BackTable Vascular & Interventional

In this episode of BackTable Podcast, host Dr. Sabeen Dhand interviews guest Dr. Aaron Fischman about the TREAT Symposium and its evolution into TREAT Live, a platform for broadcasting live endovascular cases. Dr. Fischman is a vascular and interventional radiologist at Mount Sinai in New York.

Dr. Fischman details the journey from TREAT’s inception as a conference focused on radial interventions to its current form, which includes a monthly live case streaming setup aimed at providing continuous medical education. The discussion covers the strategic shift from annual conferences to monthly live streams due to the pandemic, the logistical challenges and solutions for setting up live broadcasts, and the educational benefits of showcasing live cases, including the potential for offering CME credits. Dr. Fischman also shares insights into the selection of cases and operators, emphasizing the diversity of cases and the future direction of the program. The doctors also underscore the importance of innovation in medical education and the potential of live case broadcasts to enhance learning and improve patient care.

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CHECK OUT OUR SPONSOR

Varian, a Siemens Healthineers company

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

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SHOW NOTES

00:00 - Introduction

01:53 - Meet Dr. Aaron Fischman: A Pioneer in Transradial Interventions

02:19 - Evolution of TREAT Symposium: From Concept to Live Cases

06:06 - TREAT Live’s Monthly Case Broadcasts

10:28 - Future of Medical Education: Live Cases and CME Credits

16:32 - Impact and Expansion of TREAT Live

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RESOURCES

TREAT Live:

https://treatsymposium.com/

BackTable VI Episode #30 - Transradial Access: Basic to Advanced with Dr. Aaron Fischman:

https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Neil Khilnani about the management of pelvic venous disorders, focusing on embolization practices for treating conditions such as chronic pelvic pain and pelvic venous syndrome. Dr. Khilnani is an interventional radiologist at Weill Cornell Medicine in New York Presbyterian Hospital.

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CHECK OUT OUR SPONSOR

Cook Medical Embolization

https://www.cookmedical.com/embobacktable

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SYNPOSIS

Dr. Khilnani discusses the significance of identifying and treating venous disorders in patients with chronic pelvic pain. He emphasizes the need for a comprehensive approach that includes detailed patient history, physical exams, and imaging techniques such as ultrasound, CT, and MRI for accurate diagnosis. The doctors also cover the evolution of embolization techniques, including the use of balloon occlusion and sclerosants and they underscore the importance of addressing underlying venous insufficiencies for effective pain management. Additionally, Dr. Khilnani highlights the interconnectedness of various pelvic symptoms and the potential for embolization to alleviate not just pelvic pain, but also related conditions such as painful bladder syndrome and orthostatic hypotension. The doctors acknowledge the ongoing research and the need for collaboration across specialties to improve patient outcomes in pelvic venous disorder.

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TIMESTAMPS

00:00 - Introduction

04:44 - Pelvic Venous Disease

09:20 - Prevalence of Pelvic Venous Disease

13:54 - Challenges in Communication with Referring Doctors

18:32 - Workup and Diagnosis of Pelvic Venous Disorders

30:08 - Treatment Options and Patient Education

36:19 - Role of Social Media in Patient Support Networks

37:04 - Procedure: From Planning to Execution to Post-Intervention

54:07 - Navigating Difficult Anatomy and Potential Complications

01:02:34 - Future of Pelvic Venous Disorders Treatment: Research and Trials

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RESOURCES

BackTable VI Episode 389 - Pelvic PT: An Introduction for Interventionalists with Ingrid Harm-Ernandes, PT:

https://www.backtable.com/shows/vi/podcasts/389/pelvic-pt-an-introduction-for-interventionalists

BackTable VI Episode 337 - Management of Vulvar Varices with Dr. Brooke Spencer:

https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices

BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 1: Diagnosis and Planning

with Dr. Mark Meissner and Dr. Michael Cumming:

https://www.backtable.com/shows/vi/podcasts/101/pelvic-congestion-syndrome-part-1-diagnosis-planning

BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 2: Technique and Follow-Up with Dr. Mark Meissner and Dr. Michael Cumming:

https://www.backtable.com/shows/vi/podcasts/102/pelvic-congestion-syndrome-part-2-technique-follow-up

A standardized ultrasound approach to pelvic congestion syndrome (Labropoulos et al):

https://pubmed.ncbi.nlm.nih.gov/27799418/

Comparison of Fibered versus Nonfibered Coils for Venous Embolization in an Ovine Model (White et al):

https://pubmed.ncbi.nlm.nih.gov/37105664/

Pelvic Venous Disorders in Women due to Pelvic Varices: Treatment by Embolization: Experience in 520 Patients (De Gregorio et al):

https://www.jvir.org/article/S1051-0443(20)30534-0/abstract

Improvement in chronic pelvic pain, orthostatic intolerance and interstitial cystitis symptoms after treatment of pelvic vein insufficiency (Smith et al):

https://journals.sagepub.com/doi/abs/10.1177/02683555231219737

The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders:

https://www.jvsvenous.org/article/S2213-333X(21)00071-8/fulltext

Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel:

https://pubmed.ncbi.nlm.nih.gov/30857986/

Find this episode on BackTable.com for the full list of resources.

