Why are some GJ tubes more prone to failure, and what can you actually do about it? In this episode of the BackTable Podcast, Dr. Chris Beck hosts Dr. Kevin Wong, a pediatric interventional radiologist at the University of South Alabama, to discuss the complexities of gastrojejunostomy (GJ) tube management in hospital-based IR, especially in pediatric patients. The discussion offers clinically relevant guidance on troubleshooting, device selection, and multidisciplinary approaches to enhance GJ tube care and improve patient outcomes.

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Timestamps

00:00 - Introduction
05:40 - Etiologies of GJ Tube Dislodgement and Placement Considerations
12:17 - Spiral Upsizing Solutions
14:30 - Parent Education Playbook
19:34 - Indications for GJ Conversion
21:55 - Criteria for GJ Removal
24:12 - Preferred Low-Profile Tube Designs
27:15 - Addressing Suboptimal Angles and Guidewire Selection
31:26 - Strategies to Prevent Tube Occlusion
33:34 - Wish List for Industry
36:12 - Balloon Assisted Placement Techniques
37:58 - Wrap Up and Credits

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More about this episode

The doctors explore why GJ tubes fail and how to manage common complications, such as balloon failures, vomiting-induced dislodgement, stoma enlargement, and recurrent malfunction due to poor gastrostomy angle or architecture, often seen with surgically placed G-tubes. Dr. Wong shares prevention strategies, including parent education on balloon-volume checks and refills, sending patients home with a backup G-tube, minimizing upsizing, and addressing traction and granulation tissue (including the use of silver nitrate). He also covers approaches to clog management such as warm water, Coke, aggressive flushing, and avoiding routing medications through the G port. The episode wraps up with a discussion on device preferences (AMT G-JET versus MIC-KEY), tips for wire and catheter exchanges, and the need for industry improvements in materials and lumen design.

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

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A high-functioning HCC tumor board can turn complex transplant decisions into coordinated treatment plans that account for liver reserve, tumor biology, and evolving biomarkers. In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, abdominal transplant surgeon Dr. Ari Cohen (Ochsner Health) and transplant hepatologist Dr. Neil Mehta (UCSF) join host Dr. Kavi Krishnasamy to map out strategies for effective multidisciplinary treatment and transplantation planning in HCC.

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This podcast is supported by an educational grant from Sirtex and Boston Scientific.

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Timestamps

00:00 - Introduction
00:51 - Starting a Tumor Board
06:39 - Building Referral Streams
09:03 - Academic and Community Practice Integration
14:31 - Treatment Selection Criteria
20:38 - Modern HCC Biomarkers
25:24 - Role of ctDNA and Biopsy
29:37 - Bridging Therapy on Transplant Waitlist
32:34 - Downstaging Strategy and Risks
39:25 - Final Thoughts and Closing Remarks

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More about this episode

The physicians discuss what it takes to build a robust tumor board, from fostering hospital buy-in to engaging leaders across specialties and utilizing virtual formats for consistent participation. The conversation explores clinical decision-making, emphasizing the integration of AFP-L3 and DCP biomarkers alongside AFP to better understand tumor biology and predict post-transplant recurrence. Dr. Mehta and Dr. Cohen also share their patient selection criteria, discussing how bilirubin, liver disease etiology, and INR influence decisions. While radiographic guidance remains central to HCC management, they highlight the growing potential of reliable ctDNA analysis and other biomarkers. The specialists conclude by emphasizing that an integrated, communicative tumor board is the most effective way to navigate the nuances of liver reserve and HCC biology to achieve the best possible patient outcomes.

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Resources

Sustained AFP-L3 or DCP expression is associated with progression risk and inferior outcomes in unresectable hepatocellular carcinoma.
https://doi.org/10.1007/s10238-025-01877-8

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

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Can arterial closure devices transform your OBL workflow and get patients moving sooner? In this episode of the BackTable Podcast, Dr. Mike Barraza sits down with Interventional Radiologist Dr. Dave Johnson to discuss the ins and outs of launching and running an office-based lab (OBL) in Florida. While covering startup logistics, staffing, regulatory requirements, and cost-saving strategies, the conversation centers on how the use of arterial closure devices can streamline workflow, speed post-procedure recovery, and enhance both efficiency and patient care in the OBL setting.

