BackTable Vascular & Interventional

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.

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https://www.backtable.com/app

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This podcast is supported by

Varian OmniBone
https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone

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Timestamps

00:00 - Introduction
03:31 - Referral Trends and Procedure Volume
06:15 - Indications and Contraindications
12:28 - Sedation and the Periosteal Block
16:30 - Procedure Walkthrough
23:13 - Powered Access and Variable Speed
29:43 - Sclerotic Bone and Dry Taps
34:55 - Aspiration Pain and On-Site Pathology
37:35 - Sternal Bone Marrow Aspiration
39:07 - Efficiency With Powered Systems
43:37 - Ultrasound Guidance and Workflow
46:45 - Hemodilution and Repeat Biopsies
48:14 - Closing Remarks

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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.

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Resources

Increasing Volume of Bone Marrow Biopsies by Radiology Providers: Evaluation of Trends by Physician Specialty and Practice Setting. J Am Coll Radiol. 2020
https://doi.org/10.1016/j.jacr.2020.02.004

BackTable Episode 1, the very first BackTable episode, on bone marrow biopsy, with Dr. Chris Beck, Dr. Aaron Fritts, and Anish Parikh
https://www.backtable.com/shows/vi/podcasts/1/bm-bx-devices-jamshidi-vs-oncontrol

Dr. Mohammad Samim, NYU Langone Health
https://nyulangone.org/doctors/1487966693/mohammad-m-samim

Dr. Chris Beck, BackTable contributor page
https://www.backtable.com/shows/vi/contributors/dr-christopher-beck

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

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.

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https://www.backtable.com/app

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This podcast is supported by

Terumo
https://www.terumois.com/haepodcast

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Timestamps

00:00 - Introduction
03:33 - Surgical Options and Recovery
07:31 - Ideal Candidates for Embolization
10:47 - HEMORR1 Trial Design and Embolics
15:37 - Arterial Anatomy and Coil Technique
19:53 - Collaboration with Colorectal Surgery
24:18 - Pelvic Pain and Patient Selection
28:48 - Scalability and Contraindications
32:02 - Recurrence and Collateral Supply
35:27 - Patient Goals and Expectations
37:37 - Closing Remarks

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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.

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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 for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques (RadioGraphics)
https://pubs.rsna.org/doi/full/10.1148/rg.220014

Is the Goligher Classification a Valid Tool in Clinical Practice and Research for Hemorrhoidal Disease?
https://link.springer.com/article/10.1007/s10151-022-02591-3

Scott M. Thompson, M.D., Ph.D., Mayo Clinic
https://www.mayoclinic.org/biographies/thompson-scott-m-m-d-ph-d/bio-20535376

Kristy K. Rumer, M.D., Ph.D., Mayo Clinic
https://www.mayoclinic.org/biographies/rumer-kristy-k-m-d-ph-d/bio-20519891

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Instylla
https://instylla.com/embrace/

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Timestamps

00:00 - Introduction
02:23 - Liquid Embolic Use in Practice
04:46 - Case 1: Renal Mass
07:51 - Delivery Technique and Target Vessel Size
13:08 - Device Setup and Catheter Compatibility
21:57 - Case 2: Multifocal HCC
27:44 - Case 3: Large Renal Tumor
40:21 - Randomized Trial Outcomes
43:28 - Case 4: HCC Near the Gallbladder
49:39 - Case 5: Pelvic Tumor and Femoral Metastases
55:30 - Lessons from Early Use and Case Selection
1:01:37 - Case 6: Breast Cancer Liver Metastasis
1:05:23 - Closing Remarks

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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.

