BackTable Vascular & Interventional

In this episode, host Dr. Bryan Hartley takes us on a deep dive into the origin story and mission of Pulmera, a medtech company dedicated to transforming the field of bronchoscopic lung cancer diagnosis by retrofitting existing fluoroscopy machines into cone beam CT-like scanners. Dr. Hartley is a vascular and interventional radiologist and co-founded Pulmera, alongside interventional pulmonologist Dr. Harmeet Bedi at Stanford.

Pulmera is developing a novel approach to enhance physicians’ ability to diagnose lung nodules accurately through innovative technology. Dr. Hartley shares insights into the challenges of existing diagnostic methods, the inspiration behind Pulmera, and the technology’s potential to combine the best of 3D imaging and endoscopy techniques. Dr. Hartley discusses the benefits for both patients and physicians, such as improved diagnostic yields and patient outcomes, and introduces an investment opportunity for the BackTable community to be part of this revolutionary project. The episode also explores the broader implications of this technology across various medical specialties beyond pulmonology.

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RADPAD® Radiation Protection

https://www.radpad.com/

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SHOW NOTES

00:00 - Introduction

02:18 - Personal Journey: From Vanderbilt to Stanford Biodesign

06:11 - Pulmera’s Mission: Enhancing Diagnostic Accuracy in Lung Biopsies

15:02 - Introducing a Game-Changing Technology for Bronchoscopic Procedures

22:09 - Challenges and Breakthroughs in Portable CT Imaging

27:44 - Economic Impact of Enhanced Diagnostic Procedures

29:48 - Building a Team and Securing Funding for Innovation

31:30 - Understanding Investment Opportunities and Equity Financing

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RESOURCES

Dr. Bryan Hartley’s email:

[email protected]

Dr. Bryan Hartley’s cell:

423-432-0612

Pulmera:

http://www.pulmera.com/

Stanford Biodesign Fellowship:

https://biodesign.stanford.edu/programs/fellowships/innovation-fellowships.html

BackTable Innovation Episode #1 - Needs Driven Innovation with Dr. Todd Brinton (Stanford BioDesign):

https://www.backtable.com/shows/innovation/podcasts/1/needs-driven-innovation

BackTable Innovation Episode #30 - Host Stories with Dr. Bryan Hartley and Dr. Eric Gantwerker (Stanford BioDesign):

https://www.backtable.com/shows/innovation/podcasts/30/host-stories

BackTable VI Episode #422 - Pathology 101: Solid Advice for Percutaneous Biopsies with Dr. Andrew Sholl:

https://www.backtable.com/shows/vi/podcasts/422/pathology-101-solid-advice-for-percutaneous-biopsies

In this episode, Dr. Jos van den Berg discusses the benefits of joining the Critical Limb Ischemia (CLI) Global Society, including discounts on Amputation Prevention Symposium (AMP) meetings, access to a specialized journal, and participation in Multidisciplinary CLI Network (MCLIN) discussion boards.

Dr. van den Berg is an interventional radiologist at University of Bern in Switzerland and Europe Office Chairman and Member of Board of Directors for CLI Global Society. Dr. van den Berg also serves as a reviewer and editorial board member of multiple high-impact scientific journals.

With members across the globe, the CLI Global Society emphasizes a multidisciplinary approach to combat CLI, aiming to prevent amputation and death through education, patient advocacy, and awareness about CLI. Dr. van den Berg also sheds light on the complexity of CLI management in Europe due to varied reimbursement systems among countries and the society’s efforts to tackle these challenges. The episode also touches on the society’s future goals, including expanding its global presence and continuing to offer extensive resources and networking opportunities to its members.