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Terumo
https://www.terumo.com/

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Timestamps

00:00 - Introduction
01:31- Launching The OBL
04:41- Logistics And Staffing
07:14 - Standardizing Supplies
11:57 - OBL vs. Hospital Cases
15:30 - Patient Experience Benefits
17:41 - Efficiency And Throughput
20:49 - Closure Devices For Flow
23:28 - Early Ambulation With AngioSeal
26:14 - Anticoagulation Decisions
28:31 - AngioSeal Access Technique
30:20 - Avoiding Hostile CFA Access
32:19 - Choosing SFA or Radial
34:04 - Do You Need Groin Runs
36:14 - Closure Device Fundamentals
38:53 - Ultrasound Guided AngioSeal
45:11 - Post Op Monitoring Checklist

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More about this episode

Dr. Johnson explains that some procedures, such as Prostate Artery Embolization (PAE), may still require a hospital setting due to insurance coverage, patient preference, or unique clinical needs. He compares patient experiences in OBLs versus hospitals, emphasizing the advantages of privacy, convenience, and personalized communication in the OBL environment. A major challenge discussed is managing post-procedure recovery and patient throughput with limited holding beds, where femoral arterial closure devices like Angio-Seal are essential for early ambulation and efficient turnover. The discussion highlights best practices for access site selection, ultrasound guidance, and post-closure assessment, providing actionable insights for IR physicians aiming to optimize office-based procedures.

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Resources

Cost Comparison of Prostatic Artery Embolization Between In-Hospital and Outpatient-Based Lab Settings
https://pubmed.ncbi.nlm.nih.gov/39310461/

Prostate Artery Embolization: Indication, Technique and Clinical Results
https://pubmed.ncbi.nlm.nih.gov/29975976/

Ultrasound-guided angio-seal deployment
https://pubmed.ncbi.nlm.nih.gov/25735527/

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

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With recent updates to the Barcelona Clinic Liver Classification (BCLC), how should multidisciplinary teams adapt their treatment strategies to accommodate the newest evidence? In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, Dr. Neil Mehta of UCSF and Dr. Riad Salem of Northwestern Medicine join host Dr. Tyler Sandow to explore the complexities of hepatocellular carcinoma (HCC) therapies and the practical application of the latest global algorithms in balancing standardized therapeutic algorithms with individual patient factors.

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Timestamps

00:00 - Introduction
01:54 - HCC Case Discussion
08:05 - Guest Introductions
10:37 - BCLC Committee and 2025 Update
15:54 - CUSE and Tumor Board Goals
17:46 - Bridging vs Curative Y90
22:37 - Patient Factors in Treatment Algorithms
26:41 - Liver Function and Hyperbilirubinemia Trends
30:25 - HCC Treatment Decision Ownership
34:36 - Radiation Segmentectomy vs Surgical Resection
37:35 - BCLC B Heterogeneity
41:51 - Improving HCC Risk Stratification
43:48 - Final Thoughts and Closing Remarks

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More about this episode

The discussion begins with an inside look at the consensus process behind the 2025 BCLC updates, highlighting the official inclusion of Y90 radioembolization as a recognized therapeutic option. The experts introduce the "CUSE" (Complexity, Uncertainty, Subjectivity, and Emotion) framework to provide a structured approach to the subjective considerations that modulate purely data-based algorithms in multidisciplinary decision-making. Dr. Salem and Dr. Mehta speak on the nuances of surgical resection versus radiation segmentectomy in a case-based discussion, highlighting how factors such as portal hypertension, patient age, and etiology of cirrhosis should influence treatment pathways. Finally, they underscore the paradigm shift toward pursuing complete pathonecrosis (CPN) as a primary curative goal, regardless of bridging status, and reiterate that success in HCC care is driven by continuous communication and collaboration between physicians and patients.

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Resources

BCLC 2026 Update
https://doi.org/10.1016/j.jhep.2025.10.020

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

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When a liver tumor is hard to see, the limits of conventional image guidance can become the limits of treatment. In this episode of the BackTable Podcast, Netherlands interventional oncologist Dr. Maarten (M.L.J.) Smits shares a step-by-step walkthrough of the new hepatic arteriography and C-arm CT–guided ablation (HepACAGA) technique, punctuated with a real-world case series at the end. Find out how intra-arterial contrast, cone-beam CT, and 3D needle guidance can improve tumor conspicuity, targeting accuracy, and ablation margin assessment within a single angiography suite.

