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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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.

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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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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.

---

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.

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What characteristics make bone biopsies unique in both presentation and procedure? In this episode of the BackTable Podcast, Drs. Junjian Huang and Majid Khan join host Dr. Neil Jain to break down the complexities of bone biopsy technique. They discuss key strategies for tackling difficult cases, from understanding referral patterns and pre-procedure planning to selecting the best guidance modality and anticipating complications.

---

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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

---

Timestamps

00:00 - Introduction
08:06 - Referrals And Pre-Procedure Planning
12:35 - Triaging and Managing Difficult Cases
17:06 - Measuring and Improving Diagnostic Yield
18:58 - Knowing Boundaries Behind Difficult Cases
22:37 - Choosing the Best Guidance Modality
26:16 - The Future with Augmented Reality
28:11 - Tough Case Scenarios and Setup
41:27 - Preventing and Managing Complications
47:49 - Technical Tips for Future IRs
51:40 - Wrap-up and Credits

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More about this episode

The conversation covers how to triage complex cases, adjust technique for smaller or hard-to-reach lesions, and benchmark diagnostic success. Drs. Huang and Khan share their preferred imaging guidance, from CT to fluoroscopy, and explore new frontiers like augmented reality. Case scenarios highlight practical problem-solving, and the episode wraps up with technical pearls and complication-prevention tips gained from years of experience in targeted bone biopsy.

---

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.

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Once your PERT is assembled, how do you navigate the evolving pulmonary embolism (PE) literature to improve patient outcomes at all risk levels? In this episode of the BackTable Podcast, interventional radiologist Dr. Robert Lookstein (Mount Sinai) and pulmonary critical care specialist Dr. Timothy Fernandes (UC San Diego) join host Dr. Harris Chengazi to examine the latest evidence and multidisciplinary strategies for managing acute pulmonary embolism. The discussion highlights the complexities of catheter-directed therapies in intermediate- to high-risk PE, evolving guidelines in the face of new trial data, and prioritization of improving patients’ clinical trajectories.

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This podcast is supported by

Penumbra

https://www.penumbrainc.com/

Timestamps

00:00 - Introduction
03:57 - PERT Structure and Activation
08:24 - PE Risk Stratification Tools
12:02 - Patient Selection for IR Intervention
15:21 - Assessing Clot Chronicity
21:03 - Standardizing Workup
26:38 - Managing Unstable PE
28:31 - STORM-PE and HI-PEITHO Trial Data
35:49 - Guidelines vs. New Evidence
40:12 - Determining Therapeutic Endpoints
45:05 - Upcoming Trials and Future Directions
51:46 - Final Thoughts and Closing Remarks

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More about this episode

The physicians explore the nuances of validated PE risk stratification tools, assessing the relationship between various PE scoring systems and the 2026 ACC/AHA classification for acute PE. They emphasize that the integration of clinical assessment, serial lab work, and patient history must take precedence over static imaging alone in guiding care. The doctors go on to review new trial data, including the improved RV-to-LV ratio and 90-day functional gains seen with mechanical thrombectomy in STORM-PE and reduced clinical deterioration observed with ultrasound-assisted catheter-directed thrombolysis in HI-PEITHO. The conversation concludes with a call for collaborative, safety-first management that focuses on the patient’s clinical status and long-term post-PE functional recovery.

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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

Composite Pulmonary Embolism Shock (CPES) Score
https://doi.org/10.1161/CIRCINTERVENTIONS.124.014088

FOCUS study
https://doi.org/10.1093/eurheartj/ehac206

STORM-PE trial
https://doi.org/10.1161/CIRCULATIONAHA.125.077232

HI-PEITHO trial
https://doi.org/10.1056/nejmoa2516567

PE-TRACT study
https://petractstudy.org/homepage

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

PERSEVERE trial
https://clinicaltrials.gov/study/NCT06588634

---

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.

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Why do nearly half of IR residents consider leaving the specialty, and what can be done to change that? On this episode of the BackTable Podcast, Dr. Neil Jain interviews Dr. David Mittelstein, an integrated IR resident at UC San Diego and co-chair of the SIR RFS Recruitment Committee, about the findings of a national SIR survey on interventional radiology resident attrition. They discuss what drives uncertainty, from lifestyle and call burden to job market fears, and highlight the program features that encourage retention, such as structured training, high case volume, and a culture of camaraderie.

