.
---
CHECK OUT OUR SPONSOR
Laborie RenovaRP Centesis System
https://www.laborie.com/product/renovarp-products/
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SYNPOSIS
Dr. Lewis also speaks on patient selection, procedural techniques, equipment choices, and other troubleshooting tips. Additionally, the doctors cover procedural nuances such as bilateral thoracentesis and patient positioning and highlight the efficiency of the RenovaRP Centesis System.
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TIMESTAMPS
00:00 - Introduction
06:07 - Thoracentesis Procedure Walkthrough
16:49 - Equipment Used
22:14 - Troubleshooting
30:56 - Post-Procedural Care
36:12 - Complications
48:07 - Helpful Resources
---
RESOURCES
Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety:
https://pubmed.ncbi.nlm.nih.gov/38042055/
Paracentesis: Faster and easier using the RenovaRP® pump:
https://pubmed.ncbi.nlm.nih.gov/35548901/
Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations:
https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext
The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/31711990/ -
In this episode, Dr. Paul Lewis discusses best practices for thoracentesis. He shares insights on using image guidance, managing complex effusions, and managing complications such as pneumothorax and hemothorax. Dr. Lewis is an interventional radiologist at the University of Pittsburgh Medical Center.
---
CHECK OUT OUR SPONSOR
Laborie RenovaRP Centesis System
https://www.laborie.com/product/renovarp-products/
---
SYNPOSIS
Dr. Lewis also speaks on patient selection, procedural techniques, equipment choices, and other troubleshooting tips. Additionally, the doctors cover procedural nuances such as bilateral thoracentesis and patient positioning and highlight the efficiency of the RenovaRP Centesis System.
---
TIMESTAMPS
00:00 - Introduction
06:07 - Thoracentesis Procedure Walkthrough
16:49 - Equipment Used
22:14 - Troubleshooting
30:56 - Post-Procedural Care
36:12 - Complications
48:07 - Helpful Resources
---
RESOURCES
Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety:
https://pubmed.ncbi.nlm.nih.gov/38042055/
Paracentesis: Faster and easier using the RenovaRP® pump:
https://pubmed.ncbi.nlm.nih.gov/35548901/
Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations:
https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext
The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/31711990/ -
Saknas det avsnitt?
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In this episode, Dr. Ally Baheti interviews interventional radiologist Dr. Lorenzo Patrone about his recent multidisciplinary editorial entitled "The 'Woundosome' Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia.”
---
CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
---
SYNPOSIS
Dr. Patrone explains his interest in critical limb ischemia (CLI) and describes how he reached out to colleagues around the world with the intention of drafting a paper that summarizes research in below-the-ankle interventions and increases awareness of the woundosome concept.
He explains the woundosome concept, which aims to understand how each patient’s foot vasculature influences the effectiveness of below-the-ankle interventions and tissue healing. Understanding each patient’s anatomy, having adequate imaging of the foot, obtaining pedal acceleration times, and using micro-oxygen sensors are strategies to assess wound perfusion, which is integral for treatment planning and prognosis. He illustrates these techniques in a case study of a non-healing wound.
Finally, Dr. Patrone shares some technical tips for below-the-ankle interventions, including the benefits of ipsilateral antegrade access, sheath selection, and strategic contrast administration.
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TIMESTAMPS
00:00 - Introduction
02:25 - Multidisciplinary and Global Collaboration
05:59 - Explaining the Woundosome Concept
07:51 - Understanding Wound Perfusion
10:20 - Assessing the Effectiveness of Revascularization
20:09 - Case Example with Pictures
28:07 - Technical Tips for CLI Interventions
---
RESOURCES
Find Your Algorithm (FYA):
https://fya-congress.com/
The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia:
https://journals.sagepub.com/doi/10.1177/15266028241231745?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Vascular imaging of the foot: the first step toward endovascular recanalization (Manzi):
https://pubmed.ncbi.nlm.nih.gov/21997985/
BASIL-2 Trial:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00462-2/fulltext
BackTable VI Ep. 90- Pedal Acceleration Time for Limb Salvage with Jill Sommerset and Dr. Mary Constantino:
https://www.backtable.com/shows/vi/podcasts/90/pedal-acceleration-time-for-limb-salvage
The First-in-Man "Si Se Puede" Study for the use of micro-oxygen sensors (Montero-Baker):
https://pubmed.ncbi.nlm.nih.gov/26004327/
PEDRA Perfusion Monitoring:
https://www.pedratech.com/
Armada XT Balloon:
https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/peripheral-dilatation-catheters/armada-14.html -
In this episode of the BackTable Podcast, vascular surgeon Dr. Nicolas Mouawad and interventional radiologist Dr. Raja Ramaswamy share their insights on the changing landscape of deep vein thrombosis (DVT) management, steps of mechanical thrombectomy, and current research on DVT interventions.
