BackTable Vascular & Interventional

In this episode, Dr. Rajeev Suri joins Dr. Christopher Beck to discuss ascites and paracentesis. Dr. Suri touches on what a potential paracentesis candidate might present with and speaks about why no lab values or blood tests are needed prior to the procedure. We discuss the basic steps for removing ascites, how to find the side with the biggest pocket, and preventing leakage by using a Z pattern. He speaks to the circumstances for using direct US guidance rather than intermittent and when, if ever, to use glue or stitches after paracentesis. We mention the benefits of utilizing the Renova Pump for fluid removal and discuss why Dr. Suri might use a vacuum container bottle rather than a wall suction. Lastly, we examine some methods for managing recurring patients in the ascites clinic. Dr. Suri also discusses how his practice has incorporated a paracentesis clinic to reduce the number of emergency room visits for ascites and how this practice has improved workflow and patient access to an interventional radiologist. RESOURCES MENTIONED: RenovaRP® Paracentesis Management System www.rethinkparas.com This website allows you to download the case study mentioned by Dr. Beck and check out other products from GI Supply. AASLD Guidelines https://www.aasld.org/publications/practice-guidelines This website includes the 2013 guidelines for ascites management. SIR Coagulation Guidelines https://www.jvir.org/article/S1051-0443(19)30407-5/pdf This pdf has recommendations for periprocedural management of thrombotic and bleeding risks in patients. Denver Shunts https://www.ajronline.org/doi/full/10.2214/AJR.12.9203 This article, mentioned by Dr. Suri, discusses the placement and management of Denver shunts for portal hypertensice ascites.

Building a PAD practice with Dr. Srini Tummala by BackTable

In this episode, Dr. Jafar Golzarian joins Dr. Michael Barraza to discuss genicular artery embolization for osteoarthritis. Dr. Golzarian describes how he worked and collaborated with orthopedic surgeons to offer this procedure for his patients. He also speaks about some potential underlying causes and aggravating factors for osteoarthritis. Dr. Golzarian provides useful tips on taking an academic approach to setting up trials and what makes his trials different from previous studies on genicular artery embolization. We discuss why patients with osteoarthritis can be a challenge for family practitioners and how collaboration with IR can benefit these patients. We go into the differences in the procedure for hemarthrosis and osteoarthritis. We review some ways to find the best angle to identify an arterial origin for embolization, and we discuss some of the challenges in the embolization procedure and how to adapt to different types of patients.

An Interview with Dr. David Kumpe- WAIS Series by BackTable

In this episode, Dr. Eric Monroe joins Dr. Christopher Beck to discuss using intra-arterial chemotherapy (IAC) as a treatment for retinoblastoma. Dr. Monroe touches on how he has been using telemedicine during this time and the process of considering a patient for IAC. We go over the details of the intra-arterial chemotherapy procedure and we mention some challenges that may arise in dealing with equipment for pediatric patients, specifically how to have a successful procedure while maintaining a low radiation dose. Dr. Monroe speaks about post procedural care including follow-up intervals and what those visits entail. We discuss some of the common complications that can occur during intra-arterial chemotherapy. Dr. Monroe gives some advice about the mental preparation and learning curve that comes with developing skills for IAC.

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RESOURCES MENTIONED: A Review of the Literature for Intra-Arterial Chemotherapy used to Treat Retinoblastoma https://pubmed.ncbi.nlm.nih.gov/26886915/ This is the article mentioned by Dr. Monroe which gives an overview of retinoblastoma.

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In this episode, Dr. Eric Keller joins Dr. Christopher Beck to discuss medical ethics within IR. He speaks about using a bottom-up approach of applied ethics, and we examine why a combination of casuistry and virtue ethics may be helpful rather than principlism. We dig deeper into medical futility and the challenge of prospectively determining if a procedure is futile. Dr. Keller describes how to design a study that can explore medical ethics as well as methods of collecting and presenting data in an ethical way. We discuss advanced care planning, managing bias, and the role that unbounded ethicality plays in research. We talk through some benefits and drawbacks of ethics boards as well as how using decision support aides may improve informed consent and allow patients to become advocates for themselves.

RESOURCES MENTIONED: Journal of the American Geriatrics Society https://onlinelibrary.wiley.com/action/doSearch?AllField=futility&SeriesKey=15325415 This website presents all the papers in the journal that are related to futility.

Journal of the American Geriatrics Society (Medical Futility: Where Do We Go from Here?) https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1532-5415.1994.tb06570.x This article discusses various perspectives on medical futility.

Decision Aids to Help People who are Facing Health Treatment of Screening Decisions https://www.cochrane.org/CD001431/COMMUN_decision-aids-help-people-who-are-facing-health-treatment-or-screening-decisions This article evaluates the effects of decision aids on health outcomes.

Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons https://pubmed.ncbi.nlm.nih.gov/31882313/

American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statements https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.12924 This article discusses feeding tubes and how to handle feeding for patients with advanced dementia.

The Impact of Advance Care Planning on End of Life Care in Elderly Patients https://www.bmj.com/content/bmj/340/bmj.c1345.full.pdf This article describes a randomized controlled trial that examines advanced care planning.

Does Facilitated Advance Care Planning Reduce the Costs of Care Near the End of Life? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838173/ This paper discusses the ethical conflicts in advanced care planning.

Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units https://www.atsjournals.org/doi/full/10.1164/rccm.201505-0924ST This article describes how to handle treatment disagreements in the ICU.

Research Ethics in IR: The Intersection Between Care and Progress https://pubmed.ncbi.nlm.nih.gov/32359529/ This paper mentions the ethical issues in collecting and presenting data. It also discusses the role IR plays in conflict of interest and bias.

Understanding Bias: A Look at Conflicts of Interest in IR https://www.researchgate.net/publication/332750177_Understanding_Bias_A_Look_at_Conflicts_of_Interest_in_IR This article examines conflicts of interest and how they affect the field of IR.

Reflect and Remember: The Ethics of Complications in Interventional Radiology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531013/ This paper discusses the ethics behind the relationship between IR and complications.

Informed Consent: Beating a Dead Horse or an Opportunity for Quality Improvement? https://www.researchgate.net/publication/338303598_Informed_Consent_Beating_a_Dead_Horse_or_an_Opportunity_for_Quality_Improvement This paper examines the ethical implications of informed consent and its complexities.

Reconsidering Requests - Futility in IR https://www.jvir.org/article/S1051-0443(19)30069-7/fulltext This article discusses the ethics in challenging healthcare situations.

Interventional Radiologist Dr. Jeffrey Chick tells us about his deep venous practice at UW Medicine including tips on growing a collaborative, multidisciplinary venous program.

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Interventional Radiologists Dr. Sam Mouli from Northwestern University and Dr. Sandeep Bagla discuss new research examining Y-90 Radioembolization as a novel therapeutic option for treating prostate cancer.