BackTable Vascular & Interventional

When cancer spreads to the brain, what is the best approach: immediate local treatment or systemic immunotherapy first? Part two of the 2025 NSCLC Creator Weekend™ series focuses on a complex case involving a 75-year-old woman with a history of breast malignancy, presenting with new dyspnea and a large mass in the left lower lobe. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS Our mock tumor board consists of surgeons, medical oncologists, and radiation oncologists to deliberate and determine the best treatment plan. The specialists explore diagnostic and treatment options, including neoadjuvant chemoimmunotherapy, invasive mediastinal staging, and the potential for surgical resection or radiation therapy. --- TIMESTAMPS 00:00 - Introduction05:01 - Approach to Isolated Brain Metastasis09:09 - Radiation Therapy Considerations12:06 - Imaging and Follow-Up Strategies14:39 - Resectability and Surgical Decisions19:10 - Conclusion --- RESOURCES PACIFIC Clinical Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1709937

Dr. Miguel Montero-Baker and Dr. Lucas M Ferrer Cardona, innovative vascular surgeons, dive deep into the transformative technique of deep venous arterialization (DVA). They share personal insights on its evolution and the hybrid approaches that enhance outcomes. Discussions include the significance of patient selection and the role of family support in successful limb preservation. They also explore new devices like the Aveera Boomerang and the future of DVA, emphasizing ongoing research to refine these life-saving methods.

Dr. Karen Reckamp, a thoracic oncologist, joins Dr. Alan Lee, a radiation oncologist, Dr. Scott Atay, a thoracic surgeon, and Dr. Scott Oh, an interventional pulmonologist, for a rich discussion on lung cancer management. They explore the dynamics of tumor boards, emphasizing collaborative decision-making and the benefits of hybrid meetings post-COVID. The panel dives into the significance of tissue diagnosis, mediastinal staging, and the evolving role of ablation therapy, highlighting challenges and strategies in treating early-stage and metastatic lung cancer.

As breast imaging is becoming increasingly sensitive, is cryoablation the next frontier for treating small cancers or patients who are poor surgical candidates? Learn from expert Dr. Robert Ward, associate professor and program director of the Breast Imaging Fellowship at Brown University as he provides a contemporary overview of the innovative field of breast cryoablation. --- SYNPOSIS Dr. Ward shares his journey to becoming an expert in breast cryoablation, from his start in residency to his well-developed service line today. He details his experience enrolling patients in the FROST Trial, which is investigating the role of breast cryoablation as an alternative for surgery in patients with early stage invasive breast cancer. The conversation also covers the intricacies of the procedure, patient selection criteria, pre- and post-procedural care, and the significance of receptor positivity and clinical markers in treatment choices. Dr. Ward talks through the challenges in needle positioning prior to ice ball formation and the possibility of treating tumors close to the skin surface given appropriate wound care. The discussion concludes with a future look at how cryoablation could change the current paradigm of breast cancer care. --- TIMESTAMPS 00:00 - Introduction 01:39 - The Rise of Breast Cryoablation06:40 - Challenges and Considerations in Cryoablation07:59 - Patient Referral and Evaluation Process13:35 - Equipment and Techniques for Cryoablation23:29 - Procedure Steps and Needle Positioning26:11 - Post-Procedure Thawing and Patient Expectations28:35 - Post-Procedure Care and Follow-Up34:20 - Future of Cryoablation in Breast Cancer Treatment38:01 - Conclusion --- RESOURCES FROST Trialhttps://clinicaltrials.gov/study/NCT01992250 Brown et al., Strategies to Optimize Success in Breast Cancer Cryoablation, Journal of Vascular and Interventional Radiologyhttps://pubmed.ncbi.nlm.nih.gov/41083146/

Dr. Juan Camacho, an interventional radiologist from Sarasota, discusses the innovative technique of thyroid artery embolization and its transformative role in thyroid cancer care. He shares insights from his multidisciplinary program at Memorial Sloan Kettering, emphasizing collaboration and patient selection criteria. Key procedural techniques, including catheter choice and the use of cone-beam CT for precision, are explored. Dr. Camacho also highlights remarkable outcomes, including significant reductions in thyroid volume and improved patient quality of life, with low rates of hypothyroidism.

Dr. Alex Lam, an assistant professor at UCSF specializing in interventional radiology, dives into bronchial artery embolization techniques and outcomes. He highlights the key factors for successful procedures, including patient evaluation and understanding causes of bronchial artery hypertrophy like tuberculosis and malignancy. Dr. Lam shares tips on catheter selection, the advantages of using glue over traditional particles, and how to manage complications effectively. With a success rate of over 90%, he emphasizes the importance of teamwork and detailed pre-procedure preparations.

With the annual trend of fluctuating reimbursement rates, have you been on the fence about turning your OBL into an ASC? Make sure your OBL is prepared for the surprising changes in coding coming in 2026. In this episode, Dr. Mary Costantino partners with fellow OBL owner Dr. Goke Akinwande and revenue cycle management expert Laurie Bouzarelos to review the new CPT code changes and how they translate to OBL and ASC reimbursement.---SYNPOSISDr. Akinwande discusses many positive takeaways after diving into the recent Medicare documents, and highlights key shifts. He believes these changes to add-on codes and territories means one thing: CLI is being heard. The upcoming code changes improve delineation of vascular territories, differentiating between "simple" (stenosis) and "complex" (CTO) procedures. These changes are aimed at rewarding physicians performing the difficult CLI work while decreasing reimbursement for more straightforward cases.Beyond the CPT code specifics, the conversation also covers real-world implications for OBL owners. Dr. Akinwande explains why these changes might narrow the reimbursement gap between OBLs and ASCs, prompting him to warn against ASC conversion. Laurie Bouzarelos provides guidance on implementation, stressing the importance of updating charge masters, reviewing payer contracts for "gap fill" clauses, and monitoring payments once the new codes go live. The episode ends with a discussion on obstacles in billing, collections, and the need for physicians to master the business side of their practice to ensure financial success.---TIMESTAMPS00:00 - Introduction04:37 - 2026 CPT Changes Overview07:18 - Simple vs. Complex Codes13:16 - Key Add-on Codes19:52 - OBL vs. ASC Conversion?24:56 - IVL Reimbursement Trends29:18 - Update Your Charge Master41:41 - Pricing & Medicare Year46:39 - Billing & Collections Reality

Dr. Paul Gulotta, a Neurointerventionalist at Ochsner Health, shares his expertise on middle meningeal artery embolization, a procedure aimed at preventing chronic subdural hematomas. He discusses the importance of patient selection, assessing vascular anatomy, and collaborative approaches with neurosurgery. Gulotta also explains various technique choices for embolization, such as unilateral vs. bilateral strategies, and highlights vital post-procedure care and follow-up protocols. Insightful tips on anesthesia, particle selection, and monitoring shed light on this complex medical area.

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.