BackTable Vascular & Interventional

In this episode of the Back Table MSK podcast, Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis.---CHECK OUT OUR SPONSORStryker Interventional Spinehttps://www.strykerivs.com---SYNPOSISThe doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses.---TIMESTAMPS00:00 - Introduction02:33 - Expanding Sacroplasty Training and Curriculum04:50 - Walkthrough of Sacroplasty Technique10:36 - Mechanical Stabilization and Cement Volume21:41 - Choosing Hardware and Needle Size27:37 - Industry-Sponsored Trials and Bias32:47 - Navigating Billing and Reimbursement38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures---RESOURCESBackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures:https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fracturesSeattle Science Foundation Annual Image Guided Interventional Spine Procedures Course:https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149Dr. Doug Beall’s Twitter: @dougbeallVertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation:https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023):https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext

Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty.---CHECK OUT OUR SPONSORStryker Interventional Spinehttps://www.strykerivs.com---SYNPOSISDr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI.We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations.---TIMESTAMPS00:00 - Introduction03:01 - Sacral Fractures and Sacroplasty15:17 - Treatment Options for Sacral Fractures17:34 - Consequences of Untreated Sacral Fractures28:32 - Sacroplasty Registry and Current Research38:08 - Imaging Modalities: CT vs. Fluoroscopy40:49 - Complications of Sacroplasty: Extravasation43:21 - Bone Quality and Fracture Healing45:42 - Growing Awareness of Sacral Fractures and Treatment Options---RESOURCESSpontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982):https://pubmed.ncbi.nlm.nih.gov/7097924/Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000):https://pubmed.ncbi.nlm.nih.gov/11094996/Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019):https://pubmed.ncbi.nlm.nih.gov/31587952/Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008):https://pubmed.ncbi.nlm.nih.gov/17981097/Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017):https://pubmed.ncbi.nlm.nih.gov/29149151/Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020):https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023):https://pubmed.ncbi.nlm.nih.gov/37207812/Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019):​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx

Dr. Dylan Suttle and Dr. Harris Chengazi discuss advancements in TIPS procedures, highlighting reduced procedure time and improved outcomes with ICE and Scorpion tools. They cover challenges, stent deployment, learning curve of ICE, and future trends in TIPS procedures.

Dr. Mina Makary and Dr. Jeff Chick discuss moral injury in interventional radiology, highlighting the distinctions between burnout and moral injury in healthcare. They delve into a study on moral injury in radiology professionals, emphasizing systemic solutions and the importance of addressing external factors for healing.

Dr. Paul Lewis, an interventional radiologist, shares thoracentesis best practices including image guidance, managing complications, patient selection, procedural techniques, equipment choices, and troubleshooting tips. He highlights the efficiency of the RenovaRP Centesis System and discusses procedural nuances such as bilateral thoracentesis.

Dr. Lorenzo Patrone discusses the 'Woundosome' concept in critical limb ischemia, emphasizing the importance of understanding foot vasculature for treatment planning. He shares techniques for assessing wound perfusion and tips for below-the-ankle interventions, including using ipsilateral antegrade access and strategic contrast administration.

Vascular surgeon Dr. Nicolas Mouawad and interventional radiologist Dr. Raja Ramaswamy discuss DVT management, emphasizing mechanical thrombectomy as a superior option over thrombolysis. They highlight the importance of long-term benefits, procedure details, stent frequency, and the impact of age on treatment outcomes, revolutionizing DVT care with decreased ICU reliance and improved patient outcomes.

Dr. Jenanan Vairavamurthy, an interventional radiologist, shares about mental health struggles in the medical field. Topics include personal tragedy, creating supportive environments in medicine, navigating personal challenges, and building supportive networks. The conversation emphasizes destigmatizing mental health issues and encouraging open conversations within the medical community.

Dr. Peter Soukas discusses Percutaneous Transmural Arterial Bypass (PTAB) using the DETOUR system for complex blockages in the superficial femoral artery. Topics include patient selection, procedural details, advantages over traditional methods, training for physicians, cost considerations, and future directions of PTAB.

Dr. Marta Lobato shares advanced endovascular techniques for below the ankle interventions, emphasizing skills like telescopic and buddy needles, vasodilation, and balloon-assisted punctures. The discussion includes tips on visualizing the fifth metatarsal, accessing lateral and medial plantar arteries, and starting with simpler procedures. Dr. Lobato also mentions the role of social media in learning innovative medical practices.