BackTable Vascular & Interventional

In this episode, Dr. David Field joins Dr. Aaron Fritts to discuss nephrostomy tube placement. We talk about the most common indications for this procedure, and Dr. Field explains why he prefers the single stick technique over the double stick technique. We discuss why it is important to scan the patient with ultrasound before preparing them for the nephrostomy tube placement. We give some tips for trainees on the process of inserting the needle, and we review the dangers of over-pressurizing. We discuss how much blood in the urine is worrisome, managing anticoagulation meds, and which labs to run prior to the nephrostomy tube placement. Dr. Field tells us about using guidance software and how to properly direct the needle, once inside the patient. We discuss why you might inject air rather than contrast. We emphasize the importance of working with urology ahead of time and what post-op care looks like for different types of patients. Dr. Field gives some advice when dealing with the challenges of nephrostomy tube placement, and we give trainees some general advice on this procedure.

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/r2AlYc

RESOURCES MENTIONED: Nephrostomy Tube Placement Procedure https://www.backtable.com/app-procedure/nephrostomy-tube-placement

In this episode, Dr. Matt Raynor and Dr. Ari Isaacson join Dr. Michael Barraza to discuss their prostatic artery embolization (PAE) program. They tell us about their new book and how they worked with IR and urology to build their program. We discuss how they got started with their first patient and explain when to follow up with PAE patients. We talk about the initial challenges of starting the PAE program, and we discuss what type of patients would be good candidates for the procedure. Dr. Raynor and Dr. Isaacson give us some advice on how to make a pitch to Urology practices that treat benign prostatic hyperplasia (BPH) patients. We discuss how IR and urology departments can collaborate and how to work with physicians who are skeptical. We examine how they approach the market for this procedure and why word-of-mouth from previous patients is so important. We emphasize learning the technique of the prostatic artery embolization, but also why interventional radiologists should learn about BPH disease process in detail. RESOURCES MENTIONED: Prostatic Artery Embolization https://www.amazon.com/Prostatic-Artery-Embolization-Ari-Isaacson/dp/3030234703/ref=sr_1_1?dchild=1&keywords=prostatic+artery+embolization&qid=1606166571&sr=8-1 This is the book by Dr. Raynor and Dr. Isaacson about PAE in IR. BackTable Podcast episode 17: Prostate Artery Embolization with Dr. Ari Isaacson and Dr. Sandeep Bagla https://www.backtable.com/podcast/17/prostate-artery-embolization Check out another episode about PAE with Dr. Isaacson!

In this episode, Dr. Brinton tells us how he started as a biomedical engineer and why he eventually went to medical school. We discuss how important mentorship can be, and we talk about how he was able to balance residency with building a company. Dr. Brinton shares some of the biggest lessons he has learned while being an innovator, and he discusses the goals of his company, Shockwave. We talk about the importance of understanding the patient population and some of the technical challenges of creating solutions to healthcare problems. We speak about Dr. Brinton’s position as the Fellowship Director of BioDesign at Stanford, and how he worked to train the next generation of innovators. We review the importance of needs driven innovation in medicine and how to keep the patient at the center of the innovation process. We discuss the importance of having a creative, multidisciplinary team behind an invention. We share some advice for physicians wanting to get started in needs driven innovation and explain when to file for intellectual property. Dr. Brinton explains why it can be important to “fail often and fail fast.”

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/oaB26u

In this episode, Dr. Douglas Beall joins Dr. Michael Barraza to discuss innovation in spine interventions. Dr. Beall tells us how he got his training in spine interventions and shifted to a more clinical approach. We talk about how following patients longitudinally can help determine the true source of pain, and the benefit of implementing new methods into a practice. We discuss what the term interventional radiologist really means and the importance of diagnostic input. We discuss an example of an out of the box spine intervention that helped a patient. Dr. Beall speaks about his new book that came out earlier this year and how it is different from other textbooks and how he has been using Twitter to give tips and tricks. We talk about how this inspired Dr. Beall to re-start a fellowship training program for spine intervention. We discuss studies and trials that were done on vertebral augmentation, and we examine the relationship between the name and value of interventional radiology. We touch on some goals for AI use in spine interventions and its impact on diagnosis and treatment.

