BackTable Vascular & Interventional

Tumor embolization is a versatile procedure that can provide symptomatic and long-term benefits for patients. In this episode of BackTable MSK, host Dr. Michael Barraza discusses musculoskeletal tumor embolizations with Dr. Gina Landinez from the Miami Cardiac and Vascular Institute, where she is helping to grow the MSK interventions program.

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This podcast is supported by:

Accountable Physician Advisors

http://www.accountablephysicianadvisors.com/

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SYNPOSIS

Dr. Landinez explains that the main indications for embolization are preoperative tumor shrinkage and pain palliation. Embolization decreases hemorrhagic risk and procedure time during surgical resection and leads to better surgical margins. Pain palliation can also be achieved due to tumor size reduction and decreased pressure on surrounding nerves and tissue. Dr. Landinez explains that lesions well-suited embolization are hypervascular, large, not sensitive to radiation, and painful. She also describes the risks of off-target skin and muscle embolization and the importance of exercising caution with vertebral tumors.

Finally, Dr. Landinez shares valuable practice-building tips about developing relationships with orthopedic surgeons and providing adequate follow up care.

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TIMESTAMPS

00:00 - Introduction

03:51 - Indications for Embolization

08:08 - Building Referral Networks

13:45 - Preoperative Planning

18:34 - Technical Aspects of Embolization

27:25 - Challenges and Considerations

31:23 - Importance of Outpatient Follow Up

Is your practice profitable? The success of a private medical practice often hinges on effective revenue cycle management (RCM). In this episode of the BackTable Podcast, private practice consultant Teri Yates and host Dr. Ally Baheti share best practices in revenue cycle management for physicians. Teri Yates is the CEO of Accountable Physician Advisors and President of DocCentric.

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This podcast is supported by:S

Accountable Physician Advisors

http://www.accountablephysicianadvisors.com/

Reflow Medical

https://www.reflowmedical.com/

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SYNPOSIS

Teri explains the importance of understanding payer rules, the benefits of using professional coders, and managing front desk staff efficiently. The episode includes real-world examples of RCM challenges and solutions, the impact of insurance policies, and the role of cybersecurity. Teri also provides actionable tips for improving collections and navigating recent changes in healthcare reimbursement, especially for outpatient-based labs (OBLs) and ambulatory surgery centers (ASCs).

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TIMESTAMPS

00:00 - Introduction

09:17 - Revenue Cycle Management: Case Scenarios

19:55 - In-House vs. Outsourced Billing

31:51 - Winning Strategies for Physicians

40:55 - Healthcare Cybersecurity

43:52 - Proposed Reimbursement Changes for 2025

48:32 - Telehealth and Legislative Concerns

55:25 - Conclusion

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RESOURCES

BackTable VI Podcast - Episode #366 Navigating OBL & ASC Business, Pitfalls to Avoid with Teri Yates:

https://www.backtable.com/shows/vi/podcasts/366/navigating-obl-asc-business-pitfalls-to-avoid

BackTable VI Podcast - Episode #431 OBL or ASC for Your Private Practice? How to Decide with Teri Yates:

https://www.backtable.com/shows/vi/podcasts/431/obl-or-asc-for-your-private-practice-how-to-decide

Accountable Physician Advisors:

http://www.accountablephysicianadvisors.com/services

DocCentric:

https://doccentricasc.com/

G2211 Add-on Code: What It Is and When To Use It:

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management/G2211-what-it-is-and-how-to-use-it.html

Are you up-to-date on microwave ablation for hepatocellular carcinoma (HCC) treatment? Dr. Zachary Berman and host Dr. Michael Barraza discuss this treatment modality. They cover the spectrum of pre-procedure imaging and planning, procedure steps, and tips for navigating difficult cases. Dr. Berman is a hepatobiliary interventional oncologist and Associate Clinical Professor of Radiology at UC San Diego School of Medicine.

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This podcast is supported by an educational grant from Varian, a Siemens Healthineers company.

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SYNPOSIS

Dr. Berman highlights the importance of a multidisciplinary approach, referral pathways, and the role of tumor boards in decision-making. The doctors also cover various ablation technologies, pre-procedure embolization, hydrodissection, biopsy considerations, and the incorporation of immunotherapy in ongoing research. Finally, Dr. Berman emphasizes the importance of ultrasound skills and presents some cases.