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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 Instylla Hydrogel Embolic System for Vascular Occlusion of Hypervascular Tumors. J Vasc Interv Radiol. 2026
https://doi.org/10.1016/j.jvir.2026.108946

Ganguli S, Lareau R, et al. A Water-Based Liquid Embolic: Evaluation of its Safety and Efficacy in a Rabbit Kidney Model. J Vasc Interv Radiol. 2021
https://doi.org/10.1016/j.jvir.2021.02.018

HALT: Embrace Hydrogel Embolic System Study of Embolization in Peripheral Arterial Bleeds (NCT05364502)
https://clinicaltrials.gov/study/NCT05364502

Kim GH, et al. Effectiveness and Safety of Transarterial Radioembolization Following Inferior Phrenic Artery Glue Embolization for Flow Redistribution in Hepatocellular Carcinoma. J Vasc Interv Radiol. 2026
https://doi.org/10.1016/j.jvir.2026.108784

Dr. Resmi Charalel, Montefiore Einstein
https://doctors.montefioreeinstein.org/providers/1558653980/resmi-charalel

Dr. Milan Patel, MD Anderson Cancer Center
https://faculty.mdanderson.org/profiles/milan_patel.html

Dr. Kavi Krishnasamy, BackTable contributor page
https://backtable.com/shows/vi/contributors/dr-venkatesh-krishnasamy

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Could replacing bulky coil packs with specialized liquid embolic agents be the key to faster, more cost-effective peripheral embolizations? In this kickoff episode of the BackTable 2026 Liquid Embolics Creator Weekend™, Dr. Kavi Krishnasamy (University of Alabama at Birmingham) and Dr. Gary Siskin (Albany Med) join Dr. Tyler Sandow to break down the foundational principles, deployment approaches, and expanding clinical applications of liquid embolics in non-neurological interventions. They discuss the transition toward a "liquid-first" procedural mindset, the technical nuances of adhesive and cohesive agents, and how targeted liquid cast creation might optimize procedure times and device expenditure compared to traditional coiling.

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https://www.backtable.com/app

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This podcast is supported by an educational grant from Sirtex.

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Timestamps

00:00 - Introduction
03:01 - Case 1: Rectus Sheath Bleed
06:15 - Liquid Embolics: Advantages and Apprehension
12:15 - Adhesive vs. Cohesive Mechanisms
14:28 - LAVA Workflow and Deployment Considerations
19:37 - Safe Post-Delivery Technique
23:49 - Risks and Preventing Adverse Events
27:06 - Case 2: Roadmap Mask for Embolic Visualization
30:22 - Stuck Catheter Experiences
34:01 - Glue Timing and Control
37:13 - Rapid-Fire Practical Pearls
41:40 - Closing Remarks

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More about this episode

The panel walks through procedural protocols, detailing microcatheter selection, dead-space calculations, and injection techniques designed to prevent arterial spasm and non-target reflux. Dr. Siskin and Dr. Krishnasamy detail troubleshooting strategies including catheter extraction maneuvers to prevent device entrapment, the use of road-map masking for better embolic visualization, and the application of pushable or detachable coils as distal backstops. They review approaches in high-yield clinical scenarios such as rectus sheath hematomas, gastroduodenal artery (GDA) obliteration, and type II endoleak interventions. The episode concludes with advice for early-career operators on gaining hands-on preclinical experience, mastering multi-embolic combinations, and identifying scenarios where liquid agents should be avoided.

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Resources

Treatment of Peripheral Arterial Hemorrhage with Lava LES (The LAVA Study)
https://clinicaltrials.gov/study/NCT04649255

Onyx™ Liquid Embolic IDE Clinical Study
https://clinicaltrials.gov/study/NCT06742801

Fluidx’s GPX Embolic Device Meets Primary Endpoints in Pivotal Trial
https://evtoday.com/news/fluidxs-gpx-embolic-device-meets-primary-endpoints-in-pivotal-trial

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What do you actually do when a Medicare audit letter lands in your inbox? On this episode of BackTable Podcast, Dr. Ally Baheti interviews healthcare attorney Jason Greis, partner at Benesch, to demystify the audit process and the rising scrutiny on interventional practices. They discuss why audits are accelerating, which procedures are under the microscope, and how enforcement economics and AI-driven review are reshaping the landscape for OBLs and ASCs.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

RADPAD® Radiation Protection
https://www.radpad.com/

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Timestamps

00:00 - Introduction
02:32 - Audit Hotspots in Endovascular Work
05:00 - AI Oversight and Proactive Compliance
13:35 - The Alphabet Soup of Audit Types
19:16 - Responding to an Audit and the Appeals Ladder
24:48 - Employment Status, Liability and AI Downcoding
30:29 - Final Advice and Wrap Up

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More about this episode

The conversation covers the “alphabet soup” of audit types, the five-step appeals process, and strategies for proactive compliance and documentation. The discussion walks through personal liability, employment status, the risks of algorithmic downcoding by commercial payers, and why practices must balance when to fight and when to let an audit go. The episode closes with actionable advice on protecting your practice, the dangers of putting patient data into AI tools, and why trade organizations are the first line of defense.