---

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This podcast is supported by

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

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Timestamps

00:00 - Introduction
04:31 - From Biomedical Engineering to IR
07:41 - Recruitment Committee Mission
12:37 - Match Trends Warning Sign
15:12 - Survey Design Demographics
20:21 - What Factors Matter
25:04 - Why Residents Consider Switching
30:23 - Recommendation 1 IR Curriculum
32:32 - Recommendation 2 More IR Rotation
34:10 - Recommendation 3 Build Camaraderie
38:30 - Advice for Residents Who Are Doubting
41:00 - What’s Next for RFS Recruitment
43:20 - Wrap Up

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More about this episode

The conversation explores free-response themes from the survey, where 78 percent of residents cited lifestyle concerns, 31 percent pointed to job market uncertainty, and 22 percent mentioned call experience as reasons for questioning IR. Retention was linked to structured training (38 percent), high case volume and procedural experience (35 percent), and program camaraderie (18 percent). Dr. Mittelstein and Dr. Jain review three concrete recommendations to improve retention, examine early changes at programs like Georgetown, and offer practical advice to residents who may be quietly doubting their path in IR.

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Resources

Episode # 554 Optimizing the IR/DR Curriculum & Experience

https://www.backtable.com/shows/vi/podcasts/554/optimizing-the-ir-dr-curriculum-experience

---

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 are new aspiration thrombectomy systems and real-time hemodynamic monitoring enabling safer, more effective pulmonary embolism treatment? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Maya Serhal and Dr. David Dexter for a deep dive into modern pulmonary embolism (PE) management, with a focus on advances in large-bore aspiration thrombectomy. They discuss evolving PE triage algorithms, real-world procedural strategies, and the clinical impact of next-generation aspiration systems on safety, efficiency, and patient recovery.

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https://www.backtable.com/app

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This podcast is supported by

Imperative Care
https://imperativecare.com/

---

Timestamps

00:00- Introduction
02:03- PE Response Workflow
05:32- Symphony Device
07:07- Sizing and Blood Loss
10:00- Multi-Port Hemodynamics
14:45- Procedure Endpoints
17:01- IVUS Guided Strategy
20:02- ProHelix and Lollipopping
25:48- Case Studies
34:12- Closing Thoughts

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More about this episode

The conversation explores multidisciplinary PE response workflows, lab and imaging triggers for escalation, and technical considerations in catheter sizing, blood loss management, and real-time hemodynamic monitoring. Dr. Dexter reviews his use of intravascular ultrasound for precise clot localization, and Dr. Serhal shares practical tips for adjusting aspiration power to avoid complications. Together, they discuss procedural endpoints, mechanical assist devices for difficult clots, and present case examples demonstrating rapid improvement in hemodynamics and oxygenation. The episode emphasizes the importance of teamwork, patient selection, and ongoing innovation in optimizing PE care.

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Resources

American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism
https://ashpublications.org/bloodadvances/article/4/19/4693/463998/American-Society-of-Hematology-2020-Guidelines-for

Prospective Multicenter IDE Study of the Next-Generation Precision Aspiration Thrombectomy System for Intermediate-Risk Pulmonary Embolism: The SYMPHONY-PE Trial
https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.125.015815

Is There a Golden Hour for Thrombectomy in Intermediate-Risk Pulmonary Embolism? Insights From SYMPHONY-PE
https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.126.016573
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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

Are you building a business that can thrive without you, or just creating a job you can never leave? In this episode of BackTable Women’s Health, host Dr. Karen Toubi sits down with Dr. Nneka Una (Unachukwu), a board-certified pediatrician, founder of Ivy League Pediatrics, and creator of EntreMD, to discuss the mindset and skills needed to build a truly sustainable medical practice. The conversation explores why physician entrepreneurship is essential in today’s evolving healthcare landscape, the difference between building yourself a job and building a resilient business, and practical strategies for long-term growth.

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---

Timestamps
00:00 - Introduction
04:47 - From Employee to Owner
05:53 - Skills That Changed Everything
07:35 - The Wake Up Call
10:44 - Why Doctors Resist Business
15:06 - Profit as Patient Care
18:20 - Job vs. Business Entity
21:13 - CEO Hat and Team Systems
25:14 - Exit Value and Sellability
29:00 - More Profit: More Time Off
30:24 - Fear Before Breakthrough
35:32 - Choose Service Over Perfection
39:11 - Invest in Your Potential
46:26 - MEAT Week Priorities
48:40 - Three-Part Daily Rhythm
55:02 - Advice for Burned-Out Docs
59:29 - Wrap Up

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More about this episode
Dr. Una shares how doctors can overcome resistance to “business,” why every practice needs a strong business engine, and how to balance profitability with ethical, people-centered care. She explains how to shift from employee to physician-CEO, tackle imposter syndrome, and develop systems that give your practice true staying power. The discussion provides actionable advice on hiring, team management, building exit value, and creating the freedom to take more time off without sacrificing patient care or financial stability.

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Resources
EntreMD https://entremd.com/about-us/
The Profitable Private Practice Playbook https://entremd.com/method-book/

---

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 decide between a dedicated aortic scaffold and kissing stents in complex aortoiliac bifurcations? On this episode of the BackTable Podcast, Dr. Sabeen Dhand and Dr. Eric Secemsky discuss the management of a female smoker presenting with rapidly progressive bilateral hip pain, ultimately revealed to be severe aortoiliac arterial disease. The case highlights the value of noninvasive vascular studies, CTA, and IVUS for precise diagnosis and procedural planning, as well as the nuanced decision-making process between different device options.