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TIMESTAMPS

00:00 - Introduction

10:09 - Techniques and Technologies

17:26 - Planning and Performing Ablations

21:35 - Tumor Size and Margins

25:09 - Navigational Software and Skills

30:47 - Hydrodissection Techniques

33:20 - Post-Ablation Imaging and Follow-Up

35:52 - Future of Ablation in IR and Cases

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RESOURCES

Liver Imaging Reporting & Data System (LI-RADS®):

https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS

Liver Cancer Stages (BCLC):

https://www.cancer.gov/types/liver/what-is-liver-cancer/stages

Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795153/

Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698169/

Prospective double-blinded randomized controlled trial of Microwave versus RadioFrequency Ablation for hepatocellular carcinoma (McRFA trial):

https://www.hpbonline.org/article/S1365-182X(20)30023-X/fulltext

Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: a randomized controlled trial:

https://jgo.amegroups.org/article/view/26929/html

Surgical microwave ablation for the treatment of hepatocellular carcinoma in 791 operations:

https://www.sciencedirect.com/science/article/abs/pii/S1365182X23020002

Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial:

https://meetings.asco.org/abstracts-presentations/234189

One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach:

https://pubmed.ncbi.nlm.nih.gov/23732261/

Is your critical limb ischemia (CLI) toolbox up to date? Dr. Kevin Herman and host Dr. Sabeen Dhand discuss treating CLI in the outpatient based lab (OBL) and ambulatory surgery center (ASC) settings. Dr. Herman is an interventional radiologist at American Endovascular and Holy Name Hospital in New Jersey.

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This podcast is supported by:

Reflow Medical

https://www.reflowmedical.com/

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SYNPOSIS

Dr. Herman discusses the evolution of vascular interventions over the past 15 years, the role of advanced devices like the Wingman catheter and IVUS, and the nuances of tackling complex cases in both hospital and outpatient settings. Additionally, Dr. Herman highlights the business challenges of OBL practices, effective marketing strategies, and the integration of innovative tools such as live-streaming cases for real-time education and consultations. The episode concludes with a detailed case study showcasing a successful treatment of CLI, underscoring the application of advanced techniques and collaborative efforts in management.

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TIMESTAMPS

00:00 - Introduction

06:57 - Balancing Hospital and OBL Work

13:48 - Educational Initiatives and Innovations

17:12 - Strategic Planning and Treatments

26:25 - Crossing Devices and Techniques

32:04 - DEEPER REVEAL Trial

39:33 - Case Presentation: Non-Healing Wound

50:09 - Conclusion

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RESOURCES

A Prospective Single-Arm Multicenter StuDy of the BarE TEmporary SPur StEnt System foR the tREatment of Vascular Lesions Located in the infrapoplitEal Arteries beLow the Knee (DEEPER REVEAL) (DEEPER REVEAL):

https://clinicaltrials.gov/study/NCT05358353

Wingman Catheter:

https://www.reflowmedical.com/wingman/

Surgical arteriovenous fistula (AVF) creation has been a mainstay of dialysis care for multiple decades. What does it take to break into such an established space with a new endovascular medical device? In this episode of the BackTable Podcast, Dr. Jeffrey Hull discusses the challenging journey of developing the Ellipsys system for endovascular AVF creation.

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CHECK OUT OUR SPONSOR

Medtronic ClosureFast

https://www.medtronic.com/closurefast6f

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SYNPOSIS

We trace Dr. Hull’s path from the device's initial conception in 2006, through the first-in-human cases in 2013, to regulatory approval and acquisition by Medtronic in 2020. Dr. Hull highlights the roles of key business mentors, the importance of multidisciplinary collaboration with vascular surgery and nephrology, and the impact of investment. He also shares valuable insights on the benefits of having competitors and selecting a well-thought-out exit strategy. Additionally, we explore deep vein arterialization (DVA) as another application of endovascular AVF creation in the context of peripheral arterial disease.

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TIMESTAMPS

00:00 - Introduction

03:05 - The Birth of the Percutaneous AV Fistula Creation

15:04 - First-in-Human Cases

17:58 - Navigating the Startup Journey

21:52 - Identifying Mentors and Investors

27:33 - Competition and Criticism

36:43 - Regulatory Hurdles

44:45 - Acquisition by Medtronic

49:14 - Deep Vein Arterialization for Peripheral Arterial Disease

54:40 - Final Thoughts and Advice

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RESOURCES

Avenu Medical:

https://avenumedical.com/

Gracz KC et al. Proximal forearm fistula for maintenance hemodialysis (1977):

https://pubmed.ncbi.nlm.nih.gov/839655/

Hull JE et al. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access (2018):

https://pubmed.ncbi.nlm.nih.gov/29275056/

Endovascular Today- Update on Percutaneous AV Fistula Creation (2015):

https://evtoday.com/articles/2015-june/update-on-percutaneous-av-fistula-creation

Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art (2020):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353338/

Get caught up on prostate artery embolization (PAE) best practices and learn the ins-and-outs of building a PAE program in 2024. Dr. Jason Hoffmann covers this and more, with host Dr. Michael Barraza. Dr. Hoffmann is an interventional radiologist and educator at NYU Langone Health.

