BackTable Vascular & Interventional

The advent of newer thrombectomy devices has turned what were once hours-long surgical cutdowns into endovascular cases that last under an hour. In this episode of BackTable, host Dr. Sabeen Dhand is joined by Dr. Shang Loh from the University of Pennsylvania and Dr. Khanjan Nagarsheth from the University of Maryland to discuss the evolution of arterial thrombectomy devices and modern techniques for acute arterial occlusions.

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This podcast is supported by:

Inari Medical
https://www.inarimedical.com/artix-system

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SYNPOSIS

The episode highlights major technological advancements over the past decade, including the development of mechanical and computer-assisted thrombectomy systems. The physicians review key features of newer devices, such as the ability to combine aspiration with stent retrievers, the use of PTFE baskets to reduce distal embolization, and the advantage of maintaining wire access throughout the case.

They share strategies for managing specific cases, including acute femoral-popliteal occlusions with distal reconstitution, intraoperative ischemic pain due to flow arrest, trauma-related thrombosis, and cases complicated by extensive calcification and chronic vascular disease. As vascular surgeons, they also discuss the ongoing role of open approaches, outlining when surgical cutdown is indicated and where they prefer endovascular first. The conversation further explores challenges such as acute limb ischemia, stent thrombosis, and visceral artery thrombosis, emphasizing the importance of staying current with rapidly evolving technologies to improve procedural efficiency and patient outcomes.

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TIMESTAMPS

00:00 - Introduction
02:04 - Evolution of Arterial Thrombosis Treatment
04:11 - New Devices and Techniques
10:42 - Case Studies and Practical Applications
24:26 - Techniques and Devices for Thrombectomy
25:33 - Managing Flow and Patient Safety
27:25 - Surgical vs. Endovascular Approaches
29:25 - Dealing with Complications and Failures
37:50 - Visceral Thrombosis and Advanced Techniques
41:09 - Future of Thrombectomy Devices
44:27 - Closing Remarks

Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral artery disease. While many patients can be treated with endovascular or surgical revascularization, a subset of individuals remain ‘no-option’ candidates when conventional therapies fail or distal targets are absent. In this episode of BackTable, host Dr. Ally Baheti speaks with Dr. Mary Costantino, interventional radiologist at Advanced Vascular Centers, and Jill Sommerset, vascular technologist and Director of Clinical Education and Training at Aveera Medical, about the emerging role of spinal cord stimulation (SCS) as a potential therapy for patients with no-option CLTI.

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SYNPOSIS

This episode explores where spinal cord stimulation may fit within the treatment landscape for advanced CLTI, particularly for patients who are not candidates for revascularization or deep venous arterialization (DVA). Dr. Costantino describes how interest in the therapy developed through multidisciplinary collaboration and early physiologic observations using pedal acceleration time (PAT) measured with duplex ultrasound alongside angiography. A representative case highlights immediate, setting-dependent improvements in PAT following stimulation, and the group reviews early trends from a small patient cohort suggesting improved distal perfusion in individuals with severe infrapopliteal disease. The conversation also addresses practical barriers to adoption, including site-of-service and reimbursement challenges and the difficulty of implanting permanent stimulators in patients with active wounds. Jill Sommerset adds perspective from the vascular lab, discussing ultrasound-based methods to quantify physiologic changes after DVA and how similar perfusion metrics may help evaluate spinal cord stimulation. The episode concludes with a discussion of the potential role of neuromodulation in this population and the need for larger datasets to better define its clinical impact.

