BackTable Vascular & Interventional

Lake Odom, an experienced IR technologist, and Chas Sanders, founder and CEO of MARGIN, discuss the importance of techs in maintaining office-based lab efficiency and culture. They explore hiring qualities and emphasize the benefits of salaried techs. The podcast also covers prepping for cases, inventory management challenges, and the need for knowledgeable staff. The chapter descriptions highlight topics like profitability, patient satisfaction, and the importance of investing in people. A new podcast on musculoskeletal topics is also announced.

Dr. Eric DePopas, interventional radiologist, discusses digital marketing strategies for physicians, including paid-search and paid-social marketing. He emphasizes the importance of building word of mouth and shares insights on patient engagement and CRM systems. The podcast also explores the challenges faced by independent doctors in marketing their services and provides tips on tailoring marketing strategies based on location and target audience. Overall, the episode highlights the significance of committing to digital marketing and working as partners to achieve success.

In this episode, interventional nephrologist Dr. Neghae Mawla discusses endovascular AV fistula creation with our host Dr. Christopher Beck.---CHECK OUT OUR SPONSORBD Advance Clinical Training & Education Programhttps://page.bd.com/Advance-Training-Program_Homepage.html---SHOW NOTESWe start off the episode by discussing Neghae’s current practice at Dallas Nephrology Associates, where most of his patient referrals come from his partners. Patients who come to see Neghae receive a standard vein mapping via ultrasound to determine whether they should receive an endovascular or a surgical procedure. If patients’ veins fit certain specifications, such as superficial location (cephalic, median cubital), large enough size (2-2.5 mm) and presence of large perforating veins (2 mm), then they are better candidates for an endovascular approach.However, these rules do not perfectly predict fistula success. Neghae noticed that even if patients fit the above criteria, their fistulas don’t always mature correctly. With experience, he began to take into consideration the brachial vein size as well. While this is not part of the official vein mapping criteria, he has seen that if the brachial vein is significantly larger than the superficial veins, it could have a competitive outflow and hinder the maturation of the fistula.The conversation then shifts to the types of devices used to create the anastomosis for the fistulas, WavelinQ and Ellipsys. Neghae notes that while most patients do well with either device, some patients do better with one over the other. Thus, he suggests that physicians are trained on both devices if possible, to guarantee the best outcomes. To end the episode, Neghae reflects on his previous decade of experience with endovascular AV fistulas and shares wisdom about failures and successes that he has learned from.---RESOURCESASDIN White Paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology:https://cdn.ymaws.com/www.asdin.org/resource/resmgr/positionpaper/Cephalic_Arch.pdfASDIN White Paper: Patient selection, education, and cannulation of percutaneous arteriovenous fistulae:https://cdn.ymaws.com/www.asdin.org/resource/resmgr/positionpaper/ASDIN_EndoAVF.pdfASDIN Certification ink:https://www.asdin.org/page/pAVFCert

In this episode, co-hosts Dr. Aaron Fritts, Dr. Michael Barraza, and Dr. Eric J. Keller discuss social media ethics in medicine.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---SHOW NOTESTo kick-off the episode, the three IR physicians discuss “clot porn” and all the debate associated with posting case-related findings (clots, imaging, etc) on social media with device/company name visible. Dr. Keller, who has a strong background in medical ethics, shares his thoughts on the matter and underscores the 6 pitfalls of medical social media: patient privacy, patient dignity, information accuracy, conflict of interest, justice inequity, and interprofessional respect.From Dr. Keller, we learn that the crux of the matter tends to circle back to two central issues– how the case is shared and intentions behind sharing. Additionally, Dr. Keller shares unique data on the relation between how often a medical device company is mentioned in social media posts, how often physicians are compensated for their public endorsements, and whether or not conflict of interests are disclosed.Dr. Barraza and Dr. Keller then compare TikTok, Instagram, and Twitter’s roles and potentials in medicine. The trio discuss Twitter’s past, present, and future influences on medical research, networking, innovation, and education. They also consider the need for more clear, comprehensive social media posting guidelines issued by specialty societies and ideas for patient consent forms over social media posting.To wrap up the episode, the doctors discuss interprofessionalism, dealing with social media trolls/negativity, and personal vs. professional accounts. Dr. Keller notes that 85% of the general public turns to social media networks to seek healthcare information, which highlights the online presence of physicians and how they are often held to a higher ethical standard on social media platforms.For listeners wanting to learn more about social media ethics in medicine, the annual Western Angiographic Interventional Society (WAIS) in Palm Springs, California (October 7-11, 2023) will have dedicated medical social media ethics panels and discussions built into programming. Be sure to register and attend! Link to the WAIS webpage below.---RESOURCESWestern Angio Interventional Symposium 2023 Schedule:https://www.westernangio.org/Western Angio Interventional Symposium 2023 Registration:https://www.westernangio.org/event-5048807Link to Thomas Webb study:https://www.jvir.org/article/S1051-0443(22)01727-4/fulltextCMS Sunshine Database:https://openpaymentsdata.cms.gov/

