Dr. Marcelo Guimaraes discusses the use of radiofrequency wires for sharp recanalization, including indications, workup, and alternative options. He also talks about the evolution of the Sniper technique, importance of cone-beam CT, application of IVUS, and future non-vascular applications. Tips for avoiding unfavorable outcomes and caution against using the Sniper technique in the office-based lab are shared.

In this episode, host Christopher Beck discusses the current landscape of IR training with Dr. Neil Jain, a fourth-year IR/DR resident at Georgetown University. Neil, who attended medical school in New Jersey, discusses his early desire for a diverse medical career encompassing clinical work, innovation, and mentorship.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---SHOW NOTESTo start the episode off, Neil offers valuable advice on when to decide on interventional radiology as a career path. He emphasizes that the ideal timing varies based on one's portfolio, but he personally found his passion for IR during his first year of medical school, which facilitated building meaningful connections early on.The conversation then explores the different pathways to entering the field of interventional radiology, including integrated, ESIR, and classic routes. Neil provides insights into the pros and cons of each pathway, shedding light on the evolving landscape of residency applications.We then delve into the changing dynamics of application processes, as Neil discusses the nuances of the recent changes and how students can strategically navigate them. He introduces the concept of "signaling" features, gold and silver star preferences, and the importance of proper program selection when applying to IR residency.Neil also offers guidance on away rotations, emphasizing their significance for students aspiring to match into competitive IR programs. He underscores the dedication to IR as a crucial factor in securing a match. Another key factor is mentorship, and Neil highlights how peer and attending mentors as well as the resources provided by the Society of Interventional Radiology (SIR) can play an enormous role in matching into IR.The discussion then shifts to the virtual residency application process, with Neil offering valuable do's and don'ts for applicants. He underscores the importance of creating a proper environment and engaging in hobbies during virtual interviews. He also provides valuable advice on preparing for common interview questions, encouraging applicants to build compelling stories that showcase their clinical understanding.As the field of interventional radiology continues to evolve, Neil emphasizes the importance of staying informed and maintaining close connections with mentors and resources like SIR.

The podcast discusses transverse sinus stenting for idiopathic intracranial hypertension. Topics covered include patient population, meticulous preparation imaging, diagnostic angiogram, pressure measurements, Plavix usage, treatment options, managing pain post-procedure.

Dr. Minhaj Khaja, Clinical Professor of Radiology and Cardiac Surgery, discusses topics such as deep venous disease, complex cases, anticoagulation, types of stents, crossing devices, and treating inflow. He also talks about using arterial re-entry devices and radiofrequency wires for crossing occluded stents, as well as the new RevCore mechanical thrombectomy device. The episode concludes by highlighting components of good patient follow-up.

In this episode, host Dr. Aaron Fritts interviews Dr. Maureen Kohi and Dr. Niten Singh on the VIVA Foundation’s multidisciplinary approach to advancing vascular medicine.---CHECK OUT OUR SPONSORSMedtronic ClosureFasthttps://www.medtronic.com/closurefast6fPhilips Image Guided Therapy Devices Academyhttps://resource.philipseliiteacademy.com---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/PO5TFV---SHOW NOTESMaureen is an interventional radiologist and Professor and Chair of the Department of Radiology at University of North Carolina - Chapel Hill. Niten is a vascular surgeon and Associate Chief of Vascular Surgery at University of Washington. Both serve on the board of directors at VIVA.We begin with how Maureen and Niten became involved at VIVA. They discuss the history and foundations of VIVA. The duo goes on to describe how VIVA has evolved throughout the years. Maureen speaks on how VEINS has become a comprehensive educational meeting for all things venous disease and interventions, which complements VIVA’s arterial focus.Niten and Maureen then explain how VIVA and VEINS have become more than just meetings. They are conglomerates of multiple initiatives for all things vascular driven by the central question of “What is best for the patient?” The duo also sheds light on the unique inner-workings of VIVA, highlighting the foundation’s speedy, nimble, and inclusive approach to the rapidly advancing landscape of vascular and endovascular surgery.We get a special look of what to expect at VIVA & VEINS Annual 2023 Conference at Wynn Las Vegas (October 28th - November 2nd) from Niten and Maureen. We conclude this episode with Maureen and Niten’s thoughts on how we can improve vascular care for our underserved patient populations and what role OBLs will play in this equation going forward.---RESOURCESVIVA 2023 Annual Conference Registration:https://viva-foundation.org/viva-programmingVEINS 2023 Annual Conference Registration:https://viva-foundation.org/veins-programmingVIVA Vascular Leaders Forum on Paclitaxel Safety (2019):https://evtoday.com/articles/2019-mar/highlights-from-the-viva-vascular-leaders-forum-on-paclitaxel-safety