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TIMESTAMPS
00:00 - Introduction
02:02 - Why CLTI Needs Options
06:25 - First No Option Case
11:06 - Trial Turns Flow On
14:38 - Timing and Reimbursement
19:59 - Early Results and Adoption
22:45 - How Spinal Cord Stimulation Might Improve Flow
26:46 - Patient Selection and Access
30:24 - Treatment Algorithm and Timing
32:37 - Quality of Life and Mobility
37:57 - Implant Delays and Coordination
39:41 - Data

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RESOURCES

Paper on Maturation after DVA
https://www.sciencedirect.com/science/article/pii/S1078588426000523

Below-the-knee (BTK) arterial disease remains one of the more challenging areas in vascular care, particularly in patients with chronic limb-threatening ischemia (CLTI), where heavy calcification complicates endovascular treatment. As new calcium-modifying technologies emerge, an important question remains: what evidence supports their use in BTK interventions? In this episode of BackTable Vascular & Interventional, host Dr. Sabeen Dhand speaks with vascular surgeon Dr. Paul Foley of Doylestown Health about the Disrupt BTK II clinical trial from Shockwave Medical, which evaluates the performance of peripheral intravascular lithotripsy (IVL) in heavily calcified BTK disease.

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This podcast is supported by:

Shockwave Medical
https://shockwavemedical.com/

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SYNPOSIS

Dr. Foley begins by outlining his training and the evolution of his vascular surgery practice, setting the stage for a broader discussion on how BTK interventions have changed over the past decade. The conversation explores shifts in access strategies, procedural approaches, and the unique characteristics of calcification encountered in CLTI. Because BTK calcium differs from calcification seen elsewhere in the peripheral vasculature, imaging and device selection play a particularly important role when planning IVL-based therapies. Dr. Foley reviews the design and outcomes of the Disrupt BTK II trial, where devices such as the Shockwave M5+ and S4 catheters were used to modify calcified plaque, demonstrating encouraging safety and performance signals.

The discussion then turns to emerging technologies, including Shockwave’s Javelin catheter, designed to deliver focused pressure waves to fracture dense calcium within peripheral arteries. Dr. Foley describes how the device fits into BTK workflows, including technique considerations and its use alongside adjunctive therapies such as balloon angioplasty. The episode also addresses the ongoing skepticism surrounding IVL in BTK disease, emphasizing the need for careful patient selection, procedural precision, and continued multidisciplinary collaboration as the field works to refine treatment strategies and improve outcomes for patients with peripheral artery disease (PAD).

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TIMESTAMPS

00:00 - Introduction
08:20 - Evolution of Below-the-Knee Treatments
11:10 - Differences in BTK Calcification
13:13 - Imaging and Technology in BTK Interventions
15:18 - Disrupt BTK II Trial Data and Results
23:17 - Introduction to the Javelin Device
26:39 - Technique Considerations with Javelin
28:36 - Comparing Javelin and E8
31:17 - Future Directions for Lithotripsy Technology
35:30 - Skepticism Around IVL in BTK Disease
38:47 - Final Thoughts

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RESOURCES

Disrupt BTK II Trial
https://www.jvascsurg.org/article/S0741-5214(24)02063-9/fulltext

When standard-of-care checkpoint blockade fails in metastatic melanoma, how can oncologists and interventional radiologists join forces to turn around patient outcomes? In this episode of the BackTable Podcast, medical oncologist Dr. Jennifer McQuade and interventional radiologist Dr. Rahul Sheth join host Dr. Tyler Sandow to discuss the growing evidence for intratumoral oncolytics as a therapeutic strategy for frontline immunotherapy-refractory melanoma and the interdisciplinary work that is required for successful implementation in practice.

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SYNPOSIS

The physicians review how engineered viral vectors, particularly RP1, complement checkpoint blockade through direct tumor lysis and immune activation, and summarize the IGNYTE trial data supporting their use in patients with metastatic melanoma refractory to anti-PD-1 and anti-CTLA-4 agents. The discussion then shifts to practical administration, highlighting the central role of interventional radiology in delivering these therapies to visceral and deep-seated lesions under image guidance. The doctors go on to address the nuances of patient and lesion selection, injection technique, and response assessment, including the importance of recognizing pseudo-progression. They place particular emphasis on the need for multidisciplinary collaboration and stakeholder buy-in efforts on the part of IRs seeking to integrate intratumoral oncolytic injections into their scope of practice. The episode concludes with a forward-looking discussion on the potential for expansion of oncolytic platforms into other solid tumors, underscoring this field as a growing, IR-forward frontier in cancer treatment.

