BackTable Vascular & Interventional

Is meningeal artery embolization the key to ending the cycle of chronic subdural hematomas? In this episode of the Back Table Podcast, Dr. Paul Gullota from Ochsner Health joins host Michael Barraza to share his technical insights on middle meningeal artery embolization, including patient workup, procedure technique, and post-operative care.---SYNPOSISThe episode begins with a discussion on the evolving role of middle meningeal artery embolization in preventing chronic subdural recurrence. The doctors talk through patient selection and procedural planning for middle meningeal artery embolization, emphasizing the importance of assessing collateral pathways and hemorrhage laterality. Dr. Gullota shares his access techniques, microcatheter and embolic options, and the critical role of teamwork with neurosurgery. He also shares his approach to navigating complex vascular anatomy as well as ensuring appropriate patient follow up.---TIMESTAMPS00:00 - Introduction03:12 - Middle Meningeal Artery Embolization: Rationale and Process04:17 - Patient Evaluation and Procedure Steps06:09 - Outpatient Procedures and Billing07:06 - Candidates for Embolization Post-Evacuation07:56 - Unilateral vs. Bilateral Embolization10:34 - Procedure Techniques and Tools19:48 - Post-Procedure Care and Follow-Up21:35 - Final Thoughts and Conclusion

Dr. Matthew Givens, Chief of Interventional Radiology at the New Orleans VA and LSU Health faculty, delves into the complexities of managing type II endoleaks. He shares his first-line approach involving transarterial access via the inferior mesenteric artery and discusses techniques for embolization, focusing on the use of long soft framing coils and liquid embolics. The conversation also covers the challenges of navigating complex sac anatomy and the benefits of various access techniques, all while emphasizing collaboration with vascular surgeons.

Dr. Jonathan Paul and Dr. Osman Ahmed, experts in interventional cardiology and radiology, share insights from the recent PERT Consortium in San Diego. They delve into cutting-edge developments in pulmonary embolism (PE) treatment, including advancements in thrombectomy devices and the importance of combined therapies. The conversation also highlights their collaboration at Flow Medical, focusing on a novel device that provides real-time pulmonary artery pressure feedback. Their passion for innovation and data-driven approaches promises a transformative future for PE care.

Join Dr. Howard Chrisman, the President and CEO of Northwestern Medicine, as he shares his inspiring journey from aspiring veterinarian to a leading figure in interventional radiology. He emphasizes the crucial role of mentorship and self-awareness in healthcare leadership. Discover how he navigates the intersection of clinical and administrative worlds, addresses specialty bias, and fosters collaboration. The discussion also explores the transformative impact of AI on radiology and offers insight into the evolving roles of physicians in health systems.

Dr. Vijay Ramalingam, a vascular and interventional radiologist at Beth Israel Deaconess Medical Center, dives into managing portal vein thrombosis (PVT). He discusses the essential multidisciplinary approach to patient care, detailing workflows and decision-making algorithms for both acute and chronic cases. Dr. Ramalingam also shares his step-by-step technique for portal vein recanalization, provides insights into when to use adjunctive therapies like suction thrombectomy, and highlights early clinic data showing impactful shifts in patient management.

This week’s episode is a masterclass on vascular anomaly treatment. Brush up on your malformations with Dr. Cliff Weiss, the Director of the Vascular Anomaly Center at Johns Hopkins. He shares next-level techniques, precision diagnostics, and his 'gold standard' approach to alcohol sclerotherapy. --- This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/ --- SYNPOSIS The episode begins with the most vital component of patient care: establishing a correct diagnosis through proper classification. Dr. Weiss shares his philosophy that “MRI is a conversation” - not just an image, detailing the specific MRI protocols to confidently make a diagnosis over 90% of the time. He then shares an overview of the classification system, differentiating vascular tumors like hemangiomas from high-flow and low-flow vascular malformations. Dr. Weiss explores a wide array of treatment strategies tailored to each diagnosis. He walks through his techniques for treating low-flow malformations with sclerotherapy—using agents like alcohol, doxycycline, and bleomycin based on a lesion’s location and characteristics—and his use of cryoablation for vascular tumors. He then dives into the creative and high-stakes approaches for treating AVMs, comparing transvenous and transarterial embolization with agents like Onyx and coils, before concluding with his predictions on the future of IR in the field. --- TIMESTAMPS 00:00 - Introduction 02:36 - Vascular Anomaly Center at Johns Hopkins06:33 - Vascular Anomaly & Malformation Diagnosis with Imaging09:04 - Classifying Vascular Anomalies15:55 - Vascular Tumors18:46 - Low-Flow Malformations27:58 - Needle Placement29:56 - Retro-orbital & ENT Malformations32:44 - AVM Treatment Strategy40:41 - Following up with Patients

What happens when the doctor suddenly becomes the patient? In this episode of the BackTable podcast, host Dr. Ally Baheti interviews Dr. Nicholas Hanson, an interventional and diagnostic radiologist from Oregon, about a life-changing event that dramatically altered his career.---SYNPOSISDr. Hanson describes the circumstances surrounding a severe car accident that resulted in a traumatic brain injury and subsequent medical complications, including the discovery of a heart aneurysm. He shares the challenges of his recovery, his struggle with insurance companies, and the emotional and professional toll of his experiences. Dr. Hanson provides valuable insights into the importance of disability insurance and the often overwhelming process of navigating healthcare systems. The discussion also touches on the ongoing debate about the separation of interventional radiology from diagnostic radiology and how sudden life events can impact one's career in medicine.---TIMESTAMPS00:00 - Introduction01:19 - The Life-Changing Event09:28 - Navigating Insurance and Disability16:39 - The Future of IR and Career Advice21:50 - Struggles with Disconnection28:56 - The Road to Recovery35:20 - Reflecting on the Journey37:42 - Closing Thoughts and Future Hopes

Dr. Driss Raissi, an interventional radiologist and division chief at the University of Kentucky, shares his expertise in microwave ablation techniques. He discusses using innovative strategies to tackle various complex cases, including large liver tumors and challenging fistulas. Dr. Raissi introduces his pre-burn technique to reduce complications and reveals his 'lung seal technique' for lung ablation. He also compares microwave versus cryoablation for different tumor types, emphasizing collaboration and effective communication in optimizing ablation outcomes.

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.