---
CHECK OUT OUR SPONSOR
Inari Medical
https://www.inarimedical.com/
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SYNPOSIS
The guests start by describing their typical referral patterns, noting that most cases come through the emergency department. In terms of workup, it is important to distinguish between acute and chronic DVTs and classify the thrombosis location as either proximal (femoral vein or higher) or distal. Anticoagulation, usually with direct oral anticoagulants, is always started, with efficacy largely determined by patient compliance.
Regarding endovascular intervention, thrombolysis may be an effective adjunctive treatment if the clot occurred within a two-week timespan, but it carries a bleeding risk and requires ICU monitoring. On the other hand, mechanical thrombectomy is an option for both acute and chronic clots, allows for intervention in patients with high bleeding risk, and does not require post-procedural hospitalization. Both physicians emphasize that interventions should be employed if there are long-term benefits of avoiding post-thrombotic syndrome and pulmonary embolism.
The physicians walk through a typical mechanical thrombectomy procedure, which involves the thrombectomy device, venogram, intravascular ultrasound, and possible stent placement. Finally, they discuss recent data, including the ATTRACT Trial for thrombolytics and the CLOUT Registry and Trial for ClotTriever use. Notably, they mention the DEFIANCE Trial as a current prospective randomized clinical trial for ClotTriever use in the iliofemoral region.
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TIMESTAMPS
00:00 - Introduction
03:48 - DVT Referral Patterns and Treatment Algorithms
08:55 - Choosing an Anticoagulation Regimen
11:01 - DVT Interventions
13:54 - Patient Scenarios and Treatment Decisions
22:29 - Post-Thrombotic Syndrome
26:16 - Mechanical Thrombectomy Technique
35:45 - Postoperative Care
39:09 - The Evolution of Mechanical Thrombectomy
43:38 - ATTRACT Trial
46:20 - CLOUT Trial
---
RESOURCES
Inari ClotTriever System:
https://www.inarimedical.com/clottriever-system
ATTRACT Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa1615066
CLOUT Trial:
https://pubmed.ncbi.nlm.nih.gov/35218955/
DEFIANCE Trial:
https://evtoday.com/news/inari-medical-begins-defiance-randomized-clinical-trial-of-clottriever-system-in-dvt -
Trigger warning: This episode contains discussions about suicide.
In this episode of the BackTable podcast, interventional radiologist Dr. Jenanan Vairavamurthy shares about the tragic loss of his physician brother to suicide and discusses his own mental health journey. He highlights the immense pressures and challenges that medical training and practice impose on providers.
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SYNPOSIS
The discussion emphasizes the need for mental health awareness and the importance of creating supportive environments within the medical community. He advocates for open conversations about mental health struggles and urges those in leadership positions to prioritize the well-being of colleagues and trainees. This powerful conversation aims to destigmatize mental health issues in the medical field and encourages medical providers to seek and provide support for each other.
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TIMESTAMPS
00:00 Introduction
04:11 Assessing Personal Mental Health
06:31 Personal Tragedy and Mindset Shift
11:49 The Realities of Wellness in Medicine
21:59 Creating Supportive Environments Within Medicine
25:58 Navigating Personal and Professional Challenges
35:15 Building and Leading Supportive Networks
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RESOURCES
Physician Support Line:
https://www.physiciansupportline.com/ -
In this episode, interventional cardiologist Dr. Peter Soukas joins us to discuss percutaneous transmural arterial bypass (PTAB) using the DETOUR system, a novel percutaneous treatment for extensive and complex blockages in the superficial femoral artery (SFA).
