As interventional radiology cements its position as a primary clinical responder for acute arterial hemorrhage, what if you could achieve rapid and durable arterial occlusion with a single, highly deliverable device? In this episode of the BackTable Podcast, Dr. Alex Villalobos (UNC), Dr. Nima Kokabi (UNC), and Dr. Brian Funaki (UChicago) join host Dr. Kavi Krishnasamy to explore the shifting paradigms of arterial embolization in a case-based discussion highlighting modern vascular plug technologies.
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https://www.backtable.com/app

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This podcast is supported by

Okami Medical
https://okamimedical.com/

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Timestamps

00:00 - Introduction
01:24 - Trauma Activation Workflow
06:42 - Empiric Arterial Embolization Indications
10:40 - Embolic Agent Preferences and Value Analysis
17:18 - Embolics on the Shelf
19:32 - LOBO Plug Use Cases
20:58 - Case 1: Abdominal Wall Hematoma
23:54 - LOBO Advantages, Cost, and Microcatheter Compatibility
26:33 - Alternative Access Approaches
30:31 - LOBO Sizing and Trackability
35:26 - Pusher Wire Features
38:20 - Delivery Catheter Requirements
43:41 - Case 2: Retroperitoneal Bleed
45:15 - LOBO Deployment Technique
49:41 - Case 3: Splenic Trauma
53:51 - Occlusion Time and Adjunct Embolics
57:07 - Closing Remarks

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More about this episode

The panel begins by discussing the range of embolic options and combinations at their disposal, sharing their preferences and treatment algorithms in various clinical scenarios. In particular, they emphasize the need for tools that provide immediate, predictable occlusion without the technical burden and cost of needing to deploy multiple embolic agents. The physicians go on to focus on Okami Medical’s LOBO vascular plug as a primary solution for rapid vessel occlusion, highlighting the micro-pore architecture and unique deliverability through microcatheters that make it advantageous for precise positioning and reliable embolization. Exploring its use in cases including rectus sheath hematomas, retroperitoneal bleeding, and splenic trauma, the physicians detail the technical nuances of sizing and positioning the LOBO as well as the long-term advantages of its artifact-free design. This episode ultimately underscores a growing preference for streamlined arterial embolization workflows that prioritize rapid stasis and clinical predictability while leveraging the strengths of a multimodal embolic toolkit.

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.

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Timestamps

00:00 - Introduction
01:51 - Complication Rates and Associated Factors
06:09 - PTC in Non-Dilated Biliary Systems
11:00 - Techniques for Access and Drain Placement
15:10 - Drain Flushing, Capping, and Ideal Positioning
17:48 - External versus Internal-External Biliary Drains
20:42 - Managing Pericatheter Leakage
23:01 - Life Expectancy and Stenting Malignant Strictures
26:32 - Tract Maturation and Minimizing Access Sites
28:56 - Addressing Unresolving Hyperbilirubinemia
34:52 - Managing Bloody Drain Output
38:12 - Approach to Dislodged Drains
39:40 - Drain-Associated Pain and Exchange Timing
42:49 - Strategy for Benign Biliary Strictures
45:18 - Final Thoughts and Closing Remarks

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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 management, assessing potential drainage strategies as survival rates improve in hepatobiliary malignancies, and underscore the critical importance of collaboration with gastroenterologists and surgeons to ensure cohesive, goals-of-care-centered management.

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Resources

Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis
https://doi.org/10.1016/j.jvir.2024.12.022

Radial roots, peripheral reach! Radial to peripheral (R2P) access is the focus of this week’s episode with interventional cardiologist Dr. Shailendra Singh (Pennsylvania’s Lehigh Valley Heart and Vascular Institute) and dual hosts Hady Lichaa and Sameh Sayfo. The conversation focuses on key techniques, pre-procedure planning and imaging, and ideal case selection for those new to the R2P approach.

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https://www.backtable.com/app

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This podcast is supported by

Terumo

https://www.terumois.com/

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Timestamps

00:00 - Introduction
04:42 - Radial-to-Peripheral: Right vs Left Radial
10:18 - Ultrasound and Pedal Access Applications
17:10 - Ideal Cases When Starting Radial to Peripheral
25:59 - Impactful Radial Success Stories
29:38 - Managing Radial Spasm
35:22 - Left Radial Workflow
42:00 - Shelf Setup Essentials
48:43 - Renal Mesenteric Access
55:37 - Safe Sheath Removal
01:01:10 - Training and Courses
01:04:48 - Closing Thoughts

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More about this episode

Dr. Singh shares how he began incorporating radial-to-peripheral procedures into his practice after fellowship and how his experience with radial coronary access translated naturally to peripheral interventions. The group reviews access strategy, including right versus left radial selection, along with techniques for preventing and managing radial spasm. They also touch on staff workflow and training when introducing R2P into the lab. The episode closes with practical insights on case selection for operators new to the approach, the role of pedal access in selected CTO cases, and strategies for safe sheath removal and hemostasis.

