BackTable Vascular & Interventional

With the annual trend of fluctuating reimbursement rates, have you been on the fence about turning your OBL into an ASC? Make sure your OBL is prepared for the surprising changes in coding coming in 2026. In this episode, Dr. Mary Costantino partners with fellow OBL owner Dr. Goke Akinwande and revenue cycle management expert Laurie Bouzarelos to review the new CPT code changes and how they translate to OBL and ASC reimbursement.
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SYNPOSIS
Dr. Akinwande discusses many positive takeaways after diving into the recent Medicare documents, and highlights key shifts. He believes these changes to add-on codes and territories means one thing: CLI is being heard. The upcoming code changes improve delineation of vascular territories, differentiating between "simple" (stenosis) and "complex" (CTO) procedures. These changes are aimed at rewarding physicians performing the difficult CLI work while decreasing reimbursement for more straightforward cases.
Beyond the CPT code specifics, the conversation also covers real-world implications for OBL owners. Dr. Akinwande explains why these changes might narrow the reimbursement gap between OBLs and ASCs, prompting him to warn against ASC conversion. Laurie Bouzarelos provides guidance on implementation, stressing the importance of updating charge masters, reviewing payer contracts for "gap fill" clauses, and monitoring payments once the new codes go live. The episode ends with a discussion on obstacles in billing, collections, and the need for physicians to master the business side of their practice to ensure financial success.
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TIMESTAMPS
00:00 - Introduction
04:37 - 2026 CPT Changes Overview
07:18 - Simple vs. Complex Codes
13:16 - Key Add-on Codes
19:52 - OBL vs. ASC Conversion?
24:56 - IVL Reimbursement Trends
29:18 - Update Your Charge Master
41:41 - Pricing & Medicare Year
46:39 - Billing & Collections Reality

Is meningeal artery embolization the key to ending the cycle of chronic subdural hematomas? In this episode of the Back Table Podcast, Dr. Paul Gullota from Ochsner Health joins host Michael Barraza to share his technical insights on middle meningeal artery embolization, including patient workup, procedure technique, and post-operative care.
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SYNPOSIS
The episode begins with a discussion on the evolving role of middle meningeal artery embolization in preventing chronic subdural recurrence. The doctors talk through patient selection and procedural planning for middle meningeal artery embolization, emphasizing the importance of assessing collateral pathways and hemorrhage laterality. Dr. Gullota shares his access techniques, microcatheter and embolic options, and the critical role of teamwork with neurosurgery. He also shares his approach to navigating complex vascular anatomy as well as ensuring appropriate patient follow up.
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TIMESTAMPS
00:00 - Introduction
03:12 - Middle Meningeal Artery Embolization: Rationale and Process
04:17 - Patient Evaluation and Procedure Steps
06:09 - Outpatient Procedures and Billing
07:06 - Candidates for Embolization Post-Evacuation
07:56 - Unilateral vs. Bilateral Embolization
10:34 - Procedure Techniques and Tools
19:48 - Post-Procedure Care and Follow-Up
21:35 - Final Thoughts and Conclusion

From longitudinal monitoring to complex interventions, type II endoleaks often require an individualized approach. In this episode of BackTable, host Dr. Sabeen Dhand welcomes Dr. Matt Givens, Chief of Interventional Radiology at the New Orleans VA and faculty at Louisiana State University Health, to discuss the intricacies of type II endoleak management and repair techniques.
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SYNPOSIS
The conversation begins with a walkthrough of Dr. Givens’s firstline operative approach, which involves entering the inferior mesenteric artery and choosing a microcatheter that allows for entry into the sac and nidus. The doctors cover nuances in choosing and planning transarterial, translumbar, and transcaval approaches. Dr. Givens also details his embolics of choice, his preferred tools for direct sac puncture, and the rationale behind his embolization endpoints.
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TIMESTAMPS
00:00 - Introduction
08:12 - Imaging and Follow-Up Protocols
16:27 - Transarterial Techniques for Endoleak Management
33:45 - Techniques for Targeting and Embolization
35:34 - Challenges and Solutions in Embolization
36:57 - Transcaval and Translumbar Approaches
39:09 - Complications and Case Studies
53:58 - Building a Collaborative Practice
56:09 - Conclusion