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Timestamps

00:00 - Introduction
02:55 - Netherlands Tech Access
04:31 - Origin of HepACAGA
07:14 - Why Use a Catheter?
11:24 - Tools and Setup
13:13 - Catheters and Devices
17:06 - Contrast Protocol Basics
22:51 - Targeting and Needle Guidance
31:09 - Patient Selection
35:56 - Extra Benefits and Multimodal
39:58 - Workflow and Outcomes
46:14 - Evidence and Early Studies
51:41 - Rethinking Size Cutoffs
57:54 - HCC Case Walkthrough
01:02:27 - Hard-to-See Metastasis
01:06:22 - Margin Driven Reablation
01:11:04 - Bleeding and Embolization
01:16:05 - Renal ACAGA Expansion
01:23:31 - Adoption and Next Steps

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More about this episode

Dr. Smits explains the origins of HepACAGA and why catheter-based contrast delivery can meaningfully change ablation planning, particularly for small lesions, poorly visualized tumors, and cases where ultrasound or conventional CT guidance may be insufficient. He walks through the practical setup, including catheter positioning, contrast dilution, timing protocols, needle navigation, apnea/end-expiration technique, and built-in fusion for immediate ablation verification. He also describes how the angio suite environment supports multimodal treatment, including intraprocedural embolization when bleeding occurs or when additional transarterial therapy is needed.

The episode also examines early outcomes from Dr. Smits’ group, including a reported reduction in local recurrence from approximately 25% to 5%, with a modest increase in procedure time. Case examples include HCC, small colorectal liver metastases, margin-driven re-ablation, hemorrhage management, and extension of the ACAGA concept to renal tumors (RenACAGA).

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Resources

Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation
https://pubmed.ncbi.nlm.nih.gov/37704863/

Renal Arteriography and C-arm CT-Guided Ablation (RenACAGA) for Thermal Ablation of Challenging Renal Tumors
https://pubmed.ncbi.nlm.nih.gov/40295401/

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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.

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Vascular trauma care looks a lot different when the OR is improvised, supplies are limited, and limb salvage decisions cannot wait. On this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Ahmad Hussain, a Southern California private-practice “hired gun” who volunteered on a WHO/UN-coordinated humanitarian mission to Gaza after an orthopedic colleague requested vascular surgeons due to widespread limb loss.

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Timestamps

00:00 - Introduction
04:02 - Why Volunteer In Gaza?
07:41 - Logistics and Crossing Into Gaza
10:45 - Hospital as Refugee Camp
13:34 - First Vascular Trauma Case
18:24 - Mass Casualty Triage
23:20 - Kids Guiding Doctors
27:09 - Evacuation Uncertainty
32:03 - Would You Go Back?
37:55 - How to Volunteer
39:30 - Show Wrap Up and Credits

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More about this episode

Dr. Hussain describes entering through the Rafah border with suitcases of medical supplies, working in a hospital functioning as a refugee camp for tens of thousands, and treating shrapnel-related vascular trauma with limited imaging (mainly ultrasound and X-ray), scarce anesthesia, and minimal surgical resources, relying heavily on skilled local medical students and residents. He recounts mass-casualty triage, the emotional impact of caring for injured children, bonding with the children who assisted the volunteers, and the dangerous, militarized evacuation via Israel with U.S. embassy assistance. He says he wants to return, but notes tightened restrictions and dwindling aid, and he recommends other organizations, noting any specialty of medical professionals should consider volunteering.

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Resources

Gift of Disability Alleviation (GODA)
https://indushospital.ca/appeal/gift-of-disability-alleviation-goda/

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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.

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For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization.

