BackTable Vascular & Interventional

Could hospital employment be your path to practicing 100% interventional radiology (IR)? In this episode of BackTable, host Dr. Ally Baheti sits down with Dr. Ryan Trojan, an interventional radiologist at INTEGRIS Health in Oklahoma City, to discuss the pros and cons of hospital employment contracts in IR.
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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
The physicians take a deep dive into the evolving employment models in the IR landscape. Dr. Trojan shares his journey from a private IR-DR blended practice to becoming directly employed by a hospital, highlighting the financial challenges, contract negotiations, and administrative dynamics along the way. He explains the growing loss of IR talent to lucrative diagnostic contracts and emphasizes the importance of advocating for IR’s value to hospital systems, from decreasing length of stay to supporting ECMO, trauma, and transplant services. The discussion covers financial security, administrative support, and the benefits of having aligned goals with the hospital in order to grow an IR practice. Dr. Trojan also addresses common misconceptions about IR and private practice, detailing how the landscape is likely to change over the coming years, and offers advice on navigating employment contracts.
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TIMESTAMPS
00:00 - Introduction
03:02 - Transition to Hospital Employment
12:15 - Advocating for IR’s Value
16:07 - Contract Structures and Compensation Models
25:07 - Benefits and Downsides of the Employed Model
28:27 - Negotiating Contracts and Fair Market Value
41:12 - Conclusion
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RESOURCES
Dr. Trojan’s contact information:
[email protected]

Should MRI-guided interventions be on your radar? Find out why the future of interventional radiology might lie in MRI guidance with experts Dr. Clifford Weiss from Johns Hopkins University and Dr. David Woodrum from the Mayo Clinic.
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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
The physicians join host Dr. Chris Beck to explore the benefits of MRI guided procedures, including superior imaging capabilities and reduced radiation exposure. Dr. Weiss and Dr. Woodrum detail the challenges and barriers to adoption, like the intricate set up needed to protect equipment from a strong magnetic field. They highlight the significant technological advancements and collaborations between MRI and device companies that are set to make MRI guided interventions more accessible and practical for everyday use. They also discuss the reimbursement paradigm for MRI guided biopsies and how similar the algorithm is to CT guided procedures.
The episode closes with unique insights for young physicians on training opportunities and the promising future of MRI guided interventions for trainees looking to bring a different approach to their future practices.
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TIMESTAMPS
00:00 - Introduction
05:13 - The Advantages of MRI in Interventional Radiology
13:44 - Technical Insights and Challenges of MRI Guided Procedures
18:46 - Future Prospects and Industry Developments in MRI Guided Interventions
31:01- Development of Hybrid MRI Rooms
48:19 - Economic Considerations and Reimbursement
52:33 - Community Support for MRI Interventions
56:41 - Conclusion and Final Thoughts
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RESOURCES
International Society for Magnetic Resonance in Imaging:
https://www.ismrm.org/

What tricks do you have up your sleeve to help you get through tough cases? In this special episode of the BackTable Podcast, Drs. Ally Baheti, Mike Barraza, and Chris Beck spotlight the most creative and practical pearls from the 2025 BackTable Tips & Tricks competition, showcasing standout submissions and clever techniques shared by their peers.

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SYNPOSIS

Guests include leading interventional radiologists like Dr. Aaron Fischman from Mount Sinai, who reveals his unique wire-shaping method—bending it like a question mark to navigate challenging, angulated vessels during prostate artery embolization. From Jefferson, Dr. Sean Maratto walks us through his innovative retrograde approach to placing double J stents. And from Ochsner Health, Dr. Tyler Sandow brings invaluable guidance on achieving direct portal vein access for TIPS.

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TIMESTAMPS

00:00 - Introduction
03:30 - Favorite Tips and Tricks
06:11 - Practical Techniques and Personal Experiences
15:41 - A Humbling Experience with Phil Banov
16:02 - The Bumper Stitch Technique
17:55 - Direct Portal Access for TIPS
19:35 - Navigating Challenging Cases
24:11 - Radial vs. Femoral Access Debate
27:33 - Innovative Techniques and Tricks
29:36 - Final Thoughts and Gratitude

Before the advent of TIPS, mesocaval shunts were considered a less popular option for managing portal hypertension. But today, could they serve as a lifeline when no other choices remain? This week on BackTable, Drs. Omar Chohan and Harris Chengazi (Great Lakes Medical Imaging) join host Dr. Chris Beck to discuss the evolving role of endovascular mesocaval shunts, covering patient selection, clinical decision-making, and technical pearls.