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CHECK OUT OUR SPONSORS

BD Advance Clinical Training & Education Program

https://page.bd.com/Advance-Training-Program_Homepage.html

Reflow Medical

https://www.reflowmedical.com/

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SHOW NOTES

00:00 - Introduction

02:08 - Meet Our Guest: Dr. Jos van den Berg

05:42 - Deep Dive into CLI Global Society

07:53 - Exploring the Impact and Initiatives of CLI Global Society

14:42 - Challenges and Differences of CLI Management in Europe

21:08 - Innovations and Future Endeavors in CLI Treatment

23:45 - Closing Thoughts and the Importance of Membership

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RESOURCES

CLI Global Society:

https://www.cliglobalsociety.org/

Multidisciplinary CLI Network (MCLIN) Global CLI LIVE Meeting (every 2nd Friday of the month, 7am EST):

https://www.cliglobalsociety.org/education/mclin/#myaccount

AMP CLI Meeting:

https://www.hmpglobalevents.com/amptheclimeeting

In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship.

The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases.

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CHECK OUT OUR SPONSOR

Nevro HFX Spinal Cord Stimulator

https://www.hfxforpdn.com

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SHOW NOTES

00:00 - Introduction

06:00 - Demystifying Spinal Cord Stimulation for Pain Management

17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance

26:03 - Leveraging Telehealth and Support Teams for Patient Success

30:22 - Challenges and Solutions in Managing Peripheral Neuropathy

35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology

39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements

43:46 - Addressing the Challenges of Permanent Implant Procedures

48:46 - Role of Technology and AI in Patient Management

56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics

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RESOURCES

Nevro 10 kHz Therapy:

https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx

Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021):

https://pubmed.ncbi.nlm.nih.gov/33818600/

Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023):

https://pubmed.ncbi.nlm.nih.gov/37536514/

Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996):

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract

In this episode, Dr. Mark Lessne and Dr. John Martinie discuss the importance of multidisciplinary collaboration, patient-centered care, and the role of interventional radiology and surgery in treating benign and malignant biliary diseases. Dr. Lessne is an interventional radiologist at Charlotte Radiology and Dr. Martinie is a hepatobiliary surgeon at Carolinas Medical Center, both located in North Carolina.

The doctors explore various scenarios including challenges in biliary decompression, the decision-making process behind choosing the right intervention, and the impact of such diseases on patient care plans and outcomes. Dr. Lessne and Dr. Martinie emphasize the importance of viewing interventional radiologists and gastroenterologists as physicians who not only perform procedures, but also provide comprehensive care and follow-up for their patients. Through their dialogue, it becomes clear that successful treatment of biliary diseases requires a combination of technical skill, thoughtful patient engagement, and collaborative practice among specialists.

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RADPAD® Radiation Protection

https://www.radpad.com/

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SHOW NOTES

00:00 - Introduction

02:19 - Multidisciplinary Approach to Patient Care

05:31 - Navigating the Complexities of Biliary Disease Workups

10:13 - Collaboration Between Hepatobiliary Surgery and Interventional Radiology

19:33 - Balancing Minimally Invasive Techniques with Surgical Options

30:29 - The Importance of Compassionate Consent and Patient-Centered Care

32:16 - Exploring Advanced Interventions and Team Discussions

36:31 - Considerations and Challenges in Biliary Stenting

45:46 - Role of Interventional Radiology in Patient Care

56:57 - Final Thoughts on Teamwork and Patient Care

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RESOURCES

BackTable Ep. 203- Making Informed Consent an Informed Choice with the Interventional Initiative:

https://www.backtable.com/shows/vi/podcasts/203/making-informed-consent-an-informed-choice-with-the-interventional-initiative

In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University.

Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI.

Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case.

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Merit Spine

https://www.merit.com/merit-spine/

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SHOW NOTES

00:00 - Introduction

02:09 - Dr. Prologo’s Career and Leadership Roles

09:52 - Interventional Radiology’s Role in MSK Interventions

13:37 - A Primer for Steerable Vertebral Needles

21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation

26:37 - Advanced Pain Management in Interventional Radiology’ Book

30:24 - Thermocouples in Radiofrequency Ablation

35:45 - Prior Complications and Importance of Longitudinal Care

44:24 - SIR EDGE 2024

52:31 - Accessing Targets for Basivertebral Nerve Ablation

1:01:17 - The Role of Advocacy in Patient Care

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RESOURCES

Osseoflex Steerable Needle:

