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BackTable Vascular & Interventional

A Medicine , Health & Fitness and Education podcast

#186 in Medicine · 🇿🇦
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About the show

The BackTable Podcast is a resource for interventional radiologists, vascular surgeons, interventional cardiologists, and other interventional and endovascular specialists to learn tips, techniques, and the ins and outs of the devices in their cabinets. Listen on BackTable.com or on the streaming platform of your choice. You can also visit www.BackTable.com to browse our open access, physician-catered knowledge center for all things vascular and interventional; now featuring practice tools, procedure walkthroughs, and expert guidance on more than 40 endovascular procedures.

Newest episodes

Ep. 692 Understanding Laser Atherectomy in Calcified Peripheral Artery Disease with Dr. Nicolas W. Shammas

46 min

Half or more of the femoropopliteal lesions Dr. Nicolas Shammas treats are moderately to severely calcified, the kind that turn a routine case into recoil, dissection, and a stent no one planned to place. On this episode of the BackTable Podcast, Dr. Neil Jain welcomes back Dr. Shammas, an interventional cardiologist in Davenport, Iowa, and president and research director of the Midwest Cardiovascular Research Foundation, to talk about laser atherectomy in heavily calcified peripheral artery disease (PAD). Dr. Shammas explains his workup with duplex, CT angiography, and intravascular ultrasound (IVUS), how decades of vessel prep trials shaped his device choices, and how a 355 nm laser with a very short pulse delivers enough power to cross calcium while limiting thermal injury beyond the catheter tip. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by AngioDynamicsangiodynamics.com/cardiovascular --- Timestamps 00:00 - Introduction05:12 - Who Has Severely Calcified Femoropopliteal Disease?06:38 - Preprocedural Workup and Contrast Sparing08:40 - Access, IVUS, and the Evolution of Vessel Prep13:12 - How a 355 nm Laser Acts on Calcium16:32 - Safety: Embolization, Perforation, and Filters19:10 - Technique Tips: Speed, Sizing, and Opening Pressure21:51 - Comparing Laser Atherectomy and IVL in Calcified Femoropopliteal Disease28:58 - Why Residual Narrowing Matters for Patency30:34 - Study Limitations and the Need for Randomized Trials33:15 - Combining Laser Atherectomy and IVL39:36 - Treatment Sequence and Choosing a Device by Vessel Size41:53 - Final Takeaways --- More about this episode Dr. Shammas then shares the technique lessons that matter most for new operators, from passing the catheter at no more than a millimeter per second to sizing with IVUS and finding the balloon's opening pressure, and why he now rarely uses an embolic filter. The two discuss his recent core lab adjudicated, single-center comparison of laser at...

Ep. 686 Best Practices for Efficient Bone Marrow Biopsy Procedures with Dr. Mohammad Samim

50 min

The very first episode of BackTable was about bone marrow biopsies, and the procedure has come a long way since. Powered drivers, smarter planning, and a well placed periosteal block have made it faster and far more comfortable for patients. On this episode of the BackTable Podcast, Dr. Mohammad Samim, a musculoskeletal radiologist at NYU Langone Health, joins host Dr. Chris Beck to discuss best practices for image-guided bone marrow aspiration and biopsy. They discuss how more referrals are coming from hematology, what drives the need for imaging guidance, and why a careful periosteal block lets most patients avoid sedation. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Varian OmniBonehttps://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction03:31 - Referral Trends and Procedure Volume06:15 - Indications and Contraindications12:28 - Sedation and the Periosteal Block16:30 - Procedure Walkthrough23:13 - Powered Access and Variable Speed29:43 - Sclerotic Bone and Dry Taps34:55 - Aspiration Pain and On-Site Pathology37:35 - Sternal Bone Marrow Aspiration39:07 - Efficiency With Powered Systems43:37 - Ultrasound Guidance and Workflow46:45 - Hemodilution and Repeat Biopsies48:14 - Closing Remarks --- More about this episode The conversation then walks through the procedure itself, from reviewing pelvic anatomy and planning a trajectory on the scout to choosing between a single needle and a coaxial system and aiming for a core close to 1.5 centimeters. Dr. Samim explains how variable speed powered drivers work for both soft and sclerotic bone, what to do when a needle gets stuck or a tap comes back dry, and why a slow, steady pull makes the aspirate less painful. The episode closes with workflow tips for efficiency, minimizing hemodilution, and getting a high-quality sample the first time. --- Resources Increasing Volume of Bone Marrow Biop...