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ramsey Al-Hakim about the inception and journey of Auxetics, a med-tech company innovating in the vein stent market. Dr. Al-Hakim is the co-founder of Auxetics and the Section Chief of the Division of Interventional Radiology at Scripps Hospital in San Diego, CA.

Dr. Al-Hakim covers the initial challenges of understanding the market and securing capital, the clinical significance of addressing stent-adjacent stenosis, and the process of developing a stent with a negative Poisson effect to counteract it. Dr. Al-Hakim highlights Auxetics' approach to combining cutting-edge interventional technologies with world-class imaging tools for enhanced procedural efficiency in venous interventions. The company’s progress through benchtop work, animal testing, and plans for first-in-human studies outside the U.S., aiming for commercialization within the next four to five years, is also outlined. Contributions from key figures in the vascular community and the role of mentorship and perseverance in navigating the complexities of medical device innovation are discussed as well.

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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

03:11 - The Market and Problem Solving

12:13 - Journey of Creating a Stent

22:28 - Birth of Auxetics

26:53 - Learning Process and Support from the University

29:16 - Building the Dream Team

33:01 - Starting a Company

36:42 - Challenges and Triumphs of Fundraising

37:44 - Current Status and Future Plans

45:32 - Importance of Community and Mentorship

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RESOURCES

Auxetics:

https://www.auxeticsinc.com

In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction:

https://pubmed.ncbi.nlm.nih.gov/34174500/

Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation:

https://pubmed.ncbi.nlm.nih.gov/30717966/

The Messy Middle: Finding Your Way Through the Hardest and Most Crucial Part of Any Bold Venture:

https://www.amazon.com/Messy-Middle-Finding-Through-Hardest/dp/0735218072

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Dean Ferrera about treating acute limb ischemia with mechanical thrombectomy. Dr. Ferrera is an interventional cardiologist at Community Care Network in northwestern Indiana.

Dr. Ferrera emphasizes the importance of interdisciplinary collaboration, early detection, and selection of appropriate intervention techniques. He also discusses threading issues, bleeding complications, use of lysis, and understanding the nature of clots. He recommends thrombectomy systems such as the Pounce Thrombectomy System for removing thrombus and embolus. Furthermore, Dr. Ferrera highlights the significance of continued learning and mentorship in managing these complex conditions.

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CHECK OUT OUR SPONSOR

Surmodics Pounce Thrombectomy

https://pouncesystem.com/

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SHOW NOTES

00:00 - Introduction

04:21 - Patient Presentation and Workup

09:23 - Treatment Options for Acute Limb Ischemia

17:48 - Crossing the Clot and Treatment Options

25:18 - Device Capabilities and Limitations

28:43 - Procedure Steps and Reusability

31:26 - Device Selection and Aspiration Devices

37:07 - Post-Procedure Considerations and Follow-Up

43:16 - Complications and Risk Management

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RESOURCES

Pounce Thrombectomy System:

https://pouncesystem.com/

Thrombus Structural Composition in Cardiovascular Disease:

https://pubmed.ncbi.nlm.nih.gov/34261330/

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. John Qiao about exploration of physicians’ role in medical innovation, particularly among interventional radiologists.

Dr. Qiao shares insightful information about the origin of RadioClash and details his journey as an entrepreneur. Through this discussion, Dr. Qiao covers the challenges encountered during the startup phase, the invention of a single-probe electroporation device, and the future applications of this novel medical technology. The episode concludes with broader advice on how to manage the demands of professional work, entrepreneurship, and personal life.

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CHECK OUT OUR SPONSORS

Reflow Medical

https://www.reflowmedical.com/

Medtronic Concerto

https://mobile.twitter.com/mdtvascular

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SHOW NOTES

00:00 - Introduction

02:39 - Dr. Qiao’s Journey into Medicine and Entrepreneurship

11:40 - Birth of Radioclash: A Unique Solution for Cancer Treatment

17:58 - Future of RadioClash: Targeting Metastatic Cancer

25:20 - Future of Electroporation Therapy

35:21 - Challenges of Building a Company

44:37 - Path to Market and Future Plans

47:28 - Balancing Clinical Practice and Entrepreneurship

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RESOURCES

RadioClash website:

https://www.radioclash.co/

News Article on Dr. John Qiao:

https://voyagehouston.com/interview/meet-john-qiao-m-d-of-radioclash-ltd-co/

Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086111/

The Abscopal Effect: A Reemerging Field of Interest:

https://ascopost.com/issues/november-25-2018/the-abscopal-effect-a-reemerging-field-of-interest/