PERT Consortium 2025 gives interventionalists the reins to tackle even the toughest saddle pulmonary embolisms. In this episode of the BackTable Podcast, host Dr. Aaron Fritts welcomes interventional radiologist Dr. Osman Ahmed and interventional cardiologist Dr. Jonathan Paul to discuss their experiences at the annual PERT Consortium in San Diego, and offer their perspectives on the latest developments in pulmonary embolism (PE) treatment.
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SYNPOSIS
The doctors delve into advancements and trials within the PE treatment space, including new devices and clinical studies that are set to shape the future of pulmonary embolism care. The conversation highlights the value of collaboration between interventional specialties, the safety and efficacy of various PE interventions, and the growing trend of using combined therapies. They also provide updates on their ongoing innovation with Flow Medical, describing their philosophy and motivation for developing a new device for PE treatment that incorporates real-time pulmonary artery pressures, mean systolic and diastolic pressures, and a potential for AI utilization in the future.
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TIMESTAMPS
00:00 - Introduction
01:23 - PERT Consortium Highlights
02:11 - Emerging Clinical Trials and Innovations
03:59 - Thrombectomy Devices and Market Trends
12:37 - Flow Medical: Origin and Updates
19:37 - Advanced Data Tracking in Cardiology
20:45 - Remote Monitoring and Mobile Integration
22:45 - Cardiologists’ Data-Driven Approach
23:10 - Upcoming Studies and Data Insights
24:10 - Interventional Radiology and Cardiology Collaboration
25:07 - Access to Care and Procedure Adoption
27:32 - Final Thoughts
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RESOURCES
Pulmonary Embolism Response Team (PERT) Consortium
https://pertconsortium.org/
Flow Medical
https://www.flowmedical.co/
PEERLESS RCT
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.072364
RESCUE-II
https://www.jacc.org/doi/10.1016/j.jacadv.2025.101789
PEERLESS II
https://www.jscai.org/article/S2772-9303(24)01053-6/fulltext
Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)
https://clinicaltrials.gov/study/NCT05591118
The HI-PEITHO Study
https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/pulmonary-embolism/clinical-data/hi-peitho.html
PRAGUE-26
https://eurointervention.pcronline.com/article/design-and-rationale-of-prague-26-a-multicentre-randomised-trial-of-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism
Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)
https://clinicaltrials.gov/study/NCT05591118
Aaron Fritts, MD
https://www.backtable.com/shows/vi/contributors/dr-aaron-fritts
Osman Ahmed, MD
https://jointvascular.com/team/osman-ahmed-m-d-fcirse/
Jonathan Paul, MD
https://www.uchicagomedicine.org/find-a-physician/physician/jonathan-d-paul

From the angio suite to the boardroom, what qualities of an interventional radiologist translate into pioneering leadership? Tune in to hear from Dr. Howard Chrisman, the President and CEO of Northwestern Medicine, as he discusses his journey with hosts Dr. Sabeen Dhand and Dr. Aaron Fritts.
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SYNPOSIS
Dr. Chrisman shares his inspiring journey from a student with an initial interest in veterinary medicine to a leader in interventional radiology (IR) and healthcare administration. He recounts his pivotal experiences, including his mentorship under prominent IRs, his decision to pursue an MBA, and the importance of building trust and fostering relationships within clinical and administrative realms. He details his learnings in developing self-awareness, being open to multiple viewpoints, and amplifying your voice as an IR. The discussion touches on the future of interventional radiology, the impact of artificial intelligence on the field, and the essential qualities for leadership in healthcare. Dr. Chrisman also reflects on the significance of learning from mistakes and the role of mentorship in his career, emphasizing the value of collaboration and empathy in achieving success.
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TIMESTAMPS
00:00 - Introduction
03:21 - Mentorship and Career Development
09:55 - Balancing Bias and Decision Making
18:32 - Building Trust and Value in Healthcare
23:13 - The Future of Radiology and AI Integration
28:48 - The Role of MBAs in Healthcare
32:24 - Reflections on Leadership and Career
35:43 - Conclusion and Final Thoughts