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TIMESTAMPS

00:00 - Introduction
02:28 - Immunotherapy Basics
06:51 - How Oncolytic Viruses Work
11:01 - IGNYTE Trials and Why IR Matters
18:14 - T-VEC vs RP1 Indications and Logistics
21:57 - Physician Communication and Multidisciplinary Treatment
23:06 - RP1 Protocol and Administration Techniques
30:28 - RP1 Safety Profile
32:46 - Follow-Up Imaging and Response Assessment
35:44 - Future Applications Beyond Melanoma
41:42 - Final Thoughts and Closing Remarks

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RESOURCES
Wong MK, et al. RP1 Combined With Nivolumab in Advance Anti-PD-1-Failed Melanoma (IGNYTE). J Clin Oncol. 2025;43(33):3589-3599.
https://doi.org/10.1200/jco-25-01346

IGNYTE-3 Trial
https://clinicaltrials.gov/study/NCT06264180

With data increasingly positioning thermal ablation as a viable alternative to surgery for select liver metastases, the demands on the interventional oncologist have never been higher. Mastering the nuances of patient selection and precise margin assessment is now essential for ensuring effective disease control locally. In this episode of the BackTable Podcast, interventional radiologist Dr. Jonas Redmond of UC San Diego Health joins host Dr. Sabeen Dhand to discuss the current state of microwave ablation (MWA) in the management of oligometastatic liver disease, focusing on tumor assessment, preprocedural planning, and the integration of local and systemic therapies.

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This podcast is supported by:

Varian IntelliBlate
https://www.varian.com/products/interventional-solutions/microwave-ablation-solutions

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SYNPOSIS

The conversation delves into the complexities of timing systemic versus local ablative therapies and explores questions surrounding adequate treatment margins. Dr. Redmond goes on to emphasize the need for operators to approach procedures with a high level of adaptability, advocating for interdisciplinary preprocedural planning and thoughtful modality selection. Exploring the complications that could arise from injury to adjacent viscera, the physicians speak to the critical importance of rigorous intraprocedural reassessment and discuss how modern software and robotics are transforming procedural precision and safety. Framing these MWA pearls within the context of recent clinical trials like COLLISION and ACCLAIM, the episode underscores the transition of interventional oncology from providing palliative services to increasingly curative solutions that may offer better prospects for patients with metastatic disease.

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TIMESTAMPS

00:00 - Introduction
04:30 - Role of Local Therapy in Systemic Disease
09:49 - Patient Selection and Treatment Modalities
13:15 - Challenging Lesion Characteristics and Locations
19:56 - Y-90 Radioembolization versus Microwave Ablation
23:04 - Intraoperative Ablation and Combining Locoregional Modalities
29:36 - Complications of Microwave Ablation in the Liver
36:43 - Future of Ablation and Liver Metastases Treatment
39:25 - Final Thoughts and Closing Remarks

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RESOURCES

UC San Diego Health. Cryoablation and Arterial Infusion of SD-101 in Combination with Durvalumab and Tremelimumab.
https://clinicaltrials.ucsd.edu/trial/NCT06710223

COLLISION trial
https://clinicaltrials.gov/study/NCT03088150

ACCLAIM trial
https://clinicaltrials.gov/study/NCT05265169

Better habits start now. Poor ergonomics in the angio suite lead to cumulative neck and back injuries, absenteeism, presenteeism, and even early retirement. This episode of the BackTable Podcast offers a guide on on how to improve your ergonomics in the the cath lab, featuring interventional radiologist Dr. Keith Horton and host Dr. Ally Baheti.