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Timestamps

00:00 - Introduction
01:42 - Dr. Yan Epelboym’s Origin Story in MSK
03:02 - Building Referral Networks
06:50 - Details on Clinic Workflow
10:08 - The Run Down on Shoulder Embolization Treatment Targets
22:09 - Current Insights on Shoulder OA Embolization
27:56 - Shoulder Embolization Setup and Access Choice
34:28 - Shoulder Embolization Strategy and Endpoints
36:38 - Post-Procedure Pain Control and Activity Limitations
42:26 - Shoulder Surgery Status-Post Embolization
44:17 - Discussing Existing Research Data on Shoulder Embolization
01:00:32 - Key Shoulder Arterial Anatomy and Variants
01:04:27 - Shoulder OA Case Discussion
01:09:08 - Final Thoughts

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More about this episode

The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization.

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Resources

Dr. Yan Epelboym, MD, MPH
https://www.linkedin.com/in/yan-epelboym-4a84991b/

Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)
https://clinicaltrials.gov/study/NCT06095050

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

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Your guide to better planning, access, and sampling. In this episode of the BackTable Podcast, we revisit every IR’s favorite procedure with Dr. Zoe Miller, Assistant Professor of Clinical Interventional Radiology and Associate Program Director at the University of Miami. Together with host Dr. Ally Baheti, Dr. Miller walks through a methodical approach to adrenal vein sampling to help you overcome common procedural challenges and reliably point your patients towards the proper therapies.

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Timestamps

00:00 - Introduction
02:26 - Preprocedural Workup Basics
06:21 - Planning CT Utility and Protocol
08:46 - Access Strategy
10:36 - Procedure Day Preparation
12:12 - Catheters and Side Holes
15:44 - Adrenal Vein Selection Techniques
18:50 - Troubleshooting Right Adrenal Vein Selection
24:34 - Sample Acquisition Coordination
27:38 - Aspiration Flow Optimization
29:34 - Preventing Reintervention and Vessel Damage
34:06 - Post-Procedure Follow-Up
35:46 - AVS in Cushing Syndrome
39:38 - Mentorship and Sourcing Knowledge
39:25 - Closing Remarks

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More about this episode

The physicians outline the key aspects of the pre-procedural workup, from setting expectations with patients to the utility of CT in operative planning. Dr. Miller provides a detailed exploration of strategies and tools for achieving safe access of the adrenal veins, particularly on the right side, and obtaining adequate samples. She emphasizes the importance of collaboration, both within the IR team and with other specialists, to ensure maximal procedural yield and to ultimately provide patients with valuable guidance in their treatment. The episode concludes with a discussion of the challenges presented by co-secreting tumors in hormone level assessment as well as the value of seeking out data and the experiences of mentors in developing your own best practices as an IR.

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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.

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What do the 2026 coding changes mean for the financial viability of IVL in the OBL? In this episode of the BackTable Podcast, host Dr. Ally Baheti sits down with Dr. Nicholas Petruzzi to break down how intravascular lithotripsy fits into OBL workflows, and how upcoming lower-extremity revascularization coding updates may impact outpatient economics.

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This podcast is supported by

Shockwave Medical
https://shockwavemedical.com/

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Timestamps

00:00 - Introduction
02:35 - 2026 Coding Changes Overview
05:18 - Where IVL Codes Apply
06:35 - Iliac Reimbursement Impact
08:50 - IVL vs. Atherectomy
11:54 - BTK Reality and Future
14:44 - When IVL Is Not Ideal
16:05 - Catheters and Setup Basics
17:50 - Sizing and Technique Tips
23:01 - Javelin Forward Emitter
26:25 - Wrap Up

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More about this episode

The episode starts with a walkthrough of the key 2026 coding updates, including territory-based coding, new IVL add-on codes for aorto-iliac and fem-pop segments, the introduction of below-the-ankle codes, and the shift toward ‘simple’ versus ‘complex’ designations. From there, the conversation focuses on where IVL makes sense clinically and operationally, particularly as an alternative or complement to atherectomy, with discussion of low embolization risk seen in the DISRUPT PAD trial and the potential to avoid distal protection in select cases.

Dr. Petruzzi shares how he approaches IVL in the lab, including catheter selection, sizing, low-pressure technique, and repositioning strategies. They also touch on workflow considerations in the OBL and preview newer concepts like the forward-emitting Javelin device for heavily calcified lesions and situations where device exchange is limited.

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Resources

DISRUPT PAD III RCT
https://shockwavemedical.com/en-eu/clinical-evidence/pad-iii-rct/

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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