In this episode, host Dr. Aaron Fritts and Dr. Krishna Mannava engage in a discussion with Dr. Bret Wiechmann about a concerning trend in the field—insurance denials for critical limb ischemia (CLI) interventions.---CHECK OUT OUR SPONSORPhilips SymphonySuitehttps://www.philips.com/symphonysuite---SHOW NOTESBret is an IR in Gainesville, Florida with over 26 years of experience and is one of the founders of the Outpatient Endovascular & Interventional Society (OEIS). OEIS was started 10 years ago to advocate for the viability of non-hospital IR services.We start the episode with Bret sharing his staff’s firsthand encounters with pre-authorization challenges for atherectomy procedures.The panel discusses how the recent inflammatory NY Times article regarding the use of atherectomy to treat peripheral artery disease has exacerbated these challenges. The doctors delve into the perplexing use of non-scientific articles as evidence by insurance companies, which are often influenced by third-party recommendations. The disconnect between insurance decisions and patients' actual needs becomes evident, as peer-to-peer reviews usually involve physicians unfamiliar with the specific medical speciality.Next, we explore strategies for navigating the intricacies of insurance approvals, a particularly challenging task as each insurance company has its unique set of requirements for procedure coverage. Evaluating these requirements for each patient not only limits the capabilities of the physician, but also decreases the quality of the patient's care. One strategy that is discussed is compiling a list of different payers and their specific requirements for each procedure, but this takes away valuable time away from a patient’s care. Another strategy includes the intriguing notion of physicians noting the names of insurance companies and peer reviewers on medical records as reasons for denying certain procedures. While promising, the effectiveness of this approach remains uncertain. Furthermore, the episode contemplates the possibility of refusing to work with insurance companies that consistently denying coverage— a bold strategy that warrants careful consideration as it may drop patient volumes.To combat the rising tide of insurance denials, the discussion emphasizes the pivotal role played by organizations like OEIS. It highlights the importance of involving referring physicians in various specialties, patients themselves as well as industry stakeholders manufacturing relevant devices to bring about meaningful change in the insurance approval process.---RESOURCESNew York Times Article:https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.htmlOEIS:https://oeisweb.com

In this episode, host Dr. Aaron Fritts interviews Dr. Aaron Kovaleski on good old-fashioned TV and radio marketing. Aaron is an interventional radiologist and founder of Endovascular Consultants of Colorado, who has found success in using tried and true methods of advertising to grow his practice.---CHECK OUT OUR SPONSORPhilips SymphonySuitehttps://www.philips.com/symphonysuite---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/pL6Ay0---SHOW NOTESWe begin with Aaron’s initial dive into marketing, tips that he learned, and surprising discoveries during this endeavor. He discusses differences between TV and radio advertising and ideal promotions to run through each medium. He also notes the importance of supplementing these strategies with a physical presence.Aaron also shares advice for building a marketing budget. He breaks down categories and percentage of funds invested towards his OBL’s TV and radio outreach. Aaron then speaks on how his practice measures the success of their efforts through analytics provided to them by TV and radio stations and CRM technology. We also discuss the time investment and step-by-step approaches for newer OBLs that are new to marketing outreach.We conclude this episode with future directions for marketing and a shoutout for next year’s Outpatient Endovascular and Interventional Society (OEIS) Annual Meeting in Las Vegas (April 25th-27th, 2024), which will have a dedicated session on marketing and practice building led by Aaron.---RESOURCESOutpatient Endovascular and Interventional Society (OEIS) Annual 2024 Meeting:https://oeisweb.com/meetings/2024-annual-meeting/