Ep. 684 Understanding Hemorrhoid Artery Embolization Techniques with Dr. Kristen Rumer and Dr. Scott Thompson

40 min

Which patients with bleeding hemorrhoids benefit from artery embolization, and who should go to surgery instead? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Kristen Rumer and Dr. Scott Thompson of Mayo Clinic to break down patient selection, technique, and follow-up for hemorrhoid artery embolization (HAE) at a major academic center. They explain why bleeding-predominant, Goligher grade II and III internal hemorrhoids are the best candidates, and how the technique has evolved from its origins in France to routine practice in the US. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Terumohttps://www.terumois.com/haepodcast --- Timestamps 00:00 - Introduction03:33 - Surgical Options and Recovery07:31 - Ideal Candidates for Embolization10:47 - HEMORR1 Trial Design and Embolics15:37 - Arterial Anatomy and Coil Technique19:53 - Collaboration with Colorectal Surgery24:18 - Pelvic Pain and Patient Selection28:48 - Scalability and Contraindications32:02 - Recurrence and Collateral Supply35:27 - Patient Goals and Expectations37:37 - Closing Remarks --- More about this episode The conversation covers advanced imaging, embolic selection, coil technique, and complication management. Dr. Thompson details the HEMORR1 trial protocol, including photon counting CTA, large spherical particles, and careful coil packing. Dr. Rumer discusses a bidirectional referral pathway and the unmet need for embolization options in anticoagulated and immunosuppressed patients. The episode closes with pearls for avoiding recurrence, managing chronic pelvic pain, and setting realistic expectations so patients understand what success means after HAE. --- Resources Mayo Clinic: Hemorrhoidal Embolization Trial (HEMORR1)https://www.mayo.edu/research/clinical-trials/cls-20556753 Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease (Vidal technique)https://pubmed.ncbi.nlm.nih.gov/35781988/ Rectal Artery Embolization fo...

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All episodes

Ep. 692 Understanding Laser Atherectomy in Calcified Peripheral Artery Disease with Dr. Nicolas W. Shammas

46 min

Half or more of the femoropopliteal lesions Dr. Nicolas Shammas treats are moderately to severely calcified, the kind that turn a routine case into recoil, dissection, and a stent no one planned to place. On this episode of the BackTable Podcast, Dr. Neil Jain welcomes back Dr. Shammas, an interventional cardiologist in Davenport, Iowa, and president and research director of the Midwest Cardiovascular Research Foundation, to talk about laser atherectomy in heavily calcified peripheral artery disease (PAD). Dr. Shammas explains his workup with duplex, CT angiography, and intravascular ultrasound (IVUS), how decades of vessel prep trials shaped his device choices, and how a 355 nm laser with a very short pulse delivers enough power to cross calcium while limiting thermal injury beyond the catheter tip. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by AngioDynamicsangiodynamics.com/cardiovascular --- Timestamps 00:00 - Introduction05:12 - Who Has Severely Calcified Femoropopliteal Disease?06:38 - Preprocedural Workup and Contrast Sparing08:40 - Access, IVUS, and the Evolution of Vessel Prep13:12 - How a 355 nm Laser Acts on Calcium16:32 - Safety: Embolization, Perforation, and Filters19:10 - Technique Tips: Speed, Sizing, and Opening Pressure21:51 - Comparing Laser Atherectomy and IVL in Calcified Femoropopliteal Disease28:58 - Why Residual Narrowing Matters for Patency30:34 - Study Limitations and the Need for Randomized Trials33:15 - Combining Laser Atherectomy and IVL39:36 - Treatment Sequence and Choosing a Device by Vessel Size41:53 - Final Takeaways --- More about this episode Dr. Shammas then shares the technique lessons that matter most for new operators, from passing the catheter at no more than a millimeter per second to sizing with IVUS and finding the balloon's opening pressure, and why he now rarely uses an embolic filter. The two discuss his recent core lab adjudicated, single-center comparison of laser at...

Ep. 686 Best Practices for Efficient Bone Marrow Biopsy Procedures with Dr. Mohammad Samim

50 min

The very first episode of BackTable was about bone marrow biopsies, and the procedure has come a long way since. Powered drivers, smarter planning, and a well placed periosteal block have made it faster and far more comfortable for patients. On this episode of the BackTable Podcast, Dr. Mohammad Samim, a musculoskeletal radiologist at NYU Langone Health, joins host Dr. Chris Beck to discuss best practices for image-guided bone marrow aspiration and biopsy. They discuss how more referrals are coming from hematology, what drives the need for imaging guidance, and why a careful periosteal block lets most patients avoid sedation. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Varian OmniBonehttps://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction03:31 - Referral Trends and Procedure Volume06:15 - Indications and Contraindications12:28 - Sedation and the Periosteal Block16:30 - Procedure Walkthrough23:13 - Powered Access and Variable Speed29:43 - Sclerotic Bone and Dry Taps34:55 - Aspiration Pain and On-Site Pathology37:35 - Sternal Bone Marrow Aspiration39:07 - Efficiency With Powered Systems43:37 - Ultrasound Guidance and Workflow46:45 - Hemodilution and Repeat Biopsies48:14 - Closing Remarks --- More about this episode The conversation then walks through the procedure itself, from reviewing pelvic anatomy and planning a trajectory on the scout to choosing between a single needle and a coaxial system and aiming for a core close to 1.5 centimeters. Dr. Samim explains how variable speed powered drivers work for both soft and sclerotic bone, what to do when a needle gets stuck or a tap comes back dry, and why a slow, steady pull makes the aspirate less painful. The episode closes with workflow tips for efficiency, minimizing hemodilution, and getting a high-quality sample the first time. --- Resources Increasing Volume of Bone Marrow Biop...