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SYNPOSIS

Dr. Horton and Dr. Baheti discuss common setup mistakes (especially monitor and ultrasound placement), practical positioning guidance (neutral posture, monitor height/angle, table height at elbow level), lead considerations (two-piece vs one-piece, refitting with body changes, costs vs. injury), and procedural stressors from longer, more complex cases. Horton also reviews evidence and standards (including SIR guidance), highlights surgical ergonomics programs like Duke’s education-and-leadership model with scheduled microbreaks, and describes emerging mitigations such as augmented reality guidance, robotics, and “zero-gravity” lead systems, emphasizing that strain prevention and intentional setup are essential for career longevity.

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TIMESTAMPS

00:00 - Introduction
01:43 - Defining Ergonomics
04:52 - Common Setup Mistakes
07:31 - Neutral Posture Basics
09:02 - Lead Fit And Support
12:33 - Fighting Bad Room Design
14:46 - Augmented Reality Workflow
17:11 - Leadless Shielding Options
20:53 - Repetitive Strain Tactics
25:06 - Future Tech On Horizon
27:56 - Maternity Lead Frustrations
30:22 - Why Incentives Misalign
32:45 - When Ergonomics Fails
33:59 - Duke Program Blueprint
37:02 - Tools Monitor Table Setup
39:05 - Microbreaks That Stick
42:46 - Room Setup Realities
47:08 - Reminders and Wrap Up

Prostate artery embolization may be performed by interventional radiologists, but its indications are rooted in urologic evaluation. In the second installment of our 2026 PAE University Series, Dr. Chris Beck is joined by Dr. Art Rastinehad of Northwell Health, a urologist with formal interventional radiology training, to share how his dual background informs both when to offer PAE and how to execute it thoughtfully.

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This podcast is supported by an educational grant from Guerbet.

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SYNPOSIS

Dr. Rastinehad discusses his path from urology into IR and how that combined training shapes his current hybrid practice. He outlines a practical BPH consult framework grounded in urologic evaluation, emphasizing appropriate imaging, careful patient selection, and the importance of ruling out malignancy before proceeding with embolization. From his perspective, durable outcomes begin with disciplined workup and clear counseling around expectations, including sexual side effects and alternative treatment options.

The conversation then turns to procedural strategy. Dr. Rastinehad reviews anatomic considerations, large-gland and technically challenging cases, and his experience incorporating liquid embolics into PAE. He compares glue and particles, detailing workflow decisions, medication strategy, and post-procedure management. Throughout, he highlights scenarios where PAE may not be the most appropriate intervention and how other BPH tools may better serve the patient.

The episode concludes with a discussion of the future of PAE, including questions of training, collaboration between specialties, and reimbursement; underscoring the value of cross-specialty insight in contemporary BPH care.

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TIMESTAMPS

00:00 - Introduction
01:26 - Interventional Urologist with IR Roots
04:13 - Leaving Urology for IR: Fellowship Life, Case Volume & Mentors
08:45 - Building a Hybrid Urology/IR Practice
14:32 - PAE Benefits, Sexual Side Effects & Why MRI Matters
17:39 - BPH Consult Playbook
22:17 - Anatomy Deep Dive
24:27 - Edge Cases & Big Glands
28:24 - Why Glue?
35:39 - Glue vs Particles
39:40 - Post-PAE Follow-Up
41:28 - Antibiotics and Medications
46:18 - Tough Cases
50:53 - The Future of PAE

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RESOURCES

Early Outcomes of Prostatic Artery Embolization using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Safety and Feasibility Study
https://pubmed.ncbi.nlm.nih.gov/39074551/

Dr. Rastinehad’s Website
https://drrastinehad.com/

How do experienced operators approach the most technically demanding aspects of deep venous arterialization (DVA)? In this episode of BackTable, host Dr. Sabeen Dhand sits down with Dr. Kumar Madassery for a detailed discussion of procedural strategy, technical decision-making, and real-world troubleshooting in DVA.