BackTable VI Episode #402 - Immunotherapy in HCC: Evolving Treatment Paradigms:

https://www.backtable.com/shows/vi/podcasts/402/immunotherapy-in-hcc-evolving-treatment-paradigms

Tavo and Pembrolizumab in Patients With Stage III/​IV Melanoma Progressing on Either Pembrolizumab or Nivolumab Treatment (Keynote-695):

https://clinicaltrials.gov/study/NCT03132675

PANFIRE-3 Trial: Assessing Safety and Efficacy of Irreversible Electroporation (IRE) + Nivolumab + CpG for Metastatic Pancreatic Cancer:

https://classic.clinicaltrials.gov/ct2/show/NCT04612530

Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients:

https://pubmed.ncbi.nlm.nih.gov/33129427/

The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study (Northwestern study):

https://pubmed.ncbi.nlm.nih.gov/21728392/

Irreversible electroporation reverses resistance to immune checkpoint blockade in pancreatic cancer:

https://www.nature.com/articles/s41467-019-08782-1

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Andrew Sholl, who demystifies the ins and outs of percutaneous biopsies and their impact on diagnoses. Dr. Scholl is a pathologist at LCMC Health in New Orleans, Louisiana.

Dr. Sholl emphasizes the importance of understanding substantial clinical history, as well as obtaining adequate and correctly processed samples. The doctors discuss the varying scenarios faced in pathology, such as instances when larger samples are beneficial and the nuances of differentiating malignancies in certain organs. They also cover detailed tips for conducting biopsies and the process of how pathologists assess patient samples. The overarching message is the importance of communication and collaboration between interventional radiologists and pathologists to ensure the best patient outcomes.

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CHECK OUT OUR SPONSOR

Argon BioPince Ultra

https://www.argonmedical.com/product/biopince-ultra-full-core-biopsy-instrument/

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SHOW NOTES

00:00 - Introduction

02:38 - Understanding Pathology Training and Practice

06:07 - Role of Pathology in Medical Diagnosis

18:57 - Importance of Sample Size and Quality in Pathology

26:34 - Next Gen Sequencing and Molecular Markers

29:44 - Biopsy Devices and Their Impact on Diagnosis

37:21 - Using Clinical History in Pathology

43:16 - Challenges and Considerations in Diagnosing Renal and Hepatic Tumors

50:25 - Importance of Communication Between Pathologists and Interventional Radiologists

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Brian Holly about different surgical scenarios relating to biliary interventions. Dr. Holly is a practicing interventional radiologist and Assistant Professor of Radiology and Radiological Sciences at Johns Hopkins University.

The doctors delve into various techniques including the usage of ultrasound, managing non-dilated and dilated systems, as well as handling specific clinical scenarios such as malignant obstructions, benign biliary strictures, and postoperative bile leaks. The podcast also briefly discusses the controversial topic of placing internal biliary stents and the challenges faced with managing biliary strictures and leaks.

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CHECK OUT OUR SPONSOR

RADPAD® Radiation Protection

https://www.radpad.com/

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SHOW NOTES

00:00 - Introduction

01:53 - Discussion on IR Training at Johns Hopkins

04:09 - Overview of Biliary Interventions

08:31 - Challenges and Techniques in Biliary Access

19:28 - Approach to Non-Dilated Collecting System

28:07 - Dealing with Dilated Systems and Obstructions

32:56 - Biopsy Techniques for Malignant CBD Strictures

39:30 - Approach to Benign Biliary Strictures

41:48 - Use of Internal Stents in Biliary Procedures

44:51 - Managing Bleeding in Biliary Procedures

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RESOURCES

The Hepaticojejunostomy Technique with Intra-Anastomotic Stent in Biliary Diseases and Its Evolution throughout the Years: A Technical Analysis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846744/

Percutaneous Transhepatic Cholangiography and Intraductal Radiofrequency Ablation Combined with Biliary Stent Placement for Malignant Biliary Obstruction:

https://www.jvir.org/article/S1051-0443(15)00166-9/abstract

In this episode of the Backtable Podcast, host Dr. Chris Beck interviews guests Dr. Omar Chohan and Dr. Harris Chengazi about dialysis fistula declot procedures and their own experiences with various devices and strategies, including usage of pre-procedure ultrasound, heparinization, and closure techniques. Both Dr. Chohan and Dr. Chengazi are interventional radiologists at Great Lakes Medical Imaging in Buffalo, New York.

The doctors dive into treatment of anastomosis stenosis, stressing the importance of technique refinement, physical examination, and thoughtful pre-procedure planning. The discussion concludes with an invitation for listeners to share their experiences with the ‘bottle-cap’ hemostasis trick.