Ep. 684 Understanding Hemorrhoid Artery Embolization Techniques with Dr. Kristen Rumer and Dr. Scott Thompson

40 min

Which patients with bleeding hemorrhoids benefit from artery embolization, and who should go to surgery instead? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Kristen Rumer and Dr. Scott Thompson of Mayo Clinic to break down patient selection, technique, and follow-up for hemorrhoid artery embolization (HAE) at a major academic center. They explain why bleeding-predominant, Goligher grade II and III internal hemorrhoids are the best candidates, and how the technique has evolved from its origins in France to routine practice in the US. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Terumohttps://www.terumois.com/haepodcast --- Timestamps 00:00 - Introduction03:33 - Surgical Options and Recovery07:31 - Ideal Candidates for Embolization10:47 - HEMORR1 Trial Design and Embolics15:37 - Arterial Anatomy and Coil Technique19:53 - Collaboration with Colorectal Surgery24:18 - Pelvic Pain and Patient Selection28:48 - Scalability and Contraindications32:02 - Recurrence and Collateral Supply35:27 - Patient Goals and Expectations37:37 - Closing Remarks --- More about this episode The conversation covers advanced imaging, embolic selection, coil technique, and complication management. Dr. Thompson details the HEMORR1 trial protocol, including photon counting CTA, large spherical particles, and careful coil packing. Dr. Rumer discusses a bidirectional referral pathway and the unmet need for embolization options in anticoagulated and immunosuppressed patients. The episode closes with pearls for avoiding recurrence, managing chronic pelvic pain, and setting realistic expectations so patients understand what success means after HAE. --- Resources Mayo Clinic: Hemorrhoidal Embolization Trial (HEMORR1)https://www.mayo.edu/research/clinical-trials/cls-20556753 Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease (Vidal technique)https://pubmed.ncbi.nlm.nih.gov/35781988/ Rectal Artery Embolization fo...

Ep. 682 Liquid Embolization Techniques for Treating Hypervascular Tumors with Dr. Resmi Charalel and Dr. Milan Patel

1 hr 9 min

How do you devascularize a hypervascular tumor when the vessels feeding it are too small to catheterize? On this episode of BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Resmi Charalel and Dr. Milan Patel to walk through seven real-world cases where non-adhesive hydrogel liquid embolics made the difference. They break down patient selection, case planning, and how to deploy these agents for safe, efficient devascularization when traditional approaches fall short. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Instyllahttps://instylla.com/embrace/ --- Timestamps 00:00 - Introduction02:23 - Liquid Embolic Use in Practice04:46 - Case 1: Renal Mass07:51 - Delivery Technique and Target Vessel Size13:08 - Device Setup and Catheter Compatibility21:57 - Case 2: Multifocal HCC27:44 - Case 3: Large Renal Tumor40:21 - Randomized Trial Outcomes43:28 - Case 4: HCC Near the Gallbladder49:39 - Case 5: Pelvic Tumor and Femoral Metastases55:30 - Lessons from Early Use and Case Selection1:01:37 - Case 6: Breast Cancer Liver Metastasis1:05:23 - Closing Remarks --- More about this episode The discussion reviews seven real-world cases, from renal and liver tumors to pelvic, bone, and breast metastases, sharing practical pearls on microcatheter selection, plug formation, controlled reflux, and navigating high-flow environments and multiple vessels. They dive into troubleshooting pitfalls like loose connections and procedural waste, the real learning curve for adopting liquid embolics, and the outcomes data that support broader adoption of these techniques. The episode closes with advice for early-career operators and a look at future directions for patients who are not candidates for other embolic therapies. --- Resources Instylla HES Hypervascular Tumor Pivotal Study (NCT04523350)https://clinicaltrials.gov/study/NCT04523350 Abi-Jaoudeh N, et al. Multicenter Randomized Trial Evaluating the Safety and Effectiveness of the I...