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SYNPOSIS

In this episode, the hosts delve into the specialized procedure of meso-caval shunts, focusing on its applications for patients with portal hypertension who have no other viable options. This discussion includes detailed case studies, such as one involving a woman with autoimmune hepatitis and another with pancreatic cancer, showcasing the practical challenges and innovative solutions in creating these shunts. In each case, they detail the rationale for patient selection, difficult anatomy, procedural steps, and resolution of symptoms like recurrent ascites and variceal bleeding. The episode emphasizes the importance of pre-procedure planning, collaboration, and precise imaging, utilizing advanced tools like the 4D CT scanner. The conversation also highlights the compassionate motivation behind these complex procedures, aimed at improving patients' quality of life.

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TIMESTAMPS

00:00 - Introduction
03:07 - Historical Context and Indications
06:49 - Case 1: Patient with Refractory Ascites
34:00 - Case 2: Recurrent GI Bleeding
41:16 - Case 3: TIPS Consult - Pancreatic Cancer and Duodenal Varices
47:44 - Lessons, Pearls, and Tips
56:13 - Final Thoughts

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RESOURCES

A Case Series of Dr. Chengazi's Mesocaval Shunts on X:
https://x.com/chengazimd/status/1966337167879438571

Episode 573 Portal Hypertension Treatment Strategies:
https://www.backtable.com/shows/vi/podcasts/473/portal-hypertension-treatment-strategies-ir-hepatology-perspectives

TIPS University Freshman Year:
https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup

TIPS University Sophomore Year:
https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique

TIPS University Junior Year:
https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access

TIPS University Senior Year:
https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure

What does it really take to break away from the hospital system and build your own interventional radiology practice?
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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
In this episode, host Dr. Ally Baheti interviews Dr. Kartik Kansagra and Dr. Harout Dermendjian, independent interventional radiologists from California and founders of EVS LA. They share their journey in establishing and growing an independent IR practice, discussing their training at Kaiser Sunset, the steps they took to develop their own practice, and the challenges they faced along the way. Emphasizing the importance of training, clinician communication, and balancing inpatient and outpatient services, they offer valuable insights and advice for new IR professionals considering a similar path.
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TIMESTAMPS
00:00 – Introduction and opening remarks
01:23 – Early training and transition
08:54 – Clinical vs. non-clinical IR practice differences
13:05 – Achieving parity with other interventional specialties
17:47 – Building insurance contracts and following up with patients
24:31 – Setting boundaries and documenting clinical decisions
34:32 – Final advice and closing words from the guests

Below the knee atherectomy is a hot topic right now in the vascular community. Why is it so controversial? Dr. Anahita Dua, vascular surgeon at Mass General, joins host Dr. Sabeen Dhand to explore the utility of this technique and the pressing need for more Level I evidence in this space.

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This podcast is supported by:
AngioDynamics
https://www.auryon-system.com/

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SYNPOSIS

The conversation dives into the controversial role of below-the-knee atherectomy in limb salvage, an area where data has long been debated. Dr. Dua, principal investigator of the AMBITION BTK Trial—the first randomized controlled trial comparing below-the-knee atherectomy to angioplasty alone—introduces the trial and explains how it fits into the current body of literature.

Together, the doctors review past evidence, current practice, and the future outlook for tibial interventions. Dr. Dua outlines the wide range of techniques and clinical strategies used to manage PAD, and stresses the importance of physician engagement with the NIH and research community to establish stronger, evidence-based protocols. She also shares her candid thoughts on the most overrated and underrated devices in tibial intervention, highlighting atherectomy’s potential role in vessel preparation before below-the-knee treatment.

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TIMESTAMPS

00:00 - Introduction
04:55 - Current State of Evidence and Challenges
10:54 - Heterogeneity in PAD Treatment
14:26 - Need for National Metrics and Standardization
20:51 - AMBITION BTK Trial and Importance
27:23 - Potential Outcomes and Implications
30:18 - Trial Design
34:56 - Advice for Practitioners
37:36 - Underrated and Overrated Devices
41:50 - Conclusion

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RESOURCES

AMBITION BTK Trial:
https://www.angiodynamics.com/studies/ambition-btk/

From new techniques to evolving best practices–are you up to date with the latest developments in carotid artery stenting? In this episode, Dr. Wayne Olan, Interventional Neuroradiologist and the director of Minimally Invasive Neurosurgery at George Washington University joins Dr. Michael Barraza for a discussion on the latest innovations and evolving techniques in carotid artery stenting.