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CHECK OUT OUR SPONSOR
Endologix
https://endologix.com/
---
SYNPOSIS
Dr. Soukas shares his extensive experience and insights into PTAB development, benefits, patient selection, and procedural details. The idea behind PTAB is to create an SFA-to-popliteal artery bypass through endovascular means, using a system of overlapping stent grafts within the femoral vein as a conduit. When planning the procedure, it is important to consider the location of reentry into the popliteal artery, avoid calcified zones, and meet femoral vein size criteria. Additionally, we explore the advantages of PTAB over other endovascular options and traditional open surgical bypass, which carry a higher likelihood of restenosis and longer recovery times, respectively.
We also discuss the types of training and support available for physicians interested in adopting this technique, cost and reimbursement aspects, and the future direction of PTAB, including ongoing post-market studies.
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TIMESTAMPS
00:00 Introduction
02:38 Dr. Soukas’ Career in Vascular Medicine
05:19 Introduction to PTAB
13:00 Landing Zones
19:37 Stent Graft Sizing
23:14 Patient Selection and Adjunctive Medical Therapy
28:04 Procedural Risks
29:18 Navigating PTAB Implementation
32:20 Opportunities for Learning PTAB
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RESOURCES
PTAB with the DETOUR System:
https://endologix.com/ptab/detour/
Brown Vascular and Endovascular Fellowship:
https://brownmedicine.org/3/cardiology-vascular-endovascular-fellowship/
COMPASS Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa1709118
VOYAGER Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa2000052
DETOUR 2 Trial:
https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext -
In this episode, Dr. Marta Lobato explores advanced endovascular techniques in below the knee (BTK) and below the ankle (BTA) interventions for critical limb ischemia (CLI). She introduces various skills that were developed and used by her team, such as the telescopic needle, buddy needle, balloon-assisted puncture, and vasodilation to prevent artery spasm. Dr. Lobato is a vascular surgeon at Hospital de Cruces in Barakaldo, Spain.
---
CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
---
SYNPOSIS
The discussion covers the importance of visualizing the fifth metatarsal for effective lateral views in X-rays, the intricacies of accessing the lateral and medial plantar arteries, and the significance of starting with easier procedures before attempting more complex interventions. Additionally, Dr. Lobato highlights the role of social media in learning about innovative medical practices.
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TIMESTAMPS
00:00 - Introduction
05:54 - Below the Knee and Ankle Interventions
15:35 - Complexities of Zone 2 and 3 Access
23:12 - Buddy Needle Technique for Calcified Arteries
30:12 - Advanced Techniques for Supporting the Wire
34:13 - Vasodilator Use
37:12 - Balloon-Assisted Techniques
41:02 - Advancing Your Endovascular Skills
---
RESOURCES
Tips and Tricks for Simple and Complex Below-the-Ankle Punctures:
https://pubmed.ncbi.nlm.nih.gov/38441118/
Buddy Needle Technique to Facilitate Retrograde Puncture of Heavily Calcified Tibial Vessels:
https://pubmed.ncbi.nlm.nih.gov/28587566/
Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach:
https://pubmed.ncbi.nlm.nih.gov/34989276/
Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures:
https://pubmed.ncbi.nlm.nih.gov/36415934/
The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia:
https://pubmed.ncbi.nlm.nih.gov/38523459/
New antioxidant therapy for hard-to-heal neuroischaemic diabetic foot ulcers with deep exposure:
https://pubmed.ncbi.nlm.nih.gov/37029973/
Percutaneous endovascular arteriovenous fistula creation for hemodialysis access using "off-the-shelf" conventional devices:
https://pubmed.ncbi.nlm.nih.gov/33251393/ -
In this episode, Dr. Mark Little shares his insights about genicular artery embolization (GAE), implications for patients with knee osteoarthritis, possible applications in other MSK interventions, and the importance of research for advancing the field. Dr. Little is a consultant diagnostic and interventional radiologist at Berkshire Imaging and Visiting Professor at the University of Reading in England.
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CHECK OUT OUR SPONSOR
Varian, a Siemens Healthineers company
https://www.siemens-healthineers.com/
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SYNPOSIS
The doctors also discuss challenges and considerations in patient selection, particularly concerning patients with comorbid peripheral arterial disease, and they further emphasize the need for high-quality research and collaboration within the IR community to continue improving MSK embolization practices.
