BackTable Vascular & Interventional

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Thomas Sullivan about the findings from a recent survey exploring the reasons behind professional job changes among interventional radiologists. Dr. Sullivan is the Assistant Program Director of Diagnostic and Integrated Interventional Radiology Residency programs at Wake Forest University.Dr. Sullivan highlights the importance of mentorship during residency and notes the huge impact of geography and financial compensation in determining job satisfaction and longevity in a role. He also discusses some surprising insights about trainee expectations of future practice settings, the need for a variety in practice caseload, and the desire for about 80% of clinical time to be spent on dedicated IR activities. The conversation also delves into the challenges of equipping residents for rural practice and the potential value of developing a procedural radiology curriculum. Dr. Sullivan anticipates that the survey results will help improve and adapt training paradigms to better align with the evolving landscape of interventional radiology practice.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---SHOW NOTES00:00 - Introduction02:50 - Discussion on IR Training and Practice04:51 - Survey Discussion and Key Findings16:47 - Importance of Diagnostic Skills in IR19:01 - Deciding Factors for First Job After Training21:04 - Need for Medical Services in Rural Settings25:23 - Role of Mentorship in Job Seeking28:21 - Importance of Networking in Career Development32:37 - Future of IR Training and Practice38:23 - Role of BackTable in IR Training---RESOURCESSIR 2024 Monday Session (3:27 PM - 3:36 PM MT): Trainee perceptions of current IR workforce: Are we setting our residents up for failure? With Dr. Thomas Sullivan:https://www.sirmeeting.org/fsPopup.asp?PresentationID=1348792&mode=presInfo

Dr. Charles Nutting, interventional radiologist, discusses prostatic artery embolization (PAE) in the outpatient-based lab (OBL), emphasizing the importance of learning PAE in a hospital setting before transitioning to the OBL. They also discuss the advantages of using radiopaque beads in PAE and the potential impact of the 2023 AUA Guidelines. The podcast covers procedure techniques, patient selection, and benefits of the OBL environment over the hospital.

Dr. Gary Tse, practicing interventional radiologist at UCLA Health, discusses the innovative technique of thyroid ablation for treating benign thyroid nodules. He highlights procedural details, patient experiences, potential complications, and follow-up protocols. Dr. Tse encourages other IR specialists to adopt this procedure, which he believes should become a standard of care.

Dr. Jason Wagner discusses using the HeRO graft and Surfacer system for patients with limited vascular access in hemodialysis. He explains the steps to implant the HeRO graft and its benefits, as well as the use of the Surfacer system for central venous access. Dr. Wagner emphasizes the importance of continued learning and training in utilizing these advanced dialysis solutions.

Dr. Darren Klass, interventional radiologist at the University of British Columbia, discusses best practices in aortic dissection management. Topics include intraoperative decision-making, the importance of intravascular ultrasound, treating acute complicated aortic dissections, and follow-up protocols.

En este nuevo episodio de BackTable, el Dr. Fernando Gómez Muñoz y la Dra. Sara Lojo Lendoiro profundizan en el complejo y específico campo de la radiología intervencionista pediátrica.Al enfatizar las diferencias existentes entre los pacientes adultos y los niños, el Dr. Gómez Muñoz destaca la necesidad de capacitación y enfoques especializados para el manejo de casos pediátricos, especialmente en términos de variantes propias de la edad del paciente como la volemia o el tamaño de los vasos. Se examinan críticamente los desafíos en los procedimientos intervencionistas, particularmente en relación con las complejidades propias del trabajo con pacientes pediátricos y la dificultad añadida de los materiales necesarios. Además, el Dr Gómez Muñoz comparte su trayectoria profesional, su paso por el Great Ormond Street Hospital de Londres y su continuo aprendizaje de colegas de todo el mundo.En el podcast también se explora la necesidad de una colaboración multidisciplinar y se analiza la relación entre los radiólogos intervencionistas y los cirujanos pediátricos. Se subraya la importancia de una comunicación clara con las familias de los pacientes durante procedimientos o diagnósticos particularmente complejos, afirmando que la atención al paciente comienza con el manejo de las emociones y expectativas de los propios médicos.---SHOW NOTES00:00 - Introducción a la radiología intervencionista pediátrica01:27 - Comprender las diferencias entre pacientes adultos y pediátricos03:08 - Desafíos en radiología intervencionista pediátrica08:29 - El papel de la formación y la especialización13:25 - Cómo afrontar las emergencias médicas pediátricas19:02 - La importancia del enfoque multidisciplinario en la atención pediátrica26:23 - El futuro de la radiología intervencionista pediátrica42:44 - Conclusión: La importancia de la radiología intervencionista pediátrica