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Resources

Dr. Shailendra Singh’s Provider Profile
https://www.lvhn.org/doctors/shailendra-singh

Dr. Sameh Sayfo’s Provider Profile
https://www.bswhealth.com/physician/sameh-sayf

Dr. Hady Lichaa’s Provider Profile
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

With the single-stick technique proving to be an effective addition to the venous line placement toolkit, what is stopping IRs from venturing beyond the traditional dual-incision approach? In this episode of the BackTable Podcast, pediatric interventional radiologist Dr. Kevin Wong of USA Health joins host Dr. Ally Baheti to review the single-stick technique for central venous access, a method widely utilized in pediatric practice.

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Timestamps

00:00 - Introduction
01:35 - Origins of Single-Stick Access
03:10 - Setup and Bending the Needle
07:17 - Tunneling to the IJ
10:06 - Line Positioning and Measurement
14:45 - Wire Handling Considerations
18:55 - Clinical Advantages of Single-Stick Access
21:27 - Femoral Single-Stick Tips
23:41 - Common Mistakes and Pitfalls
27:39 - Needle-Free Lidocaine Administration
30:48 - Closing Remarks

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More about this episode

Delving into the origins, technical nuances, and clinical advantages, the physicians explore how the single-stick technique can reduce the risk of infection and minimize interference with other lines and tubing to improve patient care. The discussion provides a detailed technical breakdown of the procedure, offering a masterclass on navigating the curves up the neck as well as the equipment selection and sizing necessary to facilitate the process. With the aid of visual slides and demonstrations, Dr. Wong steps us through the specifics of bending the access needle, maneuvering tools to adapt to anatomical configurations, and handling ultrasound movement to confirm and maintain a safe trajectory throughout the procedure. The conversation emphasizes the tactile “feel” and attention to forces acting on the wire that are required to appropriately position the catheter.
Recognizing the logistical constraints that make it challenging for attendings to regularly adopt alternative procedural techniques, this episode serves as an accessible primer for clinicians looking to broaden their options for venous access with this effective, patient-centric technique.

The advent of newer thrombectomy devices has turned what were once hours-long surgical cutdowns into endovascular cases that last under an hour. In this episode of BackTable, host Dr. Sabeen Dhand is joined by Dr. Shang Loh from the University of Pennsylvania and Dr. Khanjan Nagarsheth from the University of Maryland to discuss the evolution of arterial thrombectomy devices and modern techniques for acute arterial occlusions.

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This podcast is supported by:

Inari Medical
https://www.inarimedical.com/artix-system

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SYNPOSIS

The episode highlights major technological advancements over the past decade, including the development of mechanical and computer-assisted thrombectomy systems. The physicians review key features of newer devices, such as the ability to combine aspiration with stent retrievers, the use of PTFE baskets to reduce distal embolization, and the advantage of maintaining wire access throughout the case.

They share strategies for managing specific cases, including acute femoral-popliteal occlusions with distal reconstitution, intraoperative ischemic pain due to flow arrest, trauma-related thrombosis, and cases complicated by extensive calcification and chronic vascular disease. As vascular surgeons, they also discuss the ongoing role of open approaches, outlining when surgical cutdown is indicated and where they prefer endovascular first. The conversation further explores challenges such as acute limb ischemia, stent thrombosis, and visceral artery thrombosis, emphasizing the importance of staying current with rapidly evolving technologies to improve procedural efficiency and patient outcomes.

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TIMESTAMPS

00:00 - Introduction
02:04 - Evolution of Arterial Thrombosis Treatment
04:11 - New Devices and Techniques
10:42 - Case Studies and Practical Applications
24:26 - Techniques and Devices for Thrombectomy
25:33 - Managing Flow and Patient Safety
27:25 - Surgical vs. Endovascular Approaches
29:25 - Dealing with Complications and Failures
37:50 - Visceral Thrombosis and Advanced Techniques
41:09 - Future of Thrombectomy Devices
44:27 - Closing Remarks

Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral artery disease. While many patients can be treated with endovascular or surgical revascularization, a subset of individuals remain ‘no-option’ candidates when conventional therapies fail or distal targets are absent. In this episode of BackTable, host Dr. Ally Baheti speaks with Dr. Mary Costantino, interventional radiologist at Advanced Vascular Centers, and Jill Sommerset, vascular technologist and Director of Clinical Education and Training at Aveera Medical, about the emerging role of spinal cord stimulation (SCS) as a potential therapy for patients with no-option CLTI.