When a patient presents with portal vein thrombosis (PVT), how do you decide between anticoagulation, intervention, and adjunct therapies? In this episode, Dr. Vijay Ramalingam, vascular and interventional radiologist from Beth Israel Deaconess Medical Center, joins Backtable host Dr. Chris Beck to share his approach to evaluation and management of both acute and chronic PVT.
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SYNPOSIS
The discussion begins with an overview of the Splanchnic Vein Thrombosis Multidisciplinary Clinic at Beth Israel– a collaboration between Interventional Radiology, Hepatology/Gastroenterology, Surgery and Hematology. Dr. Ramalingam details the clinic's workflow, from initial case conference to the comprehensive single-day patient workup that includes imaging, lab work, and consultations with all three specialties. He shares his algorithm for treatment decisions, breaking down the distinct management pathways for patients with and without cirrhosis, and for those with acute vs. chronic thrombosis.
Finally, Dr. Ramalingam details his portal vein recanalization technique during procedure, providing a step-by-step guide to his preferred dual-access approach for complex cases, including his method for trans-splenic access and his trick on how to safely close the splenic tract. He also explains when it’s appropriate to use adjunctive therapies like suction thrombectomy and catheter-directed lysis, and describes preliminary data showing that their comprehensive approach leads to a change in management for about 40% of patients.
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TIMESTAMPS
00:00 - Introduction
05:35 - Splanchnic Vein Thrombosis Multidisciplinary Clinic
22:24 - Multidisciplinary Approach
26:17 - PVT Classification
38:47 - Treatment Evaluation and Intervention
44:21 - Alternative Treatment Options for PVT
49:00 - Procedural Techniques
59:53 - Adjunct Techniques and Case Studies
01:02:58 - Review of Preliminary Data & Final Thoughts

This week’s episode is a masterclass on vascular anomaly treatment. Brush up on your malformations with Dr. Cliff Weiss, the Director of the Vascular Anomaly Center at Johns Hopkins. He shares next-level techniques, precision diagnostics, and his 'gold standard' approach to alcohol sclerotherapy.

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This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/

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SYNPOSIS

The episode begins with the most vital component of patient care: establishing a correct diagnosis through proper classification. Dr. Weiss shares his philosophy that “MRI is a conversation” - not just an image, detailing the specific MRI protocols to confidently make a diagnosis over 90% of the time. He then shares an overview of the classification system, differentiating vascular tumors like hemangiomas from high-flow and low-flow vascular malformations.

Dr. Weiss explores a wide array of treatment strategies tailored to each diagnosis. He walks through his techniques for treating low-flow malformations with sclerotherapy—using agents like alcohol, doxycycline, and bleomycin based on a lesion’s location and characteristics—and his use of cryoablation for vascular tumors. He then dives into the creative and high-stakes approaches for treating AVMs, comparing transvenous and transarterial embolization with agents like Onyx and coils, before concluding with his predictions on the future of IR in the field.

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TIMESTAMPS

00:00 - Introduction
02:36 - Vascular Anomaly Center at Johns Hopkins
06:33 - Vascular Anomaly & Malformation Diagnosis with Imaging
09:04 - Classifying Vascular Anomalies
15:55 - Vascular Tumors
18:46 - Low-Flow Malformations
27:58 - Needle Placement
29:56 - Retro-orbital & ENT Malformations
32:44 - AVM Treatment Strategy
40:41 - Following up with Patients