https://www.merit.com/product/osseoflex-sn-steerable-needle/

STAR Tumor Ablation System:

https://www.merit.com/product/star-tumor-ablation-system/

Osteocool OsteoCool Radiofrequency Ablation System:

https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html

OptaBlate Bone Tumor Ablation System:

https://providers.strykerivs.com/products/optablate

‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr:

https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402

Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist:

https://pubmed.ncbi.nlm.nih.gov/24745905/

SIR EDGE 2024:

https://www.sirweb.org/learning-center/meetings/sir-edge/

‘The Catching Point Transformation’ by J. David Prologo:

https://www.catchingpoint.com/

In this episode, Dr. Matthew Lungren discusses the transformative potential of Artificial Intelligence (AI) in healthcare, sharing insights into large language models, deep learning, and machine learning in improving patient care, enhancing clinical workflows, and optimizing medical research.

Dr. Lungren is a pediatric diagnostic and interventional radiologist, and the Chief Data Science Officer at Microsoft Health and Life Sciences. He advocates for a future where AI acts as a tool for healthcare professionals, allowing them to devote more time to patient care rather than administrative tasks. Additionally, the discussion explores concerns such as AI’s impact on employment and interactions with insurance companies, while presenting resources for healthcare professionals to engage with and learn about AI technologies actively.

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CHECK OUT OUR SPONSOR

Reflow Medical

https://www.reflowmedical.com/

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SHOW NOTES

00:00 - Introduction

03:00 - The Journey to AI Expertise: Dr. Lungren’s Story

05:48 - Decoding AI: From Basics to Large Language Models

13:07 - AI’s Impact on Healthcare and Beyond

15:57 - Exploring AI’s Potential in Content Creation and Clinical Efficiency

20:22 - The Future of AI in Healthcare: Opportunities and Challenges

25:27 - Leveraging AI for Diagnostic Radiology and Beyond

27:42 - The Transformative Potential of Generative AI in Healthcare

33:40 - Addressing Concerns: AI’s Role in Insurance and Patient Advocacy

36:41 - Empowering Healthcare Professionals with AI: Practical Applications and Future Outlook

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RESOURCES

Fundamentals of Machine Learning for Healthcare - Stanford University Coursera Course: https://www.coursera.org/learn/fundamental-machine-learning-healthcare

Dr. Matt Lungren’s LinkedIn Learning Course on Generative AI:

https://www.linkedin.com/learning/an-introduction-to-how-generative-ai-will-transform-healthcare/introduction-to-generative-ai-in-healthcare

DeepLearning.AI Website (Professor Andrew Ng):

https://www.deeplearning.ai/

Fast.AI Website (Professor Jeremy Howard):

https://www.fast.ai/

Professor Jeremy Howard YouTube:

https://www.youtube.com/@howardjeremyp/featured

Healthcare Information and Management Systems Society (HIMMS) Meeting:

https://www.himssconference.com/en/homepage.html

In this episode of the BackTable Podcast, Teri Yates explores the nuances of choosing between an Office-Based Lab (OBL) and Ambulatory Surgery Center (ASC) for private practices. Teri is the CEO of Accountable Physician Advisors, a consulting firm which specializes in OBLs, ASCs, and hybrid models for private-practice physicians. She is also President of DocCentric, a company focused on supporting physicians building and leading their own ASCs.

The discussion includes a comprehensive analysis of the financial, regulatory, and operational considerations for physicians contemplating this decision. This includes insights into reimbursement models, Medicare regulations, and the strategic advantages of each model. The episode also touches on the importance of feasibility studies, partnerships with other specialties, and real estate strategies when developing these facilities. The conversation provides valuable advice for navigating the complexities of ASC development and emphasizes the value of maintaining independence and leveraging physician-owned models for long-term success.