In this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback about analysis of arterial calcifications using microCT.---CHECK OUT OUR SPONSORAngioDynamics Auryon Systemhttps://www.auryon-system.com/---SHOW NOTESDr. Rundback starts by describing the basic differences between microCT and current imaging techniques. MicroCT is a non-destructive imaging method where the x-ray source is stationary but the subject is on a rotating stage. This method can create 3D imaging with a 3 to 5 micron resolution. On the other hand, in traditional CT imaging, the subject is stationary and the x-ray source rotates, which gives a 3 to 5 millimeter resolution.Then, the episode shifts to a discussion on Dr. Rundback’s recent study, in which he used microCT to evaluate the treatment effect of medial arterial calcification in below knee interventions after Auryon laser atherectomy. For this study, arteries were dissected out of cadavers with cardiac risk factors. These artery segments were then subject to different energies from the Auryon laser. MicroCT was performed before and after the procedure to analyze the degree of calcification. These trials have shown that atherectomy using the Auryon laser could increase compliance of the treated arteries. MicroCT has also helped expand knowledge about different types of calcification and how atherectomy differentially impacts them.---RESOURCESTreatment effect of medial arterial calcification in below-knee after Auryon laser atherectomy using micro-CT and histologic evaluation:https://pubmed.ncbi.nlm.nih.gov/37400346/Auryon Atherectomy Device:https://www.angiodynamics.com/product/auryon/

Dr. Junjian Huang and Dr. Sean Maratto discuss their early-career experiences and offer advice on establishing and expanding IR service-lines, adapting to new workplace cultures, conflict resolution, early-career mentorship, and the challenges and pressures faced in the initial months as an attending physician. They highlight the importance of availability, communication with referring doctors, and seeking out mentors for career advancement. Mentors play a crucial role in navigating the challenges of the profession, and listeners are introduced to the SIR's early career section as a valuable resource.

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Saher Sabri and vascular surgeon Dr. Frank Arko about their perspectives on a July 2023 New York Times article about the ethics of peripheral arterial disease (PAD) treatment in outpatient based labs (OBLs) and ambulatory surgery centers (ASCs).---SHOW NOTESDr. Arko emphasizes the importance of approaching articles as an unbiased reader. He acknowledges that sensationalism in the news is common, and while bad actors do exist, he personally knows talented OBL/ASC practitioners. He also notes that the article fails to mention that the majority of these practitioners follow society guidelines to provide appropriate and effective treatment for their patients, rather than prioritizing financial gain. He believes that most non-surgical specialists have the clinical insight to know when patients would be better candidates for open bypasses as opposed to endovascular interventions. Dr. Arko describes the split response to the article within vascular surgeons on social media, based on their personal philosophies of open versus endovascular interventions for PAD.Dr. Sabri believes that PAD and critical limb-threatening ischemia (CLTI) are not very well known by the general public, this article was a missed opportunity to bring attention to these conditions and disparities in treatments depending on patients’ geographic locations and ethnicities. The article may have the effect of scaring patients away from seeking treatment for PAD and CLTI, as well as receiving care at OBLs, which were originally founded to make interventions more efficient and patient-friendly. Additionally, the article could foster divisiveness between vascular surgeons, interventional radiologists, and interventional cardiologists and as a result, increase barriers to collaboration.It is important to differentiate between PAD and CLTI and the stage at which patients present to medical care. Limb salvage rates and decisions to intervene and/or amputate are multifactorial and are not as straightforward as the article may imply. Both doctors agree that specialty societies share the responsibility of monitoring their members for overuse of interventions.In terms of rebates and volume discounts from device companies, the doctors discuss the ethics of cost savings that benefit a hospital system versus savings that benefit a physician-owned OBL. Dr. Arko recognizes that financing an OBL with device company partnerships can be a smart business decision if devices are used appropriately and only when indicated. He speaks about the need for societies to support more randomized control trials that compare the effectiveness of each atherectomy device. We also discuss implications for insurance coverage of PAD/CLTI interventions. Dr. Sabri believes that it is unfortunate when insurance companies become the decision-maker of patient treatments.---RESOURCES“They Lost Their Legs. Doctors and Health Giants Profited” (NY Times, July 2023 article):https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.htmlBEST-CLI:https://www.bestcli.com/“Blocked Artery in Your Leg? Here’s What You Should Know” (ProPublica, June 2023 article)https://www.propublica.org/article/what-to-know-about-peripheral-artery-diseaseOutpatient Endovascular Interventional Society (OEIS):https://oeisweb.com/Society of Vascular Surgery (SVS) Position Statement:https://vascular.org/news-advocacy/articles-press-releases/svs-response-new-york-times-article-overuse-interventions