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SYNPOSIS

Dr. Madassery walks through his approach from pre-procedure planning to final scaffolding. The conversation begins with imaging review, patient selection, and anesthesia considerations, emphasizing how preparation influences technical success. They then examine venous mapping and access strategy, with specific attention to femoral and tibial disease patterns and how these anatomic variables shape crossing techniques.
This episode also covers wire and catheter selection, techniques for creating the arteriovenous anastomosis, balloon sizing, valve management, and stent scaffolding. Throughout, Dr. Madassery shares practical solutions to common access challenges and highlights decision points that can determine procedural durability. The discussion closes with reflections on clinical management, operator fatigue, and the value of professional networks when navigating complex limb salvage cases.

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TIMESTAMPS

00:00 - Introduction
03:08 - Pre-Procedure Imaging and Setup
05:01 - Venous Access and Mapping
07:27 - Anesthesia and Patient Preparation
12:29 - Femoral and Tibial Disease Considerations
23:17 - Crossing Techniques and Tools
27:16 - Venous Access Challenges and Solutions
35:54 - Creating the Anastomosis
37:03 - Balloon Sizing and Scaffolding Techniques
38:26 - Navigating Venous Access Challenges
39:56 - Wire and Catheter Strategies
42:08 - Dealing with Valves and Anastomosis
44:16 - Proximal vs. Distal DVA Approaches
47:01 - Scaffolding and Stent Techniques
50:06 - Clinical Management and Case Fatigue
01:01:10 - Networking and Seeking Advice
01:05:41 - Concluding Thoughts and Future Directions

Think your medical practice is safe from hackers? Learn why humans, rather than software, are often the weakest link in patient data protection. In this episode of the BackTable Podcast, host Dr. Chris Beck delves into the critical topic of cybersecurity in healthcare with Didier Jourdain, a certified Information Systems Security Professional (CISSP).

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SYNPOSIS

Didier discusses his recently approved paper, 'Cybersecurity for Interventional Radiologists: A Clinical Imperative for Protecting Patient Data and Imaging Systems,' and shares his extensive background in software and application security, penetration testing, and cybersecurity risk governance. The conversation covers key issues such as phishing, ransomware, third-party vendor risks, and the vulnerabilities of the Internet of Medical Things (IOMT). Didier emphasizes the importance of education, tabletop exercises, and comprehensive third-party risk management strategies to enhance cybersecurity resilience in both hospital systems and independent physician practices.

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TIMESTAMPS
00:00 - Introduction
04:03 - Cybersecurity in Healthcare: A Clinical Imperative
16:07 - Mitigating Cybersecurity Risks
20:23 - Password Management and Best Practices
27:33 - The Role of IT in Cybersecurity
31:04 - Internet of Medical Things (IoMT) Vulnerabilities
39:17 - Top Cybersecurity Recommendations for Physicians

How can patients receive more consistent interventional radiology care amid a national shortage of IR physicians? That question led Dr. Rick Daniels to develop a new outpatient practice model centered on recruiting independent IRs to provide long-term, fractional coverage for groups in need. In this episode of the BackTable Podcast hosted by Dr. Aaron Fritts, Dr. Daniels outlines the thinking behind this approach and how it aims to expand access to IR services in outpatient settings.

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SYNPOSIS

The conversation examines the evolving landscape of IR practice, including the challenges associated with transitioning between practice settings and building sustainable outpatient service lines. Dr. Daniels walks through the development of his model, with particular attention to identifying and supporting outpatient embolization opportunities. The discussion also explores the consortium-style structure for independent IRs, emphasizing long-term alignment, professional autonomy, and scalability at a national level. Operational considerations such as technology partnerships, documentation workflows, and targeted marketing strategies offer a practical look at what it takes to make this model work.

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TIMESTAMPS

00:00 - Introduction
03:49 - Evolution of an Independent IR Practice
05:30 - Challenges and Opportunities in Outpatient IR
09:58 - Building Service Lines and Marketing Strategies
18:34 - Forming a National IR Group
25:21 - Balancing Business and Healthcare
25:37 - Evaluating and Correcting Site Performance
28:16 - Expanding Geographical Reach
30:45 - Recruitment and Retention Challenges
38:07 - The Importance of Tech-Doc Teams
42:35 - Future Goals and Recruitment Efforts
45:58 - Conclusion