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/BiMwPv

RESOURCES MENTIONED: Book by Dr. Beall: Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation https://www.amazon.com/gp/product/B0856PWC7G/ref=dbs_a_def_rwt_hsch_vapi_tkin_p1_i0 Check out Dr. Beall on Twitter @dougbeall

In this episode, Dr. Fadi Saab joins Dr. Sabeen Dhand to discuss deep venous arterialization for critical limb ischemia. Dr. Saab explains how gained experience in this procedure and the changes in treatment of CLI that have occurred over the past few years. We discuss the concept of deep venous arterialization and some common patient concerns. We talk about working as a team with podiatrists and wound care specialists, who the best candidates for deep venous arterialization are, and Dr. Saab explains the term “white stop sign.” We discuss the setting of these procedures and why having the right support staff throughout the case is so important. We examine the technique and steps of the deep venous arterialization procedure, as well as potential pitfalls to avoid. Dr. Saab describes his protocol for post-procedure care, and we discuss how technology has impacted this field in recent years. RESOURCES MENTIONED: https://www.iset.org/ Use the discount code (BACKTABLE) to register for ISET. CLI Fighters Global Society https://www.cliglobalsociety.org/

In this episode, Dr. Justin Lee joins Dr. Christopher Beck to discuss hepatocellular carcinoma (HCC) and interventional oncology in private practice. Dr. Lee tells us how he frames his HCC patients and works with medical oncologists for treatment plans and procedures. We talk about the importance of IR bringing cases to the tumor board, the evolution of cases involving ablation, and why Dr. Lee started moving towards radioembolization (Y90). We review how to approach HCC cases while working with medical oncologists. We examine the differences between using resin and glass for radioembolization and when they should be used. Dr. Lee shares why IR should start looking into arterial drug delivery for immunotherapies. RESOURCES MENTIONED: NEJM: Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma https://www.nejm.org/doi/10.1056/NEJMoa1915745 This paper, mentioned by Dr. Lee, discusses the third phase of an HCC trial.

In this episode, Dr. Justin Lee joins Dr. Christopher Beck to discuss interventional oncology in private practice. We talk about challenges that come with developing a private practice, the transition from academics to community hospitals, and how to be comfortable speaking the language of oncologists. Dr. Lee emphasizes why it is important to come out of a fellowship knowing the latest information in the field, and we cover some important details regarding scheduling oncology patients. We discuss ways to build physician-physician relationships when it comes to referrals and why it is important to remember that not everyone knows what an interventional radiologist is or the services they might offer. Dr. Lee mentions how he made adjustments at his private practice to maintaining a healthy conversation between diagnostic and interventional radiology.

In this episode, Jill Sommerset joins Dr. Mary Costantino to discuss how she developed Pedal Acceleration Time (PAT) for limb salvage. She begins by talking about what got her into vascular ultrasound and the importance of vascular techs, especially for pre-operative planning. We discuss how she invented the pedal acceleration time technique by tracking data from foot scans. Jill speaks about PAT classifications and how they correlate to ABI (Ankle-Brachial Index) numbers. We talk through how they use pedal acceleration time on a typical day and for some different types of patients. We go over some of the limitations of PAT and some of the cases where it is extremely helpful. Jill discusses her role in the cath lab, how she is developing a platform for pedal acceleration time training, and why it is important for both the physician and vascular tech to learn about PAT. RESOURCES MENTIONED: International Symposium on Endovascular Therapy www.iset.org Use the discount code (backtable) to register for ISET.

In this episode, Dr. Theodosios Bisdas joins Dr. Aaron Fritts to discuss online education and his e-learning platform, Vascupedia. Dr. Bisdas talks about how he started the platform and the three main parts of the website: main arena, polling station, and exhibition area. We talk about how social media has helped expand his platform to American audiences and how to collaborate with companies and medical societies to present new devices. We go over some of the main challenges of e-learning and why it is important for physicians to have time to watch webinars. Dr. Bisdas emphasizes the value of virtual learning, having forums for international conversation, and he speaks about his hopes for the future of Vascupedia. We discuss the benefits of on-demand, high quality online content and the importance of platforms created by physicians for physicians.

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/jGVeCR

RESOURCES MENTIONED: Vascupedia https://vascupedia.com/ This website contains the online learning platform mentioned by Dr. Bisdas.

In this episode, Dr. Rajeev Narayan joins Dr. Achal Sahai to discuss structural heart disease and the (Transcatheter aortic valve replacement) TAVR procedure. Dr. Narayan talks us through what an average working week looks like and speaks to the importance of having a great referral network. We define structural heart disease and discuss the development of the TAVR procedure for high risk patients and how the process is different from a regular cardiac surgery. We examine what can make a patient with structural heart disease high risk and eligible for TAVR. We talk through how access has changed over the years and some of the more technical aspects of these procedures. Dr. Narayan gives some advice to trainees and emphasizes the importance of learning to face complications on your own.

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/scgy25