In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). Dr. Beall is an interventional musculoskeletal radiologist practicing at Oklahoma Spine in Edmond, Oklahoma.Dr. Beall recounts his journey, from his beginnings in the military to his experiences with navigating institutional resistance to his clinical practice, and finally the process of moving to private practice. He discusses the positive impact of spinal cord stimulation on patients with PDN and reflects on its effectiveness in reducing pain and improving neurologic function. He underscores the crucial role of interventional radiologists in managing PDN, while also advocating for the integration of these specialists in pain management clinics. Dr. Beall argues that interventional radiologists possess unique skill sets adept for neuromodulation, which opens up new treatment possibilities in the process. He shares insights on the evolution of spinal cord stimulation technology, reimbursement considerations, and the importance of clinical trials in refining treatment approaches. The episode ends with an invitation for interested physicians to participate in professional forums and learn more about this burgeoning field.---CHECK OUT OUR SPONSORNevro HFX Spinal Cord Stimulatorhttps://www.hfxforpdn.com---SHOW NOTES00:00 - Introduction02:30 - Challenges and Triumphs of a Solo Practice14:44 - Evolution of Neuromodulation in Practice17:05 - Impact of Neuromodulation on Painful Diabetic Neuropathy31:53 - Unique Mechanism of High Frequency Neuromodulation46:02 - Role of Interventional Radiologists in Neuromodulation54:11 - Future of Neuromodulation in Interventional Radiology---RESOURCESDouglas Beall, MD Research Gate Profile:https://www.researchgate.net/scientific-contributions/Douglas-P-Beall-39583252Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial:https://pubmed.ncbi.nlm.nih.gov/37536514/High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256824/Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review:https://link.springer.com/article/10.1007/s11916-022-01035-9High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN):https://link.springer.com/article/10.1186/s13063-019-4007-y

Interventional cardiologist Dr. Thomas Davis discusses the Pioneer Plus Catheter for treating critical limb ischemia. He explains the reorientation technique to stay in the true lumen while treating chronic total occlusion. Dr. Davis shares post-procedure patient management and imaging follow-up, emphasizing the opportunities to learn more about peripheral vascular disease treatment.

In this episode of the BackTable Podcast, guest host Dr. Krishna Amuluru interviews Dr. Fawaz Al-Mufti about recent trials on large core strokes and how they may impact practice. Dr. Al-Mufti is a practicing neurointerventionalist and serves as the Associate Chair of Neurology for Research at New York Medical College.Dr. Al-Mufti examines the cost-effectiveness and socioeconomic implications of successful treatment of patients with large core strokes. The doctors highlight various stroke thrombectomy trials including the RESCUE-Japan, SELECT2 Trial, and TENSION trials. The discussion also covers how these findings affect thrombectomy expansion in lower resource settings and the future outlook of endovascular thrombectomy procedures.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---SHOW NOTES00:00 - Introduction02:53 - Large Ischemic Core Infarcts06:06 - The Importance of ASPECTS11:59 - Large Ischemic Core Trials23:37 - Socioeconomic Implications of Thrombectomy38:08 - The Future of Thrombectomy---RESOURCESMission Thrombectomy:https://missionthrombectomy.org/The Alberta Stroke Program Early CT score (ASPECTS): A predictor of mortality in acute ischemic stroke:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515558/Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomized trials (HERMES Study):https://doi.org/10.1016/S0140-6736(16)00163-XThrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging (DEFUSE III Trial):https://www.nejm.org/doi/full/10.1056/nejmoa1713973Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct (DAWN Trial):https://www.nejm.org/doi/full/10.1056/nejmoa1706442Endovascular Therapy for Acute Stroke with a Large Ischemic Region (RESCUE-Japan Trial):https://www.nejm.org/doi/full/10.1056/nejmoa2118191Trial of Endovascular Thrombectomy for Large Ischemic Strokes (SELECT2 Trial):https://www.nejm.org/doi/full/10.1056/NEJMoa2214403TESLA Trial: Rationale, Protocol, and Design:https://www.ahajournals.org/doi/10.1161/SVIN.122.000787Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomized trial (TENSION Trial):https://www.sciencedirect.com/science/article/pii/S0140673623020329Evaluation of acute mechanical revascularization in large stroke (ASPECTS ⩽5) and large vessel occlusion within 7 h of last-seen-well: The LASTE multicenter, randomized, clinical trial protocol:https://pubmed.ncbi.nlm.nih.gov/37462028/Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct (ANGEL-ASPECT Trial):https://www.nejm.org/doi/full/10.1056/NEJMoa2213379Acute endovascular stroke therapy (Dr. Mike Chen Review):https://pubmed.ncbi.nlm.nih.gov/20535000/Mechanical thrombectomy is cost-effective versus medical management alone around Europe in patients with low ASPECTS (European Cost Effectiveness Study):https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576630/

Dr. Sameh Sayfo and Dr. Nicolas Shammas discuss critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment. They explain the challenges of treating infrapopliteal disease and the efficacy of laser atherectomy for calcified lesions. The ongoing multicenter study on the Auryon laser atherectomy system in CLI patients is reviewed, along with advice on building a strong CLI program.