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TIMESTAMPS
00:00 - Introduction
12:28 - Genicular Artery Embolization
24:30 - GENESIS 1 and 2 Studies
41:04 - Future of MSK Embolization
---
RESOURCES
BackTable VI Episode 27 - Geniculate Artery Embolization for Osteoarthritis with Dr. Sandeep Bagla and Dr. Ari Isaacson:
https://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritis
BackTable VI Episode 85 - Genicular Artery Embolization for OA with Dr. Jafar Golzarian:
https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa
GEST MSK Annual Meeting:
https://thegestgroup.com/annual-msk-meeting/
GENESIS 1 - Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis:
https://pubmed.ncbi.nlm.nih.gov/33474601/
GENESIS 2 - Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/37337060/
Dr. Little Genicular Artery Anatomy Paper - Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis:
https://pubmed.ncbi.nlm.nih.gov/34657976/
Dr. Sid Padia’s Knee OA Research (UCLA) - Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis:
https://pubmed.ncbi.nlm.nih.gov/34703964/
Dr. Lars Lönn from Copenhagen Trial - Genicular Artery Embolization as Pain Treatment of Knee Osteoarthritis (GETKO):
https://classic.clinicaltrials.gov/ct2/show/NCT05360329
Dr. Anna Martinez from Spain Shoulder Study - Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment:
https://pubmed.ncbi.nlm.nih.gov/33135118/
Dr. Anna Martinez from Spain Shoulder Study - Clinical Outcomes of Transcatheter Arterial Embolization for Secondary Stiff Shoulder:
https://pubmed.ncbi.nlm.nih.gov/33478903/ -
En este episodio de nuestro podcast, Dra. Anna Alguersuari Cabiscol, una radióloga intervencionista que dejó su especialidad hace cuatro años, comparte su experiencia personal sobre los desafíos relacionados con la salud mental dentro de la profesión médica.
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SYNPOSIS
Expone cómo la insatisfacción profesional, el síndrome del impostor y la falta de bienestar mental la llevaron a tomar la decisión drástica de abandonar el intervencionismo. A través de su relato, se discute la relevancia de crear un entorno positivo en el trabajo, invertir en el bienestar mental, y la importancia de enfrentar y superar el estigma asociado con estos temas en el ámbito médico. El episodio también aborda la necesidad de cambiar la percepción del éxito y cómo el apoyo de la comunidad médica y científica es fundamental para mejorar la situación actual.
Finalmente, se destaca el rol crucial de los mentores en todas las etapas de la carrera médica para fomentar un equilibrio entre competencia y confianza, así como promover un entorno laboral saludable y respetuoso.
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TIMESTAMPS
00:00 - Bienvenido al podcast
07:16 - Redefiniendo el éxito
10:20 - Los cuatro pilares de una vida y un trabajo significativos
28:36 - Crecimiento personal y la importancia de la tutoría
32:22 - Pensamientos finales -
In this episode, Dr. Jason Hoffmann shares his harrowing personal experience as a patient with massive portal vein thrombosis - recounting the onset of his symptoms, the subsequent diagnosis, treatment, and recovery, all occurring while he was on-call for his own hospital. Dr. Hoffmann is an interventional radiologist and educator at NYU Langone Health.
---
CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
---
SYNPOSIS
Reflecting on how this experience impacted his approach to medicine and patient care, Dr. Hoffmann discusses the importance of empathy, patient education, and building trust. Additionally, he touches upon his personal and family medical history, and how these events have influenced his medical practice and perspective on patient care.
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TIMESTAMPS
00:00 - Introduction
05:55 - Dr. Hoffmann’s IR Practice and Passions
09:23 - Physician’s Experience as a Patient
22:47 - New Perspective on Patient Care
28:53 - Closing Thoughts
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RESOURCES
Combating the Health Risks of Sedentary Behavior in the Contemporary Radiology Reading Room:
https://pubmed.ncbi.nlm.nih.gov/27057784/ -
En este episodio de BackTable la Dra. Maite Velázquez, hemodinamista del Hospital 12 de Octubre de Madrid, aborda el creciente porcentaje de mujeres que ingresan en el campo de la medicina y, en comparación, el escaso porcentaje de mujeres entre los profesionales que trabajan en entornos con radiación ocupacional, como la radiología vascular intervencionista, hemodinámica o cirugía vascular. Además, se analizan los desafíos existentes alrededor del embarazo de estas profesionales, legislación existente y qué medidas protectoras existen en España y Europa, así como los riesgos reales de radiación para el feto basados en evidencia científica.