Ep. 677 Pulmonary Embolism: Catheter-Based Therapy & Importance of Blood Return with Dr. Jay Giri and Dr. Julie Bulman

55 min

As new guidelines redefine risk stratification for pulmonary embolism (PE), emerging technologies are also changing what it means to achieve procedural success. On this episode of the BackTable Podcast, interventional radiologist Dr. Julie Bulman (BIDMC) and interventional cardiologist Dr. Jay Giri (Penn Medicine) join host Dr. Chris Beck to discuss the evolving frameworks and technologies redefining standards for catheter-directed treatment of intermediate- and high-risk PE. They discuss the role of multidisciplinary PERT teams, patient selection, the impact of new thrombectomy devices, and why autologous blood return is a growing consideration for procedural success. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Endovascular Engineering (E2)E2Helo.com --- Timestamps 00:00 - Introduction03:42 - Referral Patterns and PERT Scope05:25 - PE Workup Essentials07:26 - Targeted Assessment of Acuity11:36 - Reliability of the Walk Test14:35 - PE Treatment Pathways19:26 - Procedural Walkthrough24:15 - Catheter Sizing30:05 - Adjunct Aspiration Device Features35:09 - Blood Return Process and Safety40:03 - Helo Study Early Results45:09 - Determining Procedural Endpoints50:20 - Future Trials and Technologies53:48 - Final Thoughts and Closing Remarks --- More about this episode The discussion highlights how PERT teams use updated guidelines and thorough clinical evaluation to guide patient classification and treatment pathway selection. Dr. Bulman and Dr. Giri outline their criteria for choosing anticoagulation, catheter-directed lysis, or mechanical clot removal, and compare the techniques and learning curves for medium- versus large-bore thrombectomy devices. They explore the significance of autologous blood return during aspiration thrombectomy, noting how new reinfusion systems can reduce blood loss and influence procedural decision-making. Dr. Bulman also presents early Helo Thrombectomy System study data demonstrating the...

Ep. 675 Advancements & Challenges in GAE Practice with Dr. Amin Astani and Dr. Anish Ghodadra

1 hr 23 min

As interest in genicular artery embolization grows, what does it actually take to build a sustainable GAE practice? On this episode of the BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Anish Ghodadra and Dr. Amin Astani to share their blueprint for building a successful genicular artery embolization (GAE) practice. They discuss patient selection, imaging workup, scoring tools, and procedural techniques, including access strategies, device choice, and embolic selection. The conversation also covers follow-up protocols, defining treatment success, and how to set patient expectations. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byVarian https://www.siemens-healthineers.com/ --- Timestamps 00:00 - Introduction04:00 - GAE Workup and Patient Scoring05:28 - KL Score and MRI Debate10:15 - Patient Selection and Contraindications15:11 - Access Strategy and Closure Techniques19:54 - Catheters, Wires, and Embolic Choices28:19 - Cone Beam CT Workflow31:37 - Managing Collaterals34:26 - Follow-Up and Repeat GAE38:42 - Defining Success and Setting Expectations44:25 - Technique Nuances and Flow Modulation50:28 - Building Referral Networks56:56 - Keeping Referrers Engaged59:46 - Direct-to-Patient Marketing01:04:57 - Leveraging Social Media and Reviews01:12:42 - Tracking Leads and Insurance Coverage01:19:47 - Final Thoughts and Next Steps --- More about this episode Beyond technique, the discussion dives into practical strategies for growing a GAE practice: referral pathways, engaging physical therapists and orthopedic surgeons, direct-to-patient marketing, digital outreach, and tracking outcomes. The guests share experience-driven tips on handling insurance hurdles, building relationships with referring providers, and using data to demonstrate value. The episode wraps with reflections on negative trial results, the evolving landscape of GAE, and what it takes to keep a practice thriving in a competitive environment. ---...

Ep. 674 Treatment Strategies for Acute and Chronic Limb Ischemia with Dr. Anahita Dua and Dr. Ripal Gandhi

56 min

How do you choose between thrombolysis, mechanical thrombectomy, or open surgery for acute limb ischemia, and what options remain when there’s no vessel to open? On this episode of the BackTable Podcast, host Dr. Chris Beck is joined by vascular surgeon Dr. Anahita Dua (Massachusetts General Hospital) and interventional radiologist Dr. Ripal Gandhi (Miami Cardiac and Vascular Institute) to explore treatment strategies across the full spectrum of limb ischemia. They discuss presentation and referral patterns, the imaging and exam findings that start the clock, single-session mechanical thrombectomy, the evolving role of lysis, procedural endpoints, and deep vein arterialization for chronic limb-threatening ischemia. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byStryker Peripheral Vascularhttps://www.stryker.com/us/en/peripheral-vascular.html --- Timestamps 00:00 - Introduction02:27 - Presentation, Referral Patterns, and Imaging06:07 - Acute Limb Ischemia: Treatment Algorithm 12:16 - Thrombectomy Device Selection16:09 - Thrombolysis and Applications Beyond Lower Extremity18:46 - Procedural Endpoints, Closure, and Case Selection24:43 - Deep Vein Arterialization: Patient Selection and Planning31:25 - DVA Technique: Imaging, Anesthesia, and Access34:58 - Step-by-Step DVA Approach 41:56 - Surveillance and Managing Expectations45:59 - Wound Care and Amputation Decisions49:40 - Future Directions in PAD52:43 - Closing Remarks --- More about this episode The conversation moves from acute interventions for the cold leg, where mechanical thrombectomy has become first-line and lysis is held in reserve, to the stepwise management of no-option chronic cases, including pedal access, valve disruption, and inflow for deep vein arterialization. Drs. Dua and Gandhi share practical insights on device selection, preventing distal embolization, and when to consider open embolectomy or hybrid approaches. The episode closes with a discussio...