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SYNPOSIS

This episode explores where spinal cord stimulation may fit within the treatment landscape for advanced CLTI, particularly for patients who are not candidates for revascularization or deep venous arterialization (DVA). Dr. Costantino describes how interest in the therapy developed through multidisciplinary collaboration and early physiologic observations using pedal acceleration time (PAT) measured with duplex ultrasound alongside angiography. A representative case highlights immediate, setting-dependent improvements in PAT following stimulation, and the group reviews early trends from a small patient cohort suggesting improved distal perfusion in individuals with severe infrapopliteal disease. The conversation also addresses practical barriers to adoption, including site-of-service and reimbursement challenges and the difficulty of implanting permanent stimulators in patients with active wounds. Jill Sommerset adds perspective from the vascular lab, discussing ultrasound-based methods to quantify physiologic changes after DVA and how similar perfusion metrics may help evaluate spinal cord stimulation. The episode concludes with a discussion of the potential role of neuromodulation in this population and the need for larger datasets to better define its clinical impact.

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TIMESTAMPS
00:00 - Introduction
02:02 - Why CLTI Needs Options
06:25 - First No Option Case
11:06 - Trial Turns Flow On
14:38 - Timing and Reimbursement
19:59 - Early Results and Adoption
22:45 - How Spinal Cord Stimulation Might Improve Flow
26:46 - Patient Selection and Access
30:24 - Treatment Algorithm and Timing
32:37 - Quality of Life and Mobility
37:57 - Implant Delays and Coordination
39:41 - Data

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RESOURCES

Paper on Maturation after DVA
https://www.sciencedirect.com/science/article/pii/S1078588426000523

Below-the-knee (BTK) arterial disease remains one of the more challenging areas in vascular care, particularly in patients with chronic limb-threatening ischemia (CLTI), where heavy calcification complicates endovascular treatment. As new calcium-modifying technologies emerge, an important question remains: what evidence supports their use in BTK interventions? In this episode of BackTable Vascular & Interventional, host Dr. Sabeen Dhand speaks with vascular surgeon Dr. Paul Foley of Doylestown Health about the Disrupt BTK II clinical trial from Shockwave Medical, which evaluates the performance of peripheral intravascular lithotripsy (IVL) in heavily calcified BTK disease.

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This podcast is supported by:

Shockwave Medical
https://shockwavemedical.com/

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SYNPOSIS

Dr. Foley begins by outlining his training and the evolution of his vascular surgery practice, setting the stage for a broader discussion on how BTK interventions have changed over the past decade. The conversation explores shifts in access strategies, procedural approaches, and the unique characteristics of calcification encountered in CLTI. Because BTK calcium differs from calcification seen elsewhere in the peripheral vasculature, imaging and device selection play a particularly important role when planning IVL-based therapies. Dr. Foley reviews the design and outcomes of the Disrupt BTK II trial, where devices such as the Shockwave M5+ and S4 catheters were used to modify calcified plaque, demonstrating encouraging safety and performance signals.

The discussion then turns to emerging technologies, including Shockwave’s Javelin catheter, designed to deliver focused pressure waves to fracture dense calcium within peripheral arteries. Dr. Foley describes how the device fits into BTK workflows, including technique considerations and its use alongside adjunctive therapies such as balloon angioplasty. The episode also addresses the ongoing skepticism surrounding IVL in BTK disease, emphasizing the need for careful patient selection, procedural precision, and continued multidisciplinary collaboration as the field works to refine treatment strategies and improve outcomes for patients with peripheral artery disease (PAD).

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TIMESTAMPS

00:00 - Introduction
08:20 - Evolution of Below-the-Knee Treatments
11:10 - Differences in BTK Calcification
13:13 - Imaging and Technology in BTK Interventions
15:18 - Disrupt BTK II Trial Data and Results
23:17 - Introduction to the Javelin Device
26:39 - Technique Considerations with Javelin
28:36 - Comparing Javelin and E8
31:17 - Future Directions for Lithotripsy Technology
35:30 - Skepticism Around IVL in BTK Disease
38:47 - Final Thoughts

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RESOURCES

Disrupt BTK II Trial
https://www.jvascsurg.org/article/S0741-5214(24)02063-9/fulltext

When standard-of-care checkpoint blockade fails in metastatic melanoma, how can oncologists and interventional radiologists join forces to turn around patient outcomes? In this episode of the BackTable Podcast, medical oncologist Dr. Jennifer McQuade and interventional radiologist Dr. Rahul Sheth join host Dr. Tyler Sandow to discuss the growing evidence for intratumoral oncolytics as a therapeutic strategy for frontline immunotherapy-refractory melanoma and the interdisciplinary work that is required for successful implementation in practice.