In this episode, host Aaron Fritts is joined by Teri Yates, CEO of Accountable Physician Advisors, who offers essential guidance for successfully establishing and managing Office-Based Labs (OBLs).---CHECK OUT OUR SPONSORSAccountable Physician Advisorshttp://www.accountablephysicianadvisors.com/Philips SymphonySuitehttps://www.philips.com/symphonysuite---SHOW NOTESTeri started a consulting company after working as a quality and risk officer at a radiology practice for 18 years. As the company rapidly grew, she has worked with many different physician practices and specialities.We start off the discussion by identifying key pitfalls that Teri sees in OBL ventures. First, it is common for physicians to conduct inadequate due diligence about referral sources, which can be a barrier to effective marketing and patient acquisition. Also, it is common for founders to lack a detailed revenue model or a plan for the business. Oftentimes, they will underestimate the capital needed to start the OBL and lack a clear idea about the types of procedures and patients they are catering towards. Another pitfall is not realizing the amount of time investment required. Teri estimates that approximately 10% of a physician's time will be needed to manage the OBL and it is important to take this into account. Finally, a common error is initially hiring individuals not qualified to be administrators, such as family members or trusted individuals.Teri also highlights some of the major reasons physicians consult her company. These challenges often revolve around "people problems," encompassing issues related to both administrative difficulties and employee management. Staffing and retention problems, leading to a significant turnover of employees, are common concerns. She underscores the importance of addressing issues related to physicians themselves, emphasizing that partners must set the tone for the culture within a company. Patient turnover efficiency in OBLs is also a recurring issue. Teri's advice for this issue to closely follow a few patients throughout their entire visit. This will most likely uncover redundancies in the patient experience, many of which the staff might already be aware of, but hesitant to communicate to leadership.As Teri reflects on her experiences, she notes that it typically takes 6-9 months to fully construct and operate an OBL. A comprehensive understanding of healthcare regulations in each state is crucial in the initial development stages.---RESOURCESAccountable Physician Advisors:https://www.accountablephysicianadvisors.com/

En este episodio de BackTable, la Dra. Sara Lojo Lendoiro entrevista a la Dra. Eva Criado, radióloga intervencionista del Hospital Parc Taulí de Sabadell, Barcelona, sobre el manejo de las estenosis benignas en vía biliar y los stents biodegradables.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/zVailz---SHOW NOTESEn primer lugar la Dra. Criado explica la clasificación de las estenosis biliares y las diferentes etiologías de las estenosis benignas, como causas iatrogénicas, procesos autoinmunes, inflamatorio-infecciosos, isquémicos o post-transplante hepático. Es crucial saber reconocer este tipo de estenosis y diagnosticar su etiología, ya que su no reconocimiento, o su tratamiento inadecuado deriva en complicaciones con riesgo vital para los pacientes. Las pruebas de imagen como la ecografía, el TC o la RM y colangioRM juegan un papel importante para la detección de estenosis biliares, su precisión diagnóstica y por tanto para su manejo y la planificación prequirúrgicaA continuación la Dra. Criado resume las diferentes alterativas terapéuticas para la estenosis biliar benigna, como la cirugía y los tratamientos mínimamente invasivos, tanto endoscópicos como percutáneos, como son la dilatación y la colocación de stents. Ella enfatiza que la decisión sobre qué método utilizar debe de ser valorada de manera individualizada en función de la etiología, tipo y localización de la estenosis y factores de riesgo de cada paciente. Ambas doctoras destacan el hecho de que no existen unas guías de consenso entre las distintas sociedades que faciliten el manejo estandarizado con protocolos para el manejo de esta patología, lo cual sería muy Valioso.Adicionalmente, la Dra. Criado explica las posibilidades terapéuticas que ofrece la radiología intervencionista: la bilioplastia percutánea o dilatación, así como sus resultados y complicaciones, como la alta tasa de re-estenosis. Posteriormente pasa a evaluar los distintos tipos de stents, y específicamente los stents biodegradables, comentando las tasas de éxito técnico en su colocación, su permeabilidad primaria y la baja tasa de complicaciones que han demostrado en estudios multicéntricos a largo plazo, uno de los cuales es el registro Biella, un registro multicéntrico en el que han participado 11 centros españoles. También realiza un resumen de los diferentes tipos de stents biodegradables que hay hoy en día en el mercado y comenta las principales características mecánicas de los mismos.La Dra Criado concluye el episodio comentando su experiencia personal en el tratamiento de estenosis biliares benignas con stents biodegradables dando una serie de consejos prácticos para la liberación de estos stents y para prevenir complicaciones, así como las principales contraindicaciones y el tipo de seguimiento recomendado. También destaca la importancia de valorar cada caso individualmente y tomar decisiones bajo el marco de un equipo multidisciplinar. Finalmente comparte sus predicciones para el futuro de los stents biodegradables.

Dr. Sean Lyden, vascular surgeon and Chairman of Vascular Surgery at Cleveland Clinic, discusses the breakthrough therapy of percutaneous transarterial bypass (PTAB) for treating occlusive/stenotic superficial femoral artery (SFA) disease. They cover the DETOUR trials, DVT and PE risks, patency of femoral vein following DETOUR intervention, and future directions of the FDA-approved DETOUR device.