Ep. 673 Y90 for Liver-Directed Cancer Treatments: The PROACTIF Study with Dr. Tyler Sandow and Dr. Ryan Hickey

1 hr 31 min

The key to personalizing Y90 may not just be treating the tumor, but understanding how much radiation a patient can tolerate, where to deliver it, and when to safely push the dose. In this episode of the BackTable Podcast, Drs. Tyler Sandow and Ryan Hickey join host Dr. Kavi Krishnasamy to explore strategies for using Y90 in hepatocellular carcinoma and liver metastases. They combine real-world data from a study of nearly 1,000 patients with insights into methodology and the many variables that influence these procedures. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90. --- Timestamps 00:00 - Introduction02:36 - Resection After Radioembolization06:07 - Personal Practices Between HCC and Liver Metases07:26 - Bridging Radiation Segmentectomy 11:22 - Understanding Portal Vein Tumor Thrombus14:21 - Preferences in Dosimetry Software17:57 - Liver Reserve Limits25:11 - Microsphere Activity and Density29:16 - Diving into PROACTIF33:32 - RCTs and Trial Challenges36:57 - Patient Diversity in PROACTIF41:42 - Extrahepatic Disease43:03 - Data Gaps and Takeaways45:32 - Defining Personalized Dosimetry and Bridging Software50:15 - Mixed Delivery Approaches and Dose Thresholds01:01:36 - Response and Local Control01:04:26 - Treating PVT Subgroups01:09:03 - Comparison Between Dosing and Survival01:15:03 - Differences in Patients Quality of Life After Transplantation01:26:34 - Wrap-Up and Credits --- More about this episode The discussion covers radiation segmentectomy and selective delivery, the nuances of portal vein tumor thrombus levels, and how multidisciplinary collaboration differs between resection and transplant. The doctors dive into the PROACTIF study, focusing on personalized dosimetry, dose escalation, trial challenges, tumor response, and survival outcomes across disease stages. Drs. Sandow and Hickey also explain the limits of Y90, such as lung shunts, liver res...

Ep. 657 Advanced Techniques in Y90 Cancer Treatment with Dr. Beau Toskich and Dr. Juan Gimenez

52 min

What do you do when Y-90 doesn’t deliver the results you expected? In this episode of the 2026 HCC Creator Weekend™, host Dr. Tyler Sandow is joined by Drs. Beau Toskich and Juan Gimenez to discuss the technical challenges and troubleshooting strategies that can make or break a Y-90 radioembolization case. Together, they explore innovative approaches like the PREDATr technique, share tips for reducing complications, and offer guidance on optimizing outcomes for patients with complex liver tumors. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction04:24 - Treatment Nonresponse Troubleshooting06:12 - Navigating Y90 Through Replaced Arteries09:09 - Mitigating Vasospasm in Embolization13:31 - What is ‘PREDATr’?21:12 - Dual Balloon Microcatheter System23:37 - Gelfoam Techniques and Application26:06 - Embolization Agents Preferences36:16 - Concerns with Cystic Artery Treatment and Biliary Stents42:15 - Prophylactic Antibiotics 44:29 - Utilizing High Lung Shunts49:28 - Wrap Up and Credits --- More about this episode The conversation begins with case-based examples of HCC radioembolization, focusing on how to assess treatment response and troubleshoot nonresponsive cases. They discuss how to interpret SPECT findings, identify missed tumor supply with cone-beam CT, and overcome obstacles such as vasospasm, extrahepatic feeders, and challenging arterial anatomy. They introduce the PREDATr technique (proximal radioembolization enabled by distal angiozone truncation) and explain how tools like gelfoam, balloons, and retrievable coils can preserve healthy liver tissue and improve microsphere delivery. The episode also addresses managing biliary stents, using antibiotic prophylaxis, and strategies for handling high lung shunts, making it a practical resource for anyone navigating the complexities of Y-90 treatment. --- BackTable Vascular & In...