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Resources

OIG: Utilization Trends and Medicare Part B Billing for Office-Based Peripheral Vascular Procedures Raise Questions About Program Integrity (OEI-01-24-00250)
https://oig.hhs.gov/reports/all/2026/utilization-trends-and-medicare-part-b-billing-for-office-based-peripheral-vascular-procedures-raise-questions-about-program-integrity/

CMS Wasteful and Inappropriate Service Reduction (WISeR) Model
https://www.cms.gov/priorities/innovation/innovation-models/wiser

CMS Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH)
https://www.cms.gov/fraud

CMS Medicare Fee-for-Service Appeals: The Five Levels
https://www.cms.gov/medicare/appeals-grievances/fee-for-service

CMS Medicare Fee-for-Service Compliance Programs (TPE, RAC, SMRC, CERT)
https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs

BackTable VI Ep. 478: ASC vs. OBL: Legal Insights Explained
https://www.backtable.com/shows/vi/podcasts/478/asc-vs-obl-legal-insights-explained

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Endovascular Engineering (E2)
E2Helo.com

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Timestamps

00:00 - Introduction
03:42 - Referral Patterns and PERT Scope
05:25 - PE Workup Essentials
07:26 - Targeted Assessment of Acuity
11:36 - Reliability of the Walk Test
14:35 - PE Treatment Pathways
19:26 - Procedural Walkthrough
24:15 - Catheter Sizing
30:05 - Adjunct Aspiration Device Features
35:09 - Blood Return Process and Safety
40:03 - Helo Study Early Results
45:09 - Determining Procedural Endpoints
50:20 - Future Trials and Technologies
53:48 - Final Thoughts and Closing Remarks

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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 benefits of mechanized aspiration with minimal complications. The episode closes with a critical look at defining true functional procedural endpoints beyond pulmonary arterial pressures and offers a preview of upcoming trial data, such as HI-PEITHO and PEERLESS II, that could further advance PE management.

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Resources

2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults
https://doi.org/10.1161/CIR.0000000000001415

Ultrasound-Facilitated, Catheter-Directed Thrombolysis in Intermediate-High Risk Pulmonary Embolism (HI-PEITHO)
https://clinicaltrials.gov/study/NCT04790370

PEERLESS II study
https://clinicaltrials.gov/study/NCT06055920

Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism (PRAGUE-26)
https://doi.org/10.1056/nejmoa2608012

Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3)
https://clinicaltrials.gov/study/NCT04430569

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

When is it time to move from repeat drainage to a tunneled catheter for managing pleural effusions or ascites? On this episode of BackTable Podcast, Dr. Neil Jain interviews Dr. Marco Ertreo, interventional radiologist and IR residency program director at Strong Memorial Hospital, University of Rochester, about best practices for tunneled catheter management in both the chest and abdomen. They discuss the triggers for placing a tunneled catheter, patient selection, placement technique, home drainage protocols, complication management, and the unique considerations for malignant versus cirrhotic ascites.

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Get the BackTable app
https://www.backtable.com/app

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Timestamps

00:00 - Introduction
06:39 - Indications and Pleural Catheter Placement Technique
12:10 - Tunneling, Cuff Position and Exit Site Selection
17:42 - Home Drainage, Volume Limits and Complications
26:13 - Peritoneal Catheters, TIPS Candidacy and Catheter Choice
35:16 - Avoiding Bowel and Varices
43:42 - Key Takeaways and Closing Remarks

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More about this episode

Dr. Ertreo shares practical details about pocket selection, access points, catheter testing, and choosing Tenckhoff catheters for abdominal cases to avoid proprietary systems. The conversation covers volume limits, complication counseling, criteria for removal, and the psychological impact of living with a long-term drain. They discuss when to consider TIPS for cirrhotic patients, the importance of early conversations with patients and referring providers, and why multidisciplinary teamwork and family support are essential for long-term success.