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SYNPOSIS
La Dra. Velázquez disipa mitos, enfatiza la seguridad existente a la hora de mantener la actividad profesional durante el embarazo con las protecciones adecuadas y destaca la brecha de género y el impacto de la escasez de relevo generacional en estas especialidades. La conversación tiene como objetivo informar y reflejar la evidencia científica existente en cuanto al manejo del embarazo mientras se trabaja en ambientes expuestos a la radiación ionizante.
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TIMESTAMPS
00:00 - Introducción
03:11 - Exposición a la radiación durante el embarazo
07:33 – Evidencia científica y legislación
20:19 - Abordar el impacto profesional del embarazo
26:56 - Combatir conceptos erróneos y promover prácticas seguras
34:59 - Comentarios finales -
In this episode, Dr. Amit Srivastava discusses the transformation of peripheral interventional practices through radial access techniques, emphasizing reduced complication rates, the extensive range of devices now available, and the option for same-day discharge.
---
CHECK OUT OUR SPONSOR
Terumo Interventional Systems
https://terumois.com/education
---
SYNPOSIS
Through a series of real-world examples and discussion on the R2P registry, the doctors illustrate the high success rates and low complications of the transradial approach, debunking common misconceptions, and highlighting the significance of team collaboration in executing these procedures efficiently. Additionally, the conversation covers the evolution of devices suited for R2P, including longer length wires, catheters, and novel training methods like immersive virtual reality courses designed to educate and inspire practitioners to adopt radial access in their endovascular practices.
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TIMESTAMPS
00:00 - Introduction
02:19 - Current Role of Radial Access in Peripheral Interventions
15:08 - Future of Radial Access
21:11 - The R2P Registry
28:44 - Educational Opportunities and Community Support
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RESOURCES
TERUMO Transradial Training & Education:
https://www.terumois.com/education-training/healthcare-provider-education-programs/transradial-courses.html
BT Episode 342 - Radial Access for PAD with Dr. Rami Tadros:
https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad
Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study:
https://pubmed.ncbi.nlm.nih.gov/22858390/
Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions (RPI Study):
https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext -
In this episode, Dr. Nicole Lamparello discusses the strides and challenges in achieving gender equity in interventional radiology (IR), sharing insights from her research on gender disparities in IR, and revealing how women currently comprise a significantly low percentage of the IR workforce compared to men despite equal numbers of male and female medical students. Dr. Lamparello is an interventional radiologist and serves as the Program Director for Weill Cornell Medicine’s Integrated IR Residency in New York City.
---
CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
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SYNPOSIS
The doctors cover the importance of workplace culture with flexibility for family and maternity needs, mentorship, visibility of female leaders in IR, and strategies for attracting more women to the field. The conversation also touches on the impact of diverse IR professionals on patient outcomes, and how outsourcing personal tasks can help maintain work-life balance. The necessity of early exposure to IR for medical students and addressing specific hurdles for women in IR, such as work-life balance, radiation exposure fears, and lack of female role models are also explored.
---
TIMESTAMPS
00:00 - Introduction
05:40 - Addressing Gender Disparity in IR
13:48 - Importance of Physician Workforce Diversity
18:31 - Challenges and Solutions for Gender Equity in IR
25:28 - Work-Life Balance
38:40 - Concluding Thoughts
---
RESOURCES
The Gender Gap in Interventional Radiology: Barriers, Opportunities, and the Role of the Integrated IR Residency:
https://pubmed.ncbi.nlm.nih.gov/36870809/
The IR Trainee Workforce 10 Years after Becoming a Primary Medical Specialty:
https://www.jvir.org/article/S1051-0443(23)00651-6/fulltext
Lack of exposure and perceived occupational hazards as barriers to entry into IR for women: a survey of 143 female medical students:
https://www.jvir.org/article/S1051-0443(16)31526-3/fulltext
Untapped Resources: Attaining Equitable Representation for Women in IR:
https://www.jvir.org/article/S1051-0443(18)31645-2/fulltext
Gender and racial diversity among plenary session speakers at the Society of Abdominal Radiology Annual Meetings: a five-year assessment:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9226100/
Bridging the Gender Gap in the Society of IR: A Benchmark Study:
https://www.jvir.org/article/S1051-0443(18)31492-1/pdf -
In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting.