Ep. 656 Advanced Practices in Uterine Fibroid Embolization with Dr. Francis Kang and Dr. Neil Resnick

59 min

Are new technologies and teamwork the key to better fibroid treatment? In this episode of the BackTable Podcast, Drs. Francis Kang and Neil Resnick join host Dr. Chris Beck to share how multidisciplinary treatment planning is reshaping uterine fibroid management, from patient selection and referral patterns to procedural techniques that improve outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byTriSalus Life Scienceshttps://trinavinfusion.com/ --- Timestamps00:00 - Introduction06:18 - Multidisciplinary Care of Fibroids15:45 - Treatment Decisions21:56 - Managing Asymptomatic Fibroids25:43 - Collaborative vs. Competitive Practices30:01 - UFE Procedure Approaches34:32 - Comparing Embolic Sizes and Amounts37:44 - Changes in Speed Using TriNav Catheters40:53 - Tactile Feedback at Stasis42:28 - Embolization Target Regions44:45 - Encountering and Troubleshooting Collaterals47:30 - Post-Op Pain Regiments57:28 - Wrap Up --- More about this episodeThe conversation begins with the importance of strong partnerships with OBGYN colleagues and how multidisciplinary planning leads to better outcomes for patients. They explore patient selection and education, especially for those considering surgical versus minimally invasive treatment options. Drs. Kang and Resnick compare procedural approaches, including when to use femoral versus transradial access, nerve blocks, and embolic particle selection. They also discuss strategies to achieve optimal embolization endpoints and practical tips for handling collateral vessels, avoiding non-target embolization, and managing post-procedural pain and recovery. The episode concludes with a look at newer technologies like the TriNav Catheter and its impact on embolization speed, operator confidence, and early imaging outcomes.--- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the fre...

Ep. 654 Advances in PE Treatment Guidelines with Dr. Jay Giri and Dr. Trevor Cummings

49 min

Will new PE guidelines redefine risk and therapy in pulmonary embolism (PE) care? In this episode of the BackTable podcast, host Dr. Michael Barraza is joined by interventional cardiologist Dr. Jay Giri and emergency physician Dr. Trevor Cummings to break down the latest changes in PE management. They discuss how multidisciplinary pulmonary embolism response teams (PERT) are implementing these guidelines at their institutions, the introduction of a more nuanced A-E risk stratification system, and the challenges of enrolling experienced centers into clinical trials as device innovation accelerates. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Stryker Peripheral Vascular, formerly Inari Medicalhttps://www.inarimedical.com/flowtriever-system --- Timestamps 00:00 - Introduction 01:24 - Building a PERT Team04:59 - Trials Shaping PE Care 10:20 - Why New Guidelines Now 14:06 - New Risk Categories Explained 19:51 - Applying Guidelines Locally 23:34 - What Is C1 Risk 27:52 - New D Category Explained 30:33 - Evidence for Aggressive Therapy 33:31 - How PERT Teams Communicate 38:22 - Upcoming PE Trials Pipeline 43:42 - Program Growth and High Risk Trials 45:46 - Closing Remarks --- More about this episode The conversation highlights the growth of catheter-directed lysis and mechanical thrombectomy, the rationale and practical impact of the new Category D for incipient cardiopulmonary failure (including normotensive shock), and the incorporation of PESI, sPESI, and Hestia for risk assessment. Additional topics include decision-making for low-risk patients, lactate and biomarkers for identifying higher-risk cases, communication strategies within PERT teams, AI-enabled risk stratification, and a preview of upcoming trials (PEITHO, PRAGUE-26, PEERLESS-2, PE-TRACT, and PERSEVERE) that are set to further transform PE care. --- Resources Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, a...

Ep. 646 Embolization Techniques for Pulmonary AVMs: Expert Insights with Dr. Nima Kokabi and Dr. Brian Funaki