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https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
01:56 - Patient History
05:42 - CTA and Angio Findings
09:30 - Strategy Access and IVUS
13:17 - IVUS Sizing and Lesion Review
16:38 - IVL Angioplasty Technique
18:28 - Stenting and Final Result
22:50 - Post-procedure Meds and Outcome
24:34 - Wrap Up

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More about this episode

Dr. Secemsky reviews access strategy, lesion sizing, and the use of intravascular lithotripsy to reduce rupture risk in heavily calcified arteries. The doctors explain their rationale for choosing kissing covered stents over a dedicated aortic scaffold, details the technical steps of ballooning and stenting, and discusses the transition from dual antiplatelet therapy to rivaroxaban and aspirin postprocedure. The episode concludes with key insights into device selection, procedural technique, and patient-centered decision-making for successful aortoiliac interventions.

---

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 new interventional radiologists wish they had known before starting residency? On this reflective episode of BackTable, Dr. Neil Jain is joined by chief residents Dr. Aesha Patel and Dr. Gregg Khodorov as they look back on six years of IR/DR training. They share what they wish they’d known as applicants, from the growing emotional weight of complications near graduation to the essential role of co-residents, support networks, and the evolving balance between confidence and competence.

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---

Timestamps

00:00 - Introduction
04:34 - Rapid Fire Reflections
07:20 - Complications and Confidence
12:01 - Applicant Misconceptions
16:54 - Defining a Great Program
26:38 - Lessons Learned Over Time
29:12 - Pearls and Hard-Won Lessons
33:09 - Valuing Bread-and-Butter Cases
35:24 - Complications and Empathy
41:03 - Memorable Attending Phrases
43:06 - Habits for the Future
47:34 - Mentorship and Craftsmanship
52:42 - IR Culture and Professional Pride
57:44 - The Future of IR Training
01:08:34 - Closing Thoughts

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More about this episode

They discuss how their definition of a “good case” has evolved, the importance of mastering bread-and-butter procedures, and the impact of habits like detailed note-taking, patient-centered communication, and taking ownership of complications. The episode highlights ideas for future training improvements and offers advice on valuing patient interactions, embracing growth, and developing sound clinical judgment under pressure. Throughout, the conversation underscores the personal and professional growth that comes from these challenges and the lasting value of camaraderie and mentorship in interventional radiology.

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Resources

Perspective on the New IR Residency Selection Process: 4-year Experience at a Large, Collaborative Training Program
https://www.sciencedirect.com/science/article/pii/S1076633221000568

Diversity in Interventional Radiology Residency Programs
https://www.sciencedirect.com/science/article/abs/pii/S1546144025002765

Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residency
https://www.sciencedirect.com/science/article/abs/pii/S107663322300051X

---

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

A bone biopsy can reach the target and still miss the diagnosis. In this episode of the BackTable Podcast, host Dr. Neil Jain is joined by Dr. Peter Thurlow to discuss how lesion selection, imaging review, trajectory planning, and device choice determine whether a targeted bone biopsy produces a useful sample without compromising future treatment.

---

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This podcast is supported by
Varian

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

---

Timestamps

00:00 - Introduction
04:17 - Approaching Focal Bone Lesions
06:17 - Differentiating Lesions and Pain Management
13:13 - Settling on Bone Biopsy Imaging
16:55 - Understanding Pre-Op Imaging from Lesion Characteristics
21:50 - Maintaining Communication Across Specialties
24:21 - Which Devices To Select and Navigating Challenges
32:28 - Trajectory Paths and Surgical Considerations
35:30 - How to Avoid and Mitigate Biopsy Complications
41:30 - Wrap Up

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More about this episode

The conversation begins with a systematic approach to evaluating focal bone lesions, including the likelihood of malignancy, lesion location, number of lesions, and selection of an appropriately sized sampling device. Dr. Thurlow reviews anesthesia and pain-management strategies for both superficial and deeper osseous targets, as well as the respective roles of MRI and CT in procedural planning. For challenging lesions, he explains why needle-guidance technology may be preferable to adjusting gantry tilt and outlines how imaging findings and biopsy strategy should be tailored to lesion type, with particular attention to the difficulties associated with blastic lesions.

The doctors also discuss the importance of communication with pathology, surgery, oncology, and other collaborating specialties before proceeding. Dr. Thurlow shares his preferred biopsy devices, considerations for selecting a safe trajectory, and ways to account for potential future surgical approaches. The episode concludes with practical strategies for avoiding complications, minimizing tissue injury, and obtaining an adequate diagnostic sample.

---

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