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CHECK OUT OUR SPONSOR

Merit Embolotherapy

https://www.merit.com/solutions/embolotherapy/

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SYNPOSIS

The doctors delve into strategies for developing expertise within a practice, coordinating with urologists, and effectively managing patient expectations. Dr. Hoffmann shares insights on leveraging different imaging techniques, equipment choices, and best practices for ensuring post-procedure patient satisfaction. The discussion also touches on the evolution of PAE guidelines, insurance challenges, and the importance of longitudinal care in interventional radiology.

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TIMESTAMPS

00:00 - Introduction

04:12 - Building a BPH Program and PAE Practice

06:28 - Referrals and Relationship with Urology

15:27 - Patient Workup and Setting Expectations

27:10 - SwiftNinja Study: Initial Impressions and Findings

31:43 - Patient Management and Post-Procedure Care

35:37 - Building a Successful PAE Practice

42:19 - Conclusion

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RESOURCES

BackTable VI Podcast Episode #445 - Inside the IR Suite: A Clinician's Own Battle with Portal Vein Thrombosis with Dr. Jason Hoffmann:

https://www.backtable.com/shows/vi/podcasts/445/inside-the-ir-suite-a-clinicians-own-battle-with-portal-vein-thrombosis

AUA Guidelines on Benign Prostatic Hyperplasia (Updated 2023):

https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966367/

Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice.

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This podcast is supported by an educational grant from Guerbet.

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SYNPOSIS

Dr. Ahmed, an interventional radiologist at the University of Chicago, shares details about the procedure, his journey in adopting it, and his thoughts on the current landscape of GAE. Topics include procedural techniques, patient selection, anatomical considerations, potential complications, and the importance of ongoing research in this field.

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TIMESTAMPS

00:00 - Introduction

04:43 - Knee Osteoarthritis and Current Treatments

07:54 - Building a GAE Practice

13:23 - Tools and Procedure: Step-by-Step

25:05 - Post-Procedure Care and Complications

30:26 - Future of GAE and Other Applications

34:03 - Conclusion and Contact Information

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RESOURCES

BackTable INN Ep. 46- New Innovations in Treatment of PE: The Flow Medical Story

with Founders Dr. Osman Ahmed and Dr. Jonathan Paul:

https://www.backtable.com/shows/innovation/podcasts/46/new-innovations-in-treatment-of-pe-the-flow-medical-story

BackTable VI Ep. 429- Tackling Upper GI Bleeds: Techniques and Tools with Dr. Osman Ahmed:

https://www.backtable.com/shows/vi/podcasts/429/tackling-upper-gi-bleeds-techniques-tools

BackTable VI Ep. 447- Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little:

https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes

GEST MSK Conference 2025 (Paris):

https://www.gestmsk.com/

Okuno Y et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis (2014):

https://pubmed.ncbi.nlm.nih.gov/24993956/

Little MW et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS 1) Using Permanent Microspheres: Interim Analysis (2021):

https://pubmed.ncbi.nlm.nih.gov/33474601/

Little MW et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial (2023):

https://pubmed.ncbi.nlm.nih.gov/37337060/

Correa MP et al.GAUCHO - Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial (2022):

https://pubmed.ncbi.nlm.nih.gov/35304614/

Sapoval M et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial (2024):

https://pubmed.ncbi.nlm.nih.gov/38102013/

Get caught up on the current best practices and guidelines in venous interventions. Dr. Adam Raskin covers this and more, with host Dr. Sabeen Dhand in this discussion of DVT and PE treatments. Dr. Raskin is an interventional cardiologist, medical director of Cardiac ICU, and Co-Director of the PERT program at Mercy Health in Cincinnati, Ohio.

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CHECK OUT OUR SPONSOR

Imperative Care

https://imperativecare.com/vascular/

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SYNPOSIS

Dr. Raskin shares his comprehensive approach for treating patients with DVT and PE, highlighting recent advancements in thrombectomy systems, as well as underscoring the need for more randomized trials to further build on current venous disease treatment guidelines. The doctors also touch on the significance of accurate diagnostic tools and thorough follow-up to improve patient outcomes.