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CHECK OUT OUR SPONSOR

Argon Cleaner Rotational Thrombectomy System

https://www.argonmedical.com/cleaner

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SHOW NOTES

00:00 - Introduction

05:59 - Importance of Problem Solving in Declot Procedures

07:27 - Role of Pre-Procedure Ultrasound

12:00 - Process of Declot Procedures

28:27 - Moving to the Arterial Side: Access and Treatment

32:37 - Wire Management and the Risk of Rupture

41:59 - Art of Closure: Techniques and Considerations

45:53 - When to Quit: Evaluating the Need for Revision or Alternative Treatment

50:24 - Experience and Planning in Successful Fistula Treatment

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RESOURCES

BackTable Declot Guide:

https://www.backtable.com/shows/vi/topics/procedure/declot

BackTable VI Episode #25 - Declots with the Argon Cleaner Device with Dr. Sabeen Dhand:

https://www.backtable.com/shows/vi/podcasts/25/declots-with-the-argon-cleaner-device

BackTable VI Episode #117 - Successful (and Quick!) Declots for AV Access with Dr. Neghae Mawla:

https://www.backtable.com/shows/vi/podcasts/117/successful-quick-declots-for-av-access

BackTable VI Episode #139 - AV Fistula & Graft Maintenance with Dr. Ari Kramer:

https://www.backtable.com/shows/vi/podcasts/139/av-fistula-graft-maintenance

BackTable VI Episode #141 - DEB vs. Balloon Angioplasty Alone for Dysfunctional Hemodialysis Access with Dr. Eric Therasse:

https://www.backtable.com/shows/vi/podcasts/141/deb-vs-balloon-angioplasty-alone-for-dysfunctional-hemodialysis-access

BackTable VI Episode #292 - Dialysis Interventions with Drug-Coated Balloons, Covered Stents and More Dr. Ari Kramer:

https://www.backtable.com/shows/vi/podcasts/292/dialysis-interventions-with-drug-coated-balloons-covered-stents-more

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ilan Rzadkowolsky-Raoli about his experience of being diagnosed with a large saddle embolus and subsequently being treated by his best friend, Dr. Ripal Gandhi. Dr. Rzadkowolsky-Raoli is an interventional radiologist at Palmetto General Hospital in Miami, Florida.

Dr. Rzadkowolsky-Raoli discusses the impact of his diagnosis on his practice, how it has changed the way he approaches and speaks to his patients, and his advice for clinicians.

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CHECK OUT OUR SPONSORS

Varian, a Siemens Healthineers company

https://www.varian.com/products/interventional-solutions/embolization-solutions

Medtronic ClosureFast

https://www.medtronic.com/closurefast6f

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SHOW NOTES

00:00 - Introduction

06:18 - Dr. Rzadkowolsky-Raoli’s Personal Journey

09:41 - Diagnosis and Treatment Process

12:18 - Post-Treatment Recovery and Reflections

24:18 - Impact on Practice and Patient Care

31:45 - Final Thoughts and Appreciation

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RESOURCES

Pulmonary Embolism Response Team (PERT) Consortium:

https://pertconsortium.org/

Inari FlowTriever:

https://www.inarimedical.com/flowtriever/

In this episode, host Dr. Sabeen Dhand interviews Dr. Charles Bailey about Limb Alert, a hospital protocol devised to expedite the diagnosis and treatment of patients presenting with acute limb ischemia. Dr. Bailey is a vascular surgeon and the Director of Peripheral Artery Disease (PAD) and Limb Salvage at the University of South Florida.

Dr. Bailey explains how the Limb Alert program standardizes the care pathway, rapidly alerts necessary personnel, initiates labs, and prepares the Penumbra Lightning Bolt 7 System for endovascular thrombectomy. The incorporated protocol significantly streamlines patient management, resulting in encouraging survival rates. Dr. Bailey further emphasizes the necessity for modern endovascular trials in acute limb ischemia and proposes a multicenter randomized trial to provide evidence for endovascular treatment.

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CHECK OUT OUR SPONSOR

Penumbra Lightning Flash

https://www.penumbrainc.com/products/lightning-flash/

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SHOW NOTES

00:00 - Introduction

02:43 - Dr. Bailey’s Journey to Florida and His Practice

06:43 - Importance of Timely Intervention in Acute Limb Ischemia

21:29 - Role of Debulking in Acute Limb Ischemia

28:20 - Tips and Tricks for Successful Outcomes

31:17 - Impact of the Limb Alert Program

41:19 - Future of Acute Limb Ischemia Treatment

47:40 - The Need for New Randomized Trials

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RESOURCES

Acute Limb Ischemia: An Update on Diagnosis and Management:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723825/

Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia - STRIDE Study:

https://www.jvascsurg.org/article/S0741-5214(23)02196-1/fulltext