---
CHECK OUT OUR SPONSOR
Boston Scientific Visual ICE Cryoablation System
https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html
---
SYNPOSIS
The discussion covers various aspects, including collaboration with Boston Scientific for the VISUAL ICE cryoablation system, Dr. Chary’s personal journey from academics at Emory to private practice in Memphis, the effectiveness of cryoneurolysis in different areas such as genicular nerve and palliative care, and the operational dynamics between hospital and outpatient settings. The doctors delve into the procedural specifics, patient response, and outcomes with cryoneurolysis, including Dr. Chary’s efforts to navigate insurance and reimbursement challenges.
---
TIMESTAMPS
00:00 - Introduction
07:04 - Evolution of Pain Intervention Techniques
11:08 - Building a Pain Intervention Service
16:16 - Versatility of Cryoablation in Pain Management
23:54 - Expectations and the Future of Pain Management Research
31:41 - Cryoneurolysis Insights and Patient Management
42:10 - Techniques in Celiac Cryoneurolysis
52:33 - Pain Management in the Outpatient Setting
---
RESOURCES
Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol:
https://www.jvir.org/article/S1051-0443(20)30349-3/abstract
BT VI Episode 199 - Advanced Minimally Invasive Pain Interventions with Dr. David Prologo:
https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions
BT VI Episode 433 - Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo:
https://www.backtable.com/shows/vi/podcasts/433/kyphoplasty-evolution-steering-toward-targeted-therapy
Boston Scientific, VISUAL ICE:
https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html -
In this episode, Dr. David Guez discusses the advancements in contrast enhanced ultrasound, its application in detecting endoleaks, and his journey of learning and applying this modality from residency to his current practice.
Dr. Guez emphasizes ultrasound’s utility in lesion characterization, endoleak monitoring, and sparing patients from more invasive diagnostic procedures. The doctors delve into the specifics of using ultrasound contrast agents, particularly LUMASON and its intravascular utility for real-time monitoring of disease states with superior resolution compared to CT or MRI. Dr. Guez also discusses the potential for contrast enhanced ultrasound in interventional radiology, including diagnosing vascular lesions and augmenting tumor treatments. The conversation highlights the technique’s advantages, its high sensitivity for endoleaks, and potential areas for future research and application. The episode underscores the underutilized potential of contrast enhanced ultrasound in both diagnostic and interventional radiology settings.
---
CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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SHOW NOTES
00:00 - Introduction
03:54 - Exploring the Basics of Contrast Enhanced Ultrasound
06:49 - Clinical Applications and Advantages of Contrast Enhanced Ultrasound
09:15 - Contrast Enhanced Ultrasound in Action: Diagnosing Endoleaks
23:52 - Future of Contrast Enhanced Ultrasound in Interventional Radiology
27:02 - Closing Thoughts
---
RESOURCES
Bracco LUMASON:
https://lumason.com/
Nontraditional Uses of US Contrast Agents in Abdominal Imaging and Intervention:
https://pubs.rsna.org/doi/full/10.1148/rg.220016
Book written by Andrej Lyshchik, MD, PhD (Thomas Jefferson) - Specialty Imaging: Fundamentals of CEUS:
https://www.amazon.com/Specialty-Imaging-Fundamentals-Andrej-Lyshchik/dp/0323625649
Contrast-enhanced Ultrasound Identifies Patent Feeding Vessels in Transarterial Chemoembolization Patients With Residual Tumor Vascularity:
https://pubmed.ncbi.nlm.nih.gov/32890324/
Contrast-enhanced ultrasound (CEUS) versus computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients. Are delayed type II endoleaks being missed? A systematic review and meta-analysis:
https://pubmed.ncbi.nlm.nih.gov/26191109/ -
In this episode, guest host Dr. Krishna Mannava interviews Dr. Bob Tahara about the significant multilevel impacts, ripple effects, and fallout of cyberattacks on the healthcare industry, specifically covering the recent cyberattack that targeted major clearinghouse, Change Healthcare.
Dr. Tahara is a vascular surgeon practicing in rural northwest Pennsylvania and President of Outpatient Endovascular Interventional Society (OEIS). Dr. Tahara shares his experiences as a solo vascular surgeon in rural Pennsylvania, highlighting the complexities of modern billing systems, the advantages of hiring a quality billing company, and the challenges posed by the consolidation of clearinghouses. The conversation also delves into the alarming ransomware attack on Change Healthcare, where 6 terabytes of patient data were compromised. This incident exposed vulnerabilities across the healthcare sector, from payment processes to electronic medical and prescription records. The doctors underscore the importance of cybersecurity preparedness, diversification of clearinghouses, and the role of physicians in advocating for more secure and efficient healthcare systems. They also touch on personal hobbies like Kendo to manage stress.