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

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SYNPOSIS

Dr. Olan opens the conversation with a historical perspective on the evolution of carotid stenting, tracing advancements from early techniques to modern devices. He then talks through referral patterns, noting that the majority originate from cardiologists. Dr. Olan emphasizes the importance of meticulous periprocedural planning and comprehensive post-procedural management. Central to this discussion is the critical role of antiplatelet therapy, including strategies for addressing Plavix non-responders, such as the use of Integrilin.

The discussions also covers advanced techniques in carotid artery stenting, including the utilization of the Aptus sheath and the Contego stent system. He underscores the importance of mastering the available tools, understanding patient-specific factors, meticulous procedural planning, and always maintaining a contingency plan. He concludes the discussion by exploring emerging trends and the future potential of outpatient carotid stenting.

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TIMESTAMPS

00:00 - Introduction
02:44 - The Importance of Stroke Intervention
07:16 - Carotid Stenting: Evolution and Techniques
13:29 - Challenges and Collaborations in Carotid Interventions
16:17 - Technical Insights and Best Practices
25:24 - Choosing the Right Wire for Carotid Procedures
25:53 - Anticoagulation and Filter Wire Techniques
28:30 - Managing Stent Placement and Distal Protection
30:54 - Handling Carotid Bifurcation and Skull Base Lesions
38:43 Dealing with Tandem Occlusions
42:06 - Future Trends in Outpatient Procedures
44:43 - Addressing Re-stenosis and Vertebral Lesions
45:44 - Conclusion and Final Thoughts

What does it really take to bring cutting-edge vascular care to the most underserved corners of the rural South? In this episode of the BackTable Podcast, host Dr. Ally Baheti welcomes interventional cardiologist Dr. Ash Sastry and interventional radiologist Dr. Sree Nair to discuss the financial and regulatory side of providing care to underserved rural populations in North Carolina, Virginia, and Georgia.

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SYNPOSIS

The doctors delve into the operations and challenges of running an office-based lab (OBL) and the potential transition to an ambulatory surgical center (ASC). This episode covers topics like certificate of need (CON) laws, reimbursement issues, and the importance of multidisciplinary collaboration. The conversation offers insights into the practical and regulatory hurdles faced in delivering high-quality vascular care in rural settings.

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TIMESTAMPS

00:00 - Introduction
02:14 - Challenges in Rural Healthcare
09:00 - Understanding Certificate of Need (CON) Laws
11:30 - The Financial Struggles of OBLs
19:58 - Advocacy and Legislative Efforts
27:53 - Future Prospects and Final Thoughts

What piques your clinical suspicion for biliary structure? And when is interventional endoscopy the preferred approach? Fine tune your diagnostic and treatment algorithm with Dr. Premal Trivedi from the University of Colorado and host Dr. Christopher Beck as they go in-depth on the management of biliary strictures.
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This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/
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SYNPOSIS
The doctors first break down the signs and clinical picture that alert them to a possible biliary stricture. Dr. Trivedi then explains the steps of his workup and preferred imaging, and also describes his threshold to pursue percutaneous transhepatic cholangiography (PTC), especially in diffuse conditions like primary sclerosing cholangitis. Dr. Trivedi also walks through his procedural steps for PTC and drain placement, covering his best practices and typical intraoperative decision making.
Dr. Trivedi then explains the role of angioplasty over the course of longitudinal treatment, balloon choice, and his upper limit of catheter upsizing. The doctors also delve into the role of interventional endoscopy and tackling complications such as bleeding and tube leakage. The conversation offers valuable insights for trainees and practitioners alike, and highlights future advancements in biliary interventions.
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TIMESTAMPS
00:00 - Introduction
06:19 - Approach to Biliary Strictures
08:10 - Workup and Imaging for Biliary Strictures
20:41 - Accessing the Biliary System
27:14 - Crossing the Obstruction: Next Steps
33:22 - Endoscopic Evaluation and Its Role
47:14 - Complications and Pain Management
53:40 - Future of Biliary Management
54:55 - Conclusion and Final Thoughts