BackTable Vascular & Interventional

Below the knee atherectomy is a hot topic right now in the vascular community. Why is it so controversial? Dr. Anahita Dua, vascular surgeon at Mass General, joins host Dr. Sabeen Dhand to explore the utility of this technique and the pressing need for more Level I evidence in this space.---This podcast is supported by:AngioDynamichttps://www.auryon-system.com/---SYNPOSISThe conversation dives into the controversial role of below-the-knee atherectomy in limb salvage, an area where data has long been debated. Dr. Dua, principal investigator of the AMBITION BTK Trial—the first randomized controlled trial comparing below-the-knee atherectomy to angioplasty alone—introduces the trial and explains how it fits into the current body of literature.Together, the doctors review past evidence, current practice, and the future outlook for tibial interventions. Dr. Dua outlines the wide range of techniques and clinical strategies used to manage PAD, and stresses the importance of physician engagement with the NIH and research community to establish stronger, evidence-based protocols. She also shares her candid thoughts on the most overrated and underrated devices in tibial intervention, highlighting atherectomy’s potential role in vessel preparation before below-the-knee treatment.---TIMESTAMPS00:00 - Introduction04:55 - Current State of Evidence and Challenges10:54 - Heterogeneity in PAD Treatment14:26 - Need for National Metrics and Standardization20:51 - AMBITION BTK Trial and Importance27:23 - Potential Outcomes and Implications30:18 - Trial Design34:56 - Advice for Practitioners37:36 - Underrated and Overrated Devices41:50 - Conclusion---RESOURCESAMBITION BTK Trial:https://www.angiodynamics.com/studies/ambition-btk/

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.

What does it really take to bring cutting-edge vascular care to the most underserved corners of the rural South? In this episode of the BackTable Podcast, host Dr. Ally Baheti welcomes interventional cardiologist Dr. Ash Sastry and interventional radiologist Dr. Sree Nair to discuss the financial and regulatory side of providing care to underserved rural populations in North Carolina, Virginia, and Georgia. --- SYNPOSIS The doctors delve into the operations and challenges of running an office-based lab (OBL) and the potential transition to an ambulatory surgical center (ASC). This episode covers topics like certificate of need (CON) laws, reimbursement issues, and the importance of multidisciplinary collaboration. The conversation offers insights into the practical and regulatory hurdles faced in delivering high-quality vascular care in rural settings. --- TIMESTAMPS 00:00 - Introduction02:14 - Challenges in Rural Healthcare09:00 - Understanding Certificate of Need (CON) Laws11:30 - The Financial Struggles of OBLs19:58 - Advocacy and Legislative Efforts27:53 - Future Prospects and Final Thoughts

Join Dr. Premal Trivedi, Chief of IR at the University of Colorado and an expert in interventional radiology, as he dives into the complexities of managing biliary strictures. He discusses key signs that trigger clinical suspicion and the preferred role of interventional endoscopy. You'll hear about his workup process, preferred imaging techniques, and the nuances of percutaneous transhepatic cholangiography. The conversation also highlights innovative treatment strategies and the evolution of training in interventional radiology.

Dr. Oleksandra Kutsenko, Chief of Interventional Radiology at Red Rock Radiology Associates, shares her journey from training to leadership in private equity. She discusses key differences between academic and private practice environments and the challenges of navigating a multifaceted organization. Dr. Kutsenko emphasizes the importance of skill diversification and balancing clinical work with administrative tasks. She also highlights the value of early investment in one’s career and the role of AI in enhancing radiology practices.

Dr. Keerthi Prasad, an interventional radiologist from Indiana, discusses the innovative use of resorbable embolics in musculoskeletal interventions. He shares technical insights and specific embolic agents like Imipenem and Lipiodol. Clinical experiences illustrate their efficacy in treating conditions such as knee arthritis and plantar fasciitis. Dr. Prasad emphasizes the importance of partnering with outpatient labs and encourages wider accessibility to these evolving treatments that could reshape patient care.

Dr. Zachary Berman, an interventional radiologist at UC San Diego, offers insights into pressure-enabled drug delivery for liver cancers. He explains how manipulating blood flow in tumors can optimize drug delivery, showcasing the innovative TriNav catheter's design. The discussion delves into real-world applications, including case studies of complex tumors like neuroendocrine lesions and segmental HCC. Additionally, they cover advancements in pressure-directed embolotherapy and the exciting potential future developments in enhancing treatment effectiveness.

Join interventional cardiologist Dr. Jay Mathews, with 20 years of experience in endovascular innovation, and vascular surgeon Dr. Michael Siah, Director of Limb Salvage at UT Southwestern, as they delve into cutting-edge vessel preparation techniques. They discuss advancements like bioresorbable scaffolds and the pivotal role of imaging in assessing critical limb ischemia. Listeners will learn about specialty tools like intravascular lithotripsy and the balance of treatment efficacy against device costs. Exciting emerging technologies promise to reshape their practices!

What are the key elements of a robust interventional radiology practice, and how can IRs effectively demonstrate their value to hospitals? Guest, Dr. Harris Chengazi, interventional radiologist at Great Lakes Medical Imaging, joins host Dr. Sabeen Dhand to explore the core strategies behind developing a successful and sustainable clinical IR practice. --- This podcast is supported by: RADPAD® Radiation Protectionhttps://www.radpad.com/ --- SYNPOSIS Dr. Chengazi reflects on formative experiences from the early stages of his career, highlighting the importance of joining a group that shares your vision for a clinical interventional radiology (IR) practice. He underscores the unique value IR offers hospitals—particularly through longitudinal patient care, which not only enhances reimbursement opportunities but also strengthens interdisciplinary collaboration and drives outpatient referrals.He shares insights on balancing complex cases with essential procedures, while underscoring the importance of clear communication and articulating IR’s value to hospital leadership. He also highlights the critical need for physicians to understand the business side of medicine—including coding, billing, and reimbursement—in order to effectively advocate for the specialty. He concludes the episode with a compelling message on the importance of taking ownership of both our patients and the future of our profession. --- TIMESTAMPS00:00 - Introduction and Overview01:55 - Building a Private Practice05:22 - Challenges and Successes24:58 - The Value of Complex Cases in Medical Practice27:00 - Improving Hospital Efficiency Through IR Services29:18 - Involvement of IR in Hospital Administration31:26 - Building a Successful IR Practice36:14 -The Financial Dynamics of IR and DR Practices41:14 -The Essential Role of IR in Hospital Operations

Dr. Tyler Sandow and Dr. Zach Berman, both interventional radiologists, dive into the complexities of treating metastatic diseases with Y90. They discuss the types of metastases they handle and how Y90 can alleviate tumor-related pain. Key topics include the differences between liver-dominant and liver-only conditions, advanced dosing techniques, and the significance of mutation status in treatment. They also share compelling case studies to highlight the decision-making process for various treatment strategies, ensuring improved patient outcomes.