56 min

Pulmonary AVM may be rare, but missing them can lead to lifelong complications, especially in patients with hereditary hemorrhagic telangiectasia (HHT). How do you choose the right device and strategy to ensure long-term success with embolization? In this episode of the BackTable Podcast, host Dr. Kavi Krishnasamy is joined by Dr. Brian Funaki and Dr. Nima Kokabi to unpack the evolving treatment landscape for pulmonary arteriovenous malformations (PAVM). Through imaging breakdown, review of challenging real-world cases, and a discussion on advanced treatment strategies, the conversation tackles a key debate in pulmonary embolization: are plugs replacing coils as the new standard? --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Okamihttps://okamimedical.com/ --- Timestamps 00:00 - Introduction01:43 - Defining HHT and PAVM05:53 - Democratizing Interventions for HHT Patients08:83 - Recommendations to Embolize PAVM13:19 - Imaging Specificity and Procedural Preferences23:29 - Persistence Rates with Plugs and Coils25:59 - Lag in Utilization of Plugs29:18 - Comparison of LOBO to Alternative Vascular Plugs34:26 - Post Embolization Symptoms and Troubleshooting Methods39:04 - PAVM Cases and Treatments54:26 - Wrap Up and Credits --- More about this episode The discussion begins by defining HHT and PAVM, highlighting the risks associated with untreated PAVM and the critical need for genetic screening and multi-organ evaluation. Drs. Funaki and Kokabi review current treatment recommendations, surveillance imaging, and follow-up protocols, with special considerations for pediatric and high-risk patients. They explore practical tips for optimizing embolization performance, focusing on device selection and the evolving role of vascular plugs. By comparing different plug designs, such as wire count and pore size, and sharing lessons from challenging cases, including persistent lesions, tortuous anatomy, and pseudoaneurysm management...

Ep. 633 Pelvic Venous Disease: Causes, Symptoms and Treatments with Dr. Deepak Sudheendra

49 min

How do you differentiate between iliac vein compression, gonadal vein reflux, and Nutcracker syndrome in patients with chronic pelvic pain? Dr. Deepak Sudheendra, director and interventional radiologist at 360 Vascular Institute, joins host Dr. Ally Baheti to share his approach to evaluating and managing pelvic venous disease (PVD). --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:43 - PVD Demand at Penn06:42 - Approach & Algorithm12:08 - Variation in Iliac Vein Compression15:58 - Treatment Approaches19:20 - Important Ultrasounds22:15 - Intra-Procedural Workflow31:14 - Iliac Vein Stenting and Avoiding Complications36:31 - Gonadal Vein Embolization and Working with Patients42:20 - Iliac Vein Embolization and Post-Op Care --- More about this episode Dr. Sudheendra's clinical algorithm for diagnosing PVD emphasizes the importance of patient history and specific symptoms over isolated cross-sectional imaging findings. He shares his approach to the pre-procedural workup, highlighting the necessity of a standing venous reflux ultrasound to rule out superficial venous insufficiency. Beyond the technical steps, Dr. Sudheendra emphasizes the "soft skills" of managing a venous practice: counseling patients on conservative treatments like pelvic floor therapy, explicitly setting expectations about postoperative back pain, and avoiding unnecessary bilateral stents in young women. Dr. Sudheendra details his intra-procedural workflow for diagnosing and treating PVD, providing a look into his unique preference for right internal jugular (IJ) vein access to perform venograms and place iliac vein stents. He explains how this approach allows him to consistently check inflow from the lower extremities, and shares his techniques for performing gonadal vein embolizations and accurately sizing iliac vein stents to prevent lifelong complications. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional ra...

Ep. 628 Techniques for Managing Biliary Drain Complications with Dr. Ahsun Riaz

48 min

Patients and IRs alike dread the persistent cycles of malfunction and repeated procedures that often accompany biliary drains. What can you do to keep patients off the doorstep of reintervention? In this episode of the BackTable Podcast, Dr. Ahsun Riaz of Northwestern Medicine joins host Dr. Michael Barraza to walk through strategies for preventing and managing complications of percutaneous biliary drain placement. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:51 - Complication Rates and Associated Factors06:09 - PTC in Non-Dilated Biliary Systems11:00 - Techniques for Access and Drain Placement15:10 - Drain Flushing, Capping, and Ideal Positioning17:48 - External versus Internal-External Biliary Drains20:42 - Managing Pericatheter Leakage23:01 - Life Expectancy and Stenting Malignant Strictures26:32 - Tract Maturation and Minimizing Access Sites28:56 - Addressing Unresolving Hyperbilirubinemia34:52 - Managing Bloody Drain Output38:12 - Approach to Dislodged Drains39:40 - Drain-Associated Pain and Exchange Timing42:49 - Strategy for Benign Biliary Strictures45:18 - Final Thoughts and Closing Remarks --- More about this episode The discussion begins with a look at the data on biliary drain-related adverse events, emphasizing the need to bring down the high rates of complications that may take a toll on patients' quality of life. Dr. Riaz stresses the importance of employing techniques at initial drain placement, such as placing left-sided drains where appropriate and minimizing biliary pressure buildup, to reduce the starting risk of malfunction. The physicians go on to share their algorithms for approaching various scenarios, from pericatheter leakage and drain dislodgement to unresolving hyperbilirubinemia, pointing out the factors and observations that should influence treatment approaches during planning and intraprocedurally. Finally, the physicians address the evolving landscape of long-term biliary manag...