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TIMESTAMPS

00:00 - Introduction

10:58 - Approaching DVT & PE Patients

19:04 - Thrombectomy Advancements

24:02 - Iliofemoral Interventions & Standard Practices

26:32 - Accessing Tibial Veins & Clearing Clots

38:59 - Follow-Up & Data Collection

41:09 - Future of Venous Interventions

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RESOURCES

The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II

Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine:

https://www.jvsvenous.org/article/S2213-333X(23)00322-0/fulltext

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DISCLAIMER

The Symphony Thrombectomy System is intended for the non-surgical removal of fresh, soft emboli and thrombi from blood vessels. Injection, infusion and/or aspiration of contrast media and other fluids into or from a blood vessel, intended for use in the peripheral vasculature and it is not for use in the pulmonary vasculature. Rx only. Important Safety Information may be found at http://bit.ly/3pAaUlw.

Views expressed are those of the speakers and not necessarily those of the sponsor. Certain content in this podcast contains forward-looking statements and no assurance of future results should be relied upon. Brands and trademarks referenced herein are those of their respective owners or holders.

Dr. Adam Raskin is a paid consultant of Imperative Care.

In a society where discussions about medical malpractice are often concealed from the public eye, this episode of BackTable shines a spotlight on the powerful documentary ‘A World of Hurt: How Medical Malpractice Fails Everyone,’ produced by Viknesh Kasthuri, a fourth-year medical student at Brown University. Released earlier this year, the film explores how the American medical malpractice system harms and disconnects patients and providers through three compelling case studies.

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CHECK OUT OUR SPONSOR

RADPAD® Radiation Protection

https://www.radpad.com/

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SYNPOSIS

We delve into Viknesh’s motivations and the process behind creating the documentary, discussing the need for improved provider education on lawsuits, effective communication with patients and legal teams, and strategies for coping mentally and emotionally throughout this intensive process.

Additionally, Viknesh provides a behind-the-scenes look at documentary production, including filming during the COVID pandemic, creating environments for patients and providers to share their stories, and submitting the documentary to film festivals.

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TIMESTAMPS

00:00 - Introduction

02:40 - Inspiration Behind the Documentary

06:10 - Technical and Legal Aspects of Documentary Production

14:34 - Releasing the Documentary

17:04 - Physician and Patient Responses to Medical Errors

20:27 - Highlighting Communication Resolution Programs

23:04 - Educational Gaps in Medical Training

26:43 - Exploring Systemic Solutions to Management of Medical Errors

30:16 - Final Thoughts and Future Projects

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RESOURCES

A World of Hurt Documentary:

https://www.youtube.com/watch?v=09IVcL6pACU

BackTable VI Ep. 77- Doctors and Litigation: The L Word, with Dr. Gita Pensa:

https://www.backtable.com/shows/vi/podcasts/177/doctors-litigation-the-l-word

The L Word Podcast with Dr. Gita Pensa:

https://doctorsandlitigation.com/podcast-2

BackTable ENT Ep. 90- Coaching Physicians Through the Stress of Malpractice Litigation, with Dr. Gita Pensa:

https://www.backtable.com/shows/ent/podcasts/90/coaching-physicians-through-the-stress-of-malpractice-litigation

Michigan Model Communication and Resolution Program:

https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs

Are you interested in starting an ASC or converting your OBL into an ASC, but aren’t sure where to start? We’ve got you covered with this comprehensive overview. Attorney Jason Greis joins guest host and ASC founder Dr. Krishna Mannava to explore the operational, financial, and legal intricacies of starting an ASC. Jason is a Partner of Benesch, Friedlander, Coplan & Aronoff LLP, outside co-counsel to the Renal Physicians Association and OEIS Society, and recognized faculty member of SIR Business Institute.

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CHECK OUT OUR SPONSOR

RADPAD® Radiation Protection

https://www.radpad.com/

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SYNPOSIS

Jason and Dr. Mannava discuss crucial factors such as structural modifications, financial considerations, legal requirements, Certificate of Need (CON) states, and credentialing processes. The conversation also delves into strategic partnerships with hospitals, the role of ASC management companies, and the involvement of non-physician owners. Additionally, they explain the implications of non-compete clauses, operational challenges, investment structures, and exit strategies.

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TIMESTAMPS

00:00 - Introduction

03:11 - OBL to ASC Conversion

06:08 - Financial and Regulatory Aspects

15:35 - Ownership and Investment Strategies

29:41 - Non-Competes and Legal Risks

34:21 - Specialized Legal Advice and Conclusion

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RESOURCES

Vive Vascular:

https://www.vivevascular.com/

SIR Business Center:

https://irbc.sirweb.org/