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Reflow Medical
https://www.reflowmedical.com/
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SHOW NOTES
00:00 - Introduction
02:02 - Cyberattack on Change Healthcare: An Overview
06:37 - Impact of the Cyberattack on Healthcare Practices
09:50 - Understanding Clearinghouses in Healthcare Billing
14:30 - Fallout from the Cyber Attack: A Personal Account
16:40 - Navigating the Aftermath: Strategies and Solutions
22:54 - Value of Medical Records and Cybersecurity Measures
29:18 - Action Items and Advocacy for Physicians
35:00 - OEIS 2024 Meeting and Final Thoughts
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RESOURCES
OEIS Annual Meeting Schedule 2024:
https://oeisweb.com/wp-content/uploads/2024/04/2024-AM-attendee-brochure-v4-FINAL-proof-lowres.pdf
BackTable Episode 349 - Cybersecurity for Physicians with Jason Newton, Esq:
https://www.backtable.com/shows/vi/podcasts/349/cybersecurity-for-physicians -
In this episode, Dr. Omar Saleh and Dr. Mike Watts discuss the challenging aspects of vascular interventions in the OBL setting, focusing on ‘oh $#!%’ moments and how to address various complications. Both Dr. Saleh and Dr. Watts are vascular and interventional radiologist, practicing in Southern California and New Jersey, respectively.
The doctors share specific, challenging cases they’ve encountered, including device malfunctions and unexpected outcomes during procedures. Additionally, Dr. Saleh and Dr. Watts discuss the advantages of having hybrid OBL and hospital practices, the importance of being prepared for complications by having the right tools and strategies at hand, and interdisciplinary collaboration. The conversation also touches on the value of certain devices and techniques in managing complications effectively and ensuring patient safety.
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RADPAD® Radiation Protection
https://www.radpad.com/
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SHOW NOTES
00:00 - Introduction
04:53 - Creative Solutions for Complex Vascular Cases
16:47 - Hybrid Practice: Balancing OBL and Hospital Work
21:39 - The Pros and Cons of Hybrid OBL-Hospital Practices
30:34 - Navigating Complex Medical Procedures
35:09 - Importance of Preparedness and Resourcefulness in Medical Emergencies
44:38 - Advice for Handling Complicated Medical Cases
49:26 - Concluding Thoughts and Looking Ahead to Future Conferences
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RESOURCES
BackTable VI Episode 384 - New Innovations in Closure Devices with Dr. Omar Saleh and Dr. Syed Hussain:
https://www.backtable.com/shows/vi/podcasts/384/new-innovations-in-closure-devices
BackTable VI Episode 121 - Office-Based Labs (OBLs) & What You Can Do in Them with Dr. Mike Watts:
https://www.backtable.com/shows/vi/podcasts/121/office-based-labs-obls-what-you-can-do-in-them
BackTable VI Episode 37 - Treating PAD in the OBL with Dr. Mike Watts and Dr. Omar Saleh:
https://www.backtable.com/shows/vi/podcasts/37/treating-pad-in-the-obl -
In this episode, host Dr. Bryan Hartley takes us on a deep dive into the origin story and mission of Pulmera, a medtech company dedicated to transforming the field of bronchoscopic lung cancer diagnosis by retrofitting existing fluoroscopy machines into cone beam CT-like scanners. Dr. Hartley is a vascular and interventional radiologist and co-founded Pulmera, alongside interventional pulmonologist Dr. Harmeet Bedi at Stanford.
Pulmera is developing a novel approach to enhance physicians’ ability to diagnose lung nodules accurately through innovative technology. Dr. Hartley shares insights into the challenges of existing diagnostic methods, the inspiration behind Pulmera, and the technology’s potential to combine the best of 3D imaging and endoscopy techniques. Dr. Hartley discusses the benefits for both patients and physicians, such as improved diagnostic yields and patient outcomes, and introduces an investment opportunity for the BackTable community to be part of this revolutionary project. The episode also explores the broader implications of this technology across various medical specialties beyond pulmonology.