What happens when the doctor suddenly becomes the patient? In this episode of the BackTable podcast, host Dr. Ally Baheti interviews Dr. Nicholas Hanson, an interventional and diagnostic radiologist from Oregon, about a life-changing event that dramatically altered his career.
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SYNPOSIS
Dr. Hanson describes the circumstances surrounding a severe car accident that resulted in a traumatic brain injury and subsequent medical complications, including the discovery of a heart aneurysm. He shares the challenges of his recovery, his struggle with insurance companies, and the emotional and professional toll of his experiences. Dr. Hanson provides valuable insights into the importance of disability insurance and the often overwhelming process of navigating healthcare systems. The discussion also touches on the ongoing debate about the separation of interventional radiology from diagnostic radiology and how sudden life events can impact one's career in medicine.
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TIMESTAMPS
00:00 - Introduction
01:19 - The Life-Changing Event
09:28 - Navigating Insurance and Disability
16:39 - The Future of IR and Career Advice
21:50 - Struggles with Disconnection
28:56 - The Road to Recovery
35:20 - Reflecting on the Journey
37:42 - Closing Thoughts and Future Hopes

Is microwave ablation only for simple liver tumors, or can it be a versatile ‘Swiss Army knife’ for a wide range of complex cases? In this episode, Dr. Driss Raissi of the University of Kentucky returns to BackTable to join host Dr. Chris Beck for a deep dive into advanced and unconventional microwave ablation techniques. They cover strategies for tackling a wide range of cases, from desmoid tumors to enterocutaneous fistulas.
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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
Dr. Raissi shares his ‘pre-burn’ technique that desiccates tissue and reduces complications like capsular burst and bleeding. He elaborates on his method for tackling large liver tumors with a single probe through overlapping ablations, needle placement techniques and his ‘lung seal technique’ to prevent pneumothorax. Dr. Raissi also shares how his previous experience in the ICU promotes close communication with anesthesiologists and how he ups his ablation game through collaboration, optimizing conditions for safe and effective ablation.
The episode explores a series of unique, real-world applications beyond the usual scope of IRs. Dr. Raissi walks us through his novel approach to challenging cases, including cauterization of enterocutaneous fistulas, endometriomas and desmoid tumors. He also compares using microwave or cryoablation for renal cell carcinoma, explaining thought processes based on lesion location and the need for speed and simplicity. The discussion provides an overview of ablation physics and careful techniques that expand treatment possibilities for IR patients.
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TIMESTAMPS
00:00 - Introduction
04:08 - Advanced Techniques for Liver Tumor Ablation
06:06 - Pre-Burning Ablation and Ablating a Range of Lesions
16:38 - Lung Ablation
22:00 - Partnering with Anesthesia
28:53 - Managing Postoperative Pain and Nerve Injuries
29:42 - Treating Enterocutaneous Fistulas, Endometriomas & Desmoid Tumors
38:49 - Adrenal Gland Ablation: A Case Study
44:50 - Microwave vs. Cryoablation for Renal Cell Carcinoma
49:06 - Preventing Pneumothorax in Lung Ablation

So you’ve placed the biliary drain—are your patients getting the follow up that they need? In this episode, Dr. Ahsun Riaz from Northwestern University joins host, Dr. Christopher Beck, for a deep dive into biliary strictures—how to manage them effectively and navigate the potential complications of this challenging chronic condition.
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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
Dr. Riaz takes us inside his journey of building a specialized hepatobiliary service at Northwestern, highlighting innovative practices like endoscopic techniques and radiofrequency ablation. He unpacks the nuances of distinguishing benign from malignant strictures, shares technical pearls for patient management, and emphasizes the power of collaboration with Gastroenterology to improve long-term patient outcomes. He outlines key technical considerations, including the use of the Hudson loop and strategic equipment selection to address intra-procedural challenges. He further emphasizes the importance of comprehensive patient care—ensuring appropriate follow-up, minimizing drain duration, and prioritizing quality of life as essential components of optimal management.
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TIMESTAMPS
00:00 - Introduction
01:28 - Biliary Drain Management
04:18 - Approach to Biliary Strictures
19:20 - Endoscopic Evaluation and Techniques
27:53 - Practical Tips and Experiences with Endoscopy
30:39 - Post-Procedure Follow-Up and Patient Outcomes
31:16 - Learning from the Hudson Roof Technique
32:48 - Innovations in Benign Stricture Management
36:48 - Endobiliary Ablation: Equipment and Procedure
40:23 - The Double Dragon Technique Explained
46:02 - Considerations for Malignant Biliary Stenting
52:37 - Future Innovations and Collaborative Care