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Reflow Medical

https://www.reflowmedical.com/

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SHOW NOTES

00:00 - Introduction

04:19 - Deep Dive into OBL and ASC: Definitions, Differences, and Decisions

07:26 - Financial Implications of ASC vs. OBL

10:56 - Hybrid Model: Combining OBL and ASC for Flexibility

15:14 - Navigating the Complexities of ASC Development

20:03 - Real Estate Strategies for OBL and ASC Projects

22:50 - Staffing Considerations and Physician Entrepreneur Insights

35:17 - Future of OBL and ASC: Trends and Predictions

39:43 - Closing Thoughts and Resources for Further Learning

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RESOURCES

Ambulatory Surgery Center Association:

https://www.ascassociation.org/home

OEIS Annual Meeting 2024 Las Vegas:

https://oeisweb.com/meetings/2024-annual-meeting/

Accountable Physician Advisors (Teri’s consulting firm):

http://www.accountablephysicianadvisors.com/services

DocCentric:

https://doccentricasc.com/

NOON Development Company:

https://noondevelopment.com/

BT VI 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

BT VI Episode #202 - Staffing the OBL with Dr. Krishna Mannava and Kristin Longwell:

https://www.backtable.com/shows/vi/podcasts/202/staffing-the-obl

BT VI Episode #129 - OBL / ASC Business Pearls with Dr. Jim Melton:

https://www.backtable.com/shows/vi/podcasts/129/obl-asc-business-pearls

BI VI Episode #121 - Office-Based Labs (OBLs) & What You Can Do in Them with Dr. Mike Watts:

https://www.backtable.com/shows/vi/podcasts/121/office-based-labs-obls-what-you-can-do-in-them

BT VI Episode #42 - Building an Outpatient UFE Practice with Dr. Mary Costantino:

https://www.backtable.com/shows/vi/podcasts/36/building-an-outpatient-ufe-practice

In this episode of the BackTable Podcast, host Dr. Ally Baheti interviews Dr. Deepak Sudheendra and Laurie Bouzarelos about the complexities of navigating insurance for procedures performed in vascular and interventional radiology outpatient-based labs (OBLs).

Dr. Sudheendra is an interventional radiologist at 360 Vascular Solutions in Dublin, Ohio and Laurie Bouzarelos is the founder and owner of Provider Solutions, a small business which focuses on coaching private practice and business-owning physicians on payor contracting.

The conversation illuminates common challenges faced by physicians when negotiating insurance contracts, and it emphasizes the lack of awareness among insurance companies about the roles of IRs and the significance of OBLs. Laurie Bouzarelos shares her expertise on insurance contracting, highlighting the importance of education, strategy, and patient-focused care in achieving favorable contract terms. The episode delves into tactics for contract negotiation, leveraging data for better rates, and the critical role of in-house billing for financial transparency and control. Dr. Sudheendra shares his personal journey and the tenacity required to educate insurance providers about IR and OBLs. He underscores the broader need for healthcare professionals to advocate vigorously for their both patient care standards and their financial interests. The episode also includes practical insights for setting up a fee schedule, understanding market dynamics, and the potential pitfalls in standard contracts.

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CHECK OUT OUR SPONSORS

Varian, a Siemens Healthineers company

https://www.siemens-healthineers.com/

Reflow Medical

https://www.reflowmedical.com/

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SHOW NOTES

00:00 - Introduction

03:14 - Journey of Insurance Contracting: From Confusion to Clarity

10:08 - Art of Negotiation: Laurie’s Unique Coaching Model

19:53 - Leveraging Data for Effective Insurance Negotiations

25:17 - Power of Negotiation: Changing the Game in Insurance Contracting

28:09 - Exploring the Challenges of Physician Negotiations with Insurance Companies

31:54 - Power of Personal Advocacy and Site Visits in Negotiations

36:45 - Navigating Contract Renegotiations and Understanding Fee Schedules

40:56 - Importance of In-House Billing and Vigilant Fee Management

52:16 - Final Advice: The Importance of Negotiation and Understanding Your Business

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RESOURCES

Provider Solutions (Laurie Bouzarelos’ company):

https://www.providersolutionsconsulting.com/about

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Osman Ahmed about treatment algorithms and new technologies for upper gastrointestinal (GI) bleed embolization. Dr. Ahmed is an interventional radiologist at the University of Chicago.