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SYNPOSIS

The physicians review how engineered viral vectors, particularly RP1, complement checkpoint blockade through direct tumor lysis and immune activation, and summarize the IGNYTE trial data supporting their use in patients with metastatic melanoma refractory to anti-PD-1 and anti-CTLA-4 agents. The discussion then shifts to practical administration, highlighting the central role of interventional radiology in delivering these therapies to visceral and deep-seated lesions under image guidance. The doctors go on to address the nuances of patient and lesion selection, injection technique, and response assessment, including the importance of recognizing pseudo-progression. They place particular emphasis on the need for multidisciplinary collaboration and stakeholder buy-in efforts on the part of IRs seeking to integrate intratumoral oncolytic injections into their scope of practice. The episode concludes with a forward-looking discussion on the potential for expansion of oncolytic platforms into other solid tumors, underscoring this field as a growing, IR-forward frontier in cancer treatment.

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TIMESTAMPS

00:00 - Introduction
02:28 - Immunotherapy Basics
06:51 - How Oncolytic Viruses Work
11:01 - IGNYTE Trials and Why IR Matters
18:14 - T-VEC vs RP1 Indications and Logistics
21:57 - Physician Communication and Multidisciplinary Treatment
23:06 - RP1 Protocol and Administration Techniques
30:28 - RP1 Safety Profile
32:46 - Follow-Up Imaging and Response Assessment
35:44 - Future Applications Beyond Melanoma
41:42 - Final Thoughts and Closing Remarks

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RESOURCES
Wong MK, et al. RP1 Combined With Nivolumab in Advance Anti-PD-1-Failed Melanoma (IGNYTE). J Clin Oncol. 2025;43(33):3589-3599.
https://doi.org/10.1200/jco-25-01346

IGNYTE-3 Trial
https://clinicaltrials.gov/study/NCT06264180

With data increasingly positioning thermal ablation as a viable alternative to surgery for select liver metastases, the demands on the interventional oncologist have never been higher. Mastering the nuances of patient selection and precise margin assessment is now essential for ensuring effective disease control locally. In this episode of the BackTable Podcast, interventional radiologist Dr. Jonas Redmond of UC San Diego Health joins host Dr. Sabeen Dhand to discuss the current state of microwave ablation (MWA) in the management of oligometastatic liver disease, focusing on tumor assessment, preprocedural planning, and the integration of local and systemic therapies.

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This podcast is supported by:

Varian IntelliBlate
https://www.varian.com/products/interventional-solutions/microwave-ablation-solutions

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SYNPOSIS

The conversation delves into the complexities of timing systemic versus local ablative therapies and explores questions surrounding adequate treatment margins. Dr. Redmond goes on to emphasize the need for operators to approach procedures with a high level of adaptability, advocating for interdisciplinary preprocedural planning and thoughtful modality selection. Exploring the complications that could arise from injury to adjacent viscera, the physicians speak to the critical importance of rigorous intraprocedural reassessment and discuss how modern software and robotics are transforming procedural precision and safety. Framing these MWA pearls within the context of recent clinical trials like COLLISION and ACCLAIM, the episode underscores the transition of interventional oncology from providing palliative services to increasingly curative solutions that may offer better prospects for patients with metastatic disease.

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TIMESTAMPS

00:00 - Introduction
04:30 - Role of Local Therapy in Systemic Disease
09:49 - Patient Selection and Treatment Modalities
13:15 - Challenging Lesion Characteristics and Locations
19:56 - Y-90 Radioembolization versus Microwave Ablation
23:04 - Intraoperative Ablation and Combining Locoregional Modalities
29:36 - Complications of Microwave Ablation in the Liver
36:43 - Future of Ablation and Liver Metastases Treatment
39:25 - Final Thoughts and Closing Remarks

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RESOURCES

UC San Diego Health. Cryoablation and Arterial Infusion of SD-101 in Combination with Durvalumab and Tremelimumab.
https://clinicaltrials.ucsd.edu/trial/NCT06710223

COLLISION trial
https://clinicaltrials.gov/study/NCT03088150

ACCLAIM trial
https://clinicaltrials.gov/study/NCT05265169