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Resources

Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial
https://pubmed.ncbi.nlm.nih.gov/30037711/

Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline
https://www.atsjournals.org/doi/10.1164/rccm.201807-1415ST

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://pubmed.ncbi.nlm.nih.gov/31229333/

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases (AASLD)
https://pubmed.ncbi.nlm.nih.gov/33942342/

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by
Varian
https://www.siemens-healthineers.com/

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Timestamps

00:00 - Introduction
04:00 - GAE Workup and Patient Scoring
05:28 - KL Score and MRI Debate
10:15 - Patient Selection and Contraindications
15:11 - Access Strategy and Closure Techniques
19:54 - Catheters, Wires, and Embolic Choices
28:19 - Cone Beam CT Workflow
31:37 - Managing Collaterals
34:26 - Follow-Up and Repeat GAE
38:42 - Defining Success and Setting Expectations
44:25 - Technique Nuances and Flow Modulation
50:28 - Building Referral Networks
56:56 - Keeping Referrers Engaged
59:46 - Direct-to-Patient Marketing
01:04:57 - Leveraging Social Media and Reviews
01:12:42 - Tracking Leads and Insurance Coverage
01:19:47 - Final Thoughts and Next Steps

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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.

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Resources

Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trial
https://doi.org/10.1007/s00330-026-12505-8

Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Pain
https://doi.org/10.1007/s00270-026-04410-w

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by
Stryker Peripheral Vascular
https://www.stryker.com/us/en/peripheral-vascular.html

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Timestamps

00:00 - Introduction
02:27 - Presentation, Referral Patterns, and Imaging
06:07 - Acute Limb Ischemia: Treatment Algorithm
12:16 - Thrombectomy Device Selection
16:09 - Thrombolysis and Applications Beyond Lower Extremity
18:46 - Procedural Endpoints, Closure, and Case Selection
24:43 - Deep Vein Arterialization: Patient Selection and Planning
31:25 - DVA Technique: Imaging, Anesthesia, and Access
34:58 - Step-by-Step DVA Approach
41:56 - Surveillance and Managing Expectations
45:59 - Wound Care and Amputation Decisions
49:40 - Future Directions in PAD
52:43 - Closing Remarks

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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 discussion of post-procedure surveillance, wound care, and the need for better measures of perfusion to improve limb salvage and patient outcomes.

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Resources

Rutherford classification of acute and chronic limb ischemia.
https://doi.org/10.1016/S0741-5214(97)70045-4

Global vascular guidelines on the management of chronic limb-threatening ischemia. Conte, Bradbury, Kolh et al., Journal of Vascular Surgery, 2019.
https://doi.org/10.1016/j.jvs.2019.02.016

PROMISE II. Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia. Shishehbor et al., New England Journal of Medicine, 2023.
https://doi.org/10.1056/NEJMoa2212754

BackTable VI Episode 618, How to Manage Advanced DVA Cases: Techniques and Tips, with Dr. Kumar Madassery and Dr. Sabeen Dhand. https://www.backtable.com/shows/vi/podcasts/618/how-to-manage-advanced-dva-cases-techniques-tips

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90.

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Timestamps

00:00 - Introduction
02:36 - Resection After Radioembolization
06:07 - Personal Practices Between HCC and Liver Metases
07:26 - Bridging Radiation Segmentectomy
11:22 - Understanding Portal Vein Tumor Thrombus
14:21 - Preferences in Dosimetry Software
17:57 - Liver Reserve Limits
25:11 - Microsphere Activity and Density
29:16 - Diving into PROACTIF
33:32 - RCTs and Trial Challenges
36:57 - Patient Diversity in PROACTIF
41:42 - Extrahepatic Disease
43:03 - Data Gaps and Takeaways
45:32 - Defining Personalized Dosimetry and Bridging Software
50:15 - Mixed Delivery Approaches and Dose Thresholds
01:01:36 - Response and Local Control
01:04:26 - Treating PVT Subgroups
01:09:03 - Comparison Between Dosing and Survival
01:15:03 - Differences in Patients Quality of Life After Transplantation
01:26:34 - Wrap-Up and Credits

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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 reserve, and treated liver volume, and highlight how decision-making and tailored techniques are essential for improving outcomes in liver cancer care.

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app