BackTable Vascular & Interventional

Is microwave ablation only for simple liver tumors, or can it be a versatile ‘Swiss Army knife’ for a wide range of complex cases? In this episode, Dr. Driss Raissi of the University of Kentucky returns to BackTable to join host Dr. Chris Beck for a deep dive into advanced and unconventional microwave ablation techniques. They cover strategies for tackling a wide range of cases, from desmoid tumors to enterocutaneous fistulas.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Raissi shares his ‘pre-burn’ technique that desiccates tissue and reduces complications like capsular burst and bleeding. He elaborates on his method for tackling large liver tumors with a single probe through overlapping ablations, needle placement techniques and his ‘lung seal technique’ to prevent pneumothorax. Dr. Raissi also shares how his previous experience in the ICU promotes close communication with anesthesiologists and how he ups his ablation game through collaboration, optimizing conditions for safe and effective ablation.The episode explores a series of unique, real-world applications beyond the usual scope of IRs. Dr. Raissi walks us through his novel approach to challenging cases, including cauterization of enterocutaneous fistulas, endometriomas and desmoid tumors. He also compares using microwave or cryoablation for renal cell carcinoma, explaining thought processes based on lesion location and the need for speed and simplicity. The discussion provides an overview of ablation physics and careful techniques that expand treatment possibilities for IR patients.---TIMESTAMPS00:00 - Introduction 04:08 - Advanced Techniques for Liver Tumor Ablation06:06 - Pre-Burning Ablation and Ablating a Range of Lesions16:38 - Lung Ablation22:00 - Partnering with Anesthesia28:53 - Managing Postoperative Pain and Nerve Injuries29:42 - Treating Enterocutaneous Fistulas, Endometriomas & Desmoid Tumors38:49 - Adrenal Gland Ablation: A Case Study44:50 - Microwave vs. Cryoablation for Renal Cell Carcinoma49:06 - Preventing Pneumothorax in Lung Ablation

Dr. Ahsun Riaz, an interventional radiologist at Northwestern University, specializes in hepatobiliary services. In this discussion, he shares insights on managing biliary strictures using innovative techniques like endoscopic evaluation and radiofrequency ablation. He emphasizes the importance of distinguishing between benign and malignant conditions and outlines practical tips for biliary drain management. Riaz also highlights collaborative approaches to enhance patient care and improve long-term outcomes, ensuring comprehensive follow-up and minimizing drain duration.

Dr. Ryan Trojan, an interventional radiologist at INTEGRIS Health, discusses his transition from a blended practice to hospital employment, highlighting the financial and administrative challenges involved. He emphasizes the importance of demonstrating interventional radiology's value to hospital leadership, from reducing patient stays to enhancing trauma services. Ryan also explores contract structures, advocating for salary models that support lower RVU work. With insights on job satisfaction and growth in IR services, he offers practical advice for those considering a similar shift.

Join Dr. Clifford Weiss, a pioneering radiologist from Johns Hopkins, and Dr. David Woodrum, an innovative interventional radiologist at Mayo Clinic, as they dive into the future of MRI-guided interventions. They discuss the powerful imaging advantages of MRI, including reduced radiation exposure and superior targeting for ablations. The duo also tackle the significant tech challenges facing adoption and explore the evolving landscape of hybrid MR facilities. With insights for young physicians, they highlight exciting training opportunities in this cutting-edge field.

The hosts dive into innovative techniques shared in a recent tips and tricks competition, showcasing accessibility in interventional radiology. They explore advanced urological catheterization methods, peppered with humor and personal experiences. The discussion on direct portal access for TIPS procedures highlights its benefits over newer approaches. Practical tips to navigate challenging liver procedures are shared, along with creative access techniques to enhance patient comfort and procedural efficiency. Listener engagement is celebrated throughout, enhancing the community spirit.

Join interventional radiologists Dr. Omar Chohan and Dr. Harris Chengazi as they explore the evolving role of mesocaval shunts for managing portal hypertension. They discuss patient selection, highlighting challenging cases like autoimmune hepatitis and pancreatic cancer. The conversation dives into meticulous planning using advanced imaging tools like the 4D CT scanner and emphasizes the importance of compassion in patient care. These experts share insights on overcoming procedural challenges to improve quality of life for their patients.

What does it really take to break away from the hospital system and build your own interventional radiology practice?---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISIn this episode, host Dr. Ally Baheti interviews Dr. Kartik Kansagra and Dr. Harout Dermendjian, independent interventional radiologists from California and founders of EVS LA. They share their journey in establishing and growing an independent IR practice, discussing their training at Kaiser Sunset, the steps they took to develop their own practice, and the challenges they faced along the way. Emphasizing the importance of training, clinician communication, and balancing inpatient and outpatient services, they offer valuable insights and advice for new IR professionals considering a similar path.---TIMESTAMPS00:00 – Introduction and opening remarks01:23 – Early training and transition08:54 – Clinical vs. non-clinical IR practice differences13:05 – Achieving parity with other interventional specialties17:47 – Building insurance contracts and following up with patients24:31 – Setting boundaries and documenting clinical decisions34:32 – Final advice and closing words from the guests

Dr. Anahita Dua, a vascular surgeon at Mass General and principal investigator of the AMBITION BTK Trial, dives into the complexities of below-the-knee atherectomy. She discusses its controversial role in limb salvage and the urgent need for Level I evidence. The conversation highlights the challenges of standardizing treatments for peripheral artery disease and the significance of cohesive strategies in clinical practice. Dr. Dua also shares insights on the overrated and underrated devices in tibial interventions, emphasizing the potential of atherectomy in vessel preparation.

Dr. Wayne Olan, an Interventional Neuroradiologist and Director of Minimally Invasive Neurosurgery at George Washington University, shares invaluable insights. He discusses the historical evolution of carotid artery stenting and how modern techniques have transformed the field. Dr. Olan highlights the importance of meticulous planning and the role of antiplatelet therapy, especially for Plavix non-responders. He also explores innovations like the Contego stent system and the future of outpatient carotid stenting, emphasizing the need for continuous adaptation in medical practices.