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CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
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SHOW NOTES
00:00 - Introduction
02:18 - Personal Journey: From Vanderbilt to Stanford Biodesign
06:11 - Pulmera’s Mission: Enhancing Diagnostic Accuracy in Lung Biopsies
15:02 - Introducing a Game-Changing Technology for Bronchoscopic Procedures
22:09 - Challenges and Breakthroughs in Portable CT Imaging
27:44 - Economic Impact of Enhanced Diagnostic Procedures
29:48 - Building a Team and Securing Funding for Innovation
31:30 - Understanding Investment Opportunities and Equity Financing
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RESOURCES
Dr. Bryan Hartley’s email:
[email protected]
Dr. Bryan Hartley’s cell:
423-432-0612
Pulmera:
http://www.pulmera.com/
Stanford Biodesign Fellowship:
https://biodesign.stanford.edu/programs/fellowships/innovation-fellowships.html
BackTable Innovation Episode #1 - Needs Driven Innovation with Dr. Todd Brinton (Stanford BioDesign):
https://www.backtable.com/shows/innovation/podcasts/1/needs-driven-innovation
BackTable Innovation Episode #30 - Host Stories with Dr. Bryan Hartley and Dr. Eric Gantwerker (Stanford BioDesign):
https://www.backtable.com/shows/innovation/podcasts/30/host-stories
BackTable VI Episode #422 - Pathology 101: Solid Advice for Percutaneous Biopsies with Dr. Andrew Sholl:
https://www.backtable.com/shows/vi/podcasts/422/pathology-101-solid-advice-for-percutaneous-biopsies -
In this episode, Dr. Jos van den Berg discusses the benefits of joining the Critical Limb Ischemia (CLI) Global Society, including discounts on Amputation Prevention Symposium (AMP) meetings, access to a specialized journal, and participation in Multidisciplinary CLI Network (MCLIN) discussion boards.
Dr. van den Berg is an interventional radiologist at University of Bern in Switzerland and Europe Office Chairman and Member of Board of Directors for CLI Global Society. Dr. van den Berg also serves as a reviewer and editorial board member of multiple high-impact scientific journals.
With members across the globe, the CLI Global Society emphasizes a multidisciplinary approach to combat CLI, aiming to prevent amputation and death through education, patient advocacy, and awareness about CLI. Dr. van den Berg also sheds light on the complexity of CLI management in Europe due to varied reimbursement systems among countries and the society’s efforts to tackle these challenges. The episode also touches on the society’s future goals, including expanding its global presence and continuing to offer extensive resources and networking opportunities to its members.
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BD Advance Clinical Training & Education Program
https://page.bd.com/Advance-Training-Program_Homepage.html
Reflow Medical
https://www.reflowmedical.com/
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SHOW NOTES
00:00 - Introduction
02:08 - Meet Our Guest: Dr. Jos van den Berg
05:42 - Deep Dive into CLI Global Society
07:53 - Exploring the Impact and Initiatives of CLI Global Society
14:42 - Challenges and Differences of CLI Management in Europe
21:08 - Innovations and Future Endeavors in CLI Treatment
23:45 - Closing Thoughts and the Importance of Membership
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RESOURCES
CLI Global Society:
https://www.cliglobalsociety.org/
Multidisciplinary CLI Network (MCLIN) Global CLI LIVE Meeting (every 2nd Friday of the month, 7am EST):
https://www.cliglobalsociety.org/education/mclin/#myaccount
AMP CLI Meeting:
https://www.hmpglobalevents.com/amptheclimeeting -
In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship.
The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases.
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CHECK OUT OUR SPONSOR
Nevro HFX Spinal Cord Stimulator
https://www.hfxforpdn.com
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SHOW NOTES
00:00 - Introduction
06:00 - Demystifying Spinal Cord Stimulation for Pain Management
17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance
26:03 - Leveraging Telehealth and Support Teams for Patient Success
30:22 - Challenges and Solutions in Managing Peripheral Neuropathy
35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology
39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements
43:46 - Addressing the Challenges of Permanent Implant Procedures
48:46 - Role of Technology and AI in Patient Management
56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics
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RESOURCES
Nevro 10 kHz Therapy:
https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx
Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021):
https://pubmed.ncbi.nlm.nih.gov/33818600/
Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023):
https://pubmed.ncbi.nlm.nih.gov/37536514/
Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996):
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract - Visa fler