Ep. 611 Challenges in Prostate Artery Embolization with Dr. Rajasekhara Ayyagari

47 min

Are balloon occlusion microcatheters your new best friend for prostate artery embolization (PAE)? In this episode of BackTable, Dr. Raj Ayyagari, interventional radiologist at Boston Medical Center, joins Dr. Ally Baheti to tackle complex clinical and technical challenges in PAE. --- This podcast is supported by an educational grant from Guerbet. --- SYNPOSIS Dr. Ayyagari shares his unique journey from urology to interventional radiology and his experience building successful PAE service lines at multiple institutions. He walks through a series of challenging cases involving intraprostatic penile arteries, perivesicular collaterals, and internal pudendal collaterals used to treat bilateral hemi-prostates. The discussion highlights the role of balloon occlusion microcatheters such as the Sniper, his transition from 100–300 micron particles to glue embolization, and scenarios where coil protection is essential to prevent nontarget embolization. He also covers post-procedural management, the importance of setting expectations around suprapubic tube removal, and why thorough patient and provider counseling is critical for optimal care. --- TIMESTAMPS 00:00 - Introduction 02:14 - Building a Practice in Prostate Artery Embolization08:19 - Case Studies and Techniques in Prostate Artery Embolization23:16 - Challenges in Embolization Techniques23:47 - Step-by-Step Guide to Embolizing a Hemi Prostate25:24 - Choosing the Right Beads for Embolization29:10 - Transitioning to Liquid Embolics35:38 - Setting Patient Expectations and Pre-Procedure Evaluation40:17 - Post-Procedure Care and Medications44:06 - Conclusion and Final Thoughts

Ep. 604 Mythbusters: Provocative Mesenteric Angiography for GI Bleeds with Dr. Sabeen Dhand

38 min

A negative angiogram in a patient with recurrent lower GI bleeding often calls for provocative angiography. In this episode of the BackTable Podcast, IR hosts Mike Barraza and Sabeen Dhand team up to talk tools, techniques, and tPA dosing for safe and effective treatment of lower GI bleeds with provocative mesenteric angiography.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISDr. Dhand describes the utility of provocative angiography in recurrent lower GI bleed patients with negative CTA and angiography, addressing common myths and concerns that may contribute to its underutilization. The conversation covers detailed procedure steps for both targeted and untargeted angiography, including access sites, dosing of tPA, and angiographic technique. Dr. Dhand emphasizes the importance of gradual increases in tPA dosage in 2 mg increments, and clear communication with care teams and the patient about the nature of the procedure. He also emphasizes the effectiveness and safety of this procedure by sharing real-world cases.---TIMESTAMPS00:00 - Introduction02:04 - Provocative Angiography for Lower GI Bleeds04:09 - Detailed Protocol for Provocative Angiography11:13 - Technical Details and Best Practices20:07 - Challenges in GI Bleeding Studies22:40 - Selective Embolization Techniques27:44 - Handling Negative Angiograms32:56 - Real-World Case Studies35:15 - Final Thoughts---RESOURCESThiry et al. Provocative Mesenteric Angiography: Outcomes and Standardized Protocol for Management of Recurrent Lower Gastrointestinal Hemorrhagehttps://pubmed.ncbi.nlm.nih.gov/34506023/

Ep. 594 How New Guidelines are Shaping Acute DVT Management with Dr. Steven Abramowitz

48 min

Are you up to date with the latest guidelines on deep venous thrombosis (DVT) management? Dr. Steven Abramowitz, vascular surgeon at MedStar Health, joins host Dr. Chris Beck for a deep dive into emerging clinical data in DVT management, where they review the evolving indications for mechanical thrombectomy and the implications of studies like the ATTRACT trial, the CLOUT registry, and the ongoing DEFIANCE trial. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/ --- SYNPOSIS Dr. Abramowitz reviews recent data comparing outcomes of mechanical intervention versus lytic-based therapy, outlining how each approach fits into current practice. He underscores the critical role of IVUS in determining treatment endpoints, while noting the ongoing challenge of an absent standardized definition. The conversation also offers practical insights on procedural techniques and the evolving role of anticoagulation, emphasizing the importance of close collaboration and open communication with referring physicians. --- TIMESTAMPS 00:00 - Introduction00:45 - Overview of DVT Management02:50 - New Guidelines for DVT Treatment07:30 - Technical Endpoints in DVT Treatment13:26 - Clout Registry and Its Findings17:57 - Anticoagulation and DVT23:05 - Defining Acute DVT Management27:00 - Evolving Approaches to Acute DVT28:19 - Patient Experience and Quality of Life31:08 - Referring Providers and Data Impact37:01 - Single Session Treatments and Stenting41:07 - Chronic Venous Disease Management --- RESOURCES (ATTRACT) Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019;24(5):442-451. doi:10.1177/1358863X19862043https://pubmed.ncbi.nlm.nih.gov/31354089/ (CLOUT) Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thro...

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