The doctors dive into various embolization techniques, microcatheters, and embolic materials that are ideal for managing upper GI bleeds. Dr. Ahmed highlights the importance of understanding the etiology of bleeding, differences between arterial vs. venous bleeding, and first-line therapies such as endoscopy. Dr. Ahmed also discusses the utilization of new embolic materials like Obsidio Embolic, which is designed specifically for peripheral use, and its advantages in achieving rapid and complete vessel occlusion. Additionally, the doctors cover pre-procedural imaging, procedural techniques, and operator preferences for microcatheters and embolic devices. They emphasize the procedural nuances, operator comfort, and evolving technologies in the management of GI bleeds.

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CHECK OUT OUR SPONSOR

Boston Scientific Obsidio Embolics

https://www.bostonscientific.com/obsidio

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SHOW NOTES

00:00 - Introduction

03:29 - Discussion on Upper GI Bleeds

06:35 - Pre-Procedure Imaging for Upper GI Bleeds

11:16 - Procedure Walkthrough for Upper GI Embolization

19:51 - Understanding Mesenteric Anatomy

22:50 - Embolization Devices: Coils and More

25:31 - Exploring Obsidio: A New Embolic

32:55 - Post-Procedure Care

34:17 - Case Discussions and Final Thoughts

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RESOURCES

Navigating Early Cases with the Obsidio™ Conformable Embolic - GEST 2023 Webinar with Dr. Ahmed:

https://thegestgroup.com/webinar-featuring-obsidio/

BackTable VI Episode #179 - Happiness is a Warm Coil: Treating GI Bleeds with Dr. Donald Garbett:

https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds

BackTable VI Episode #216 - Stick It: Glue Embo with Dr. Ziv Haskal:

https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo

BackTable VI Episode #321 - New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler:

https://www.backtable.com/shows/vi/podcasts/321/new-innovations-in-lower-gi-bleed-embolization

Obsidio - Conformable Embolic:

https://www.bostonscientific.com/obsidio

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Marcelo Guimaraes about the advantages and implementation of radial access in interventional radiology. Dr. Guimaraes is a vascular and interventional radiologist from the Medical University of South Carolina (MUSC).

Dr. Guimaraes shares insights on the adoption of radial access over femoral access, emphasizing its simplicity, safety, and the clear benefits recognized by younger interventionalists. He elaborates on the importance of education, partnership with the industry, and following a standard protocol to build a successful radial access program. The doctors also cover specific topics like the RAVI Registry outcomes, patient preferences for radial access based on a study, the cost-benefit analysis, and handling various challenges such as artery spasms and loops. Dr. Guimaraes advocates for radial access as the default method for embolization therapies, highlighting its efficacy across a range of procedures and patient conditions.

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CHECK OUT OUR SPONSOR

Medtronic Concerto

https://mobile.twitter.com/mdtvascular

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SHOW NOTES

00:00 - Introduction

02:56 - Insights into MUSC’s Interventional Radiology Program

04:44 - Emergence of Radial Access in Interventional Procedures

07:04 - Challenges and Solutions in Setting Up a Radial Access Program

10:14 - Essential Equipment for Radial Access

22:20 - Addressing Spasm Challenges in Radial Access

30:11 - Patient Preference: Radial vs Femoral Access

32:46 - Safety and Efficacy of Radial Access: The Data

41:11 - Post-procedure Hemostasis Protocol

43:51 - Optimal Radial Artery Access Point and Best Practices

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RESOURCES

How To Do The Barbeau Test - BackTable Demo:

https://www.backtable.com/shows/vi/demos/how-to-do-the-barbeau-test

Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis:

https://pubmed.ncbi.nlm.nih.gov/27037544/

Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: Randomized Trial to Assess Patient Satisfaction (Dr. Guimaraes paper):

https://pubmed.ncbi.nlm.nih.gov/29150395/

An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association:

https://www.ahajournals.org/doi/full/10.1161/HCV.0000000000000035

The RAVI registry: prospective, multicenter study of radial access in embolization procedures – 30 days follow up:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10828405/