In this episode, host Dr. Michael Barraza interviews Dr. Zola N’Dandu, an interventional cardiologist at Ochsner Medical Center in Louisiana, about building a successful critical limb ischemia (CLI) program.---CHECK OUT OUR SPONSORSBoston Scientific Lab Agenthttps://www.bostonscientific.com/en-US/customer-service/ordering/lab-agent/contact.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-labagent-hci&utm_content=n-backtable-n-backtable_site_labagent_1_2023&cid=n10013205Reflow Medicalhttps://www.reflowmedical.com/---SHOW NOTESDr. N’Dandu’s current practice is about 65% peripheral artery disease, with a focus on critical limb ischemia. He discusses how he developed his current CLI focus by traveling and attending conferences, after his formal training. It was during one of these conferences that Dr. N’Dandu was inspired to further get involved with the patients in the wound care center at Ochsner. This interest led to the start of his CLI team.The episode then shifts towards Dr. N’Dandu’s process of building his CLI team. His commitment to this endeavor helped bring more like-minded people to his team. Having a centralized and committed team has helped Dr. N’Dandu streamline his patient visits, reduce the number of appointments needed for each patient, and greatly decrease the burden on the patients.Dr. N’Dandu then discusses the evolution of CLI in the last decade and how there are now more medications, therapies, and data available to support patient care. Procedural advancements have also been immensely helpful. Things like radial-to-pedal, 3rd and 4th generation stents, proliferative therapy with stents, drug-coated balloons, and bio-absorbable stents are all advancements in CLI treatment. Additionally, obtaining more data on each therapy will help refine the treatment algorithm for CLI.As the conversation shifts towards aspects that still need to evolve in CLI treatment, Dr. N’Dandu emphasizes that our treatment of no-option-CLI patients needs to change. One of the treatments that he uses for these patients is deep vein arterialization, a technique that was first discovered in 1912 but still has more potential for growth. DVA involves shunting arterial blood to the veins, which works for CLI, as studies show that it increases angiogenesis and perfusion of the tissue. As Dr. N’Dandu discusses the specifics of his DVA technique, he emphasizes that new advancements are being made every day, so it is crucial to have a cohesive team that can follow up with patients.

In this episode, host Dr. Aaron Fritts interviews Jason Newton - an attorney with 14 years of private practice defense experience and current General Counsel at Curi - about cybersecurity in medicine and healthcare.---SHOW NOTESJason begins by introducing how he became an expert in cybersecurity law. Dr. Fritts and Jason then segue to the present day threats of ransomware in healthcare, beginning with a birds eye view and progressively getting more granular. They cover the topics of staffing shortage, how threat-actors are akin to present-day pirates, and the chief risk of ransomware.We learn that healthcare is the most common target of ransomware from threat-actors and how “big fish” are not only the main targets, meaning many smaller health entities are also under real threat. Jason explains well documented reports which detail the intense interest in health information of several US targets such as government leaders, military personnel, celebrities, and popular athletes.Dr. Fritts and Jason underscore how money is the central driving force behind ransomware attacks on healthcare. Jason also takes a deep dive into how threat-actors engage in social engineering to ensure their success. Troubling enough, Jason also shares how threat-actors (on average) have already infiltrated health systems 66 days prior to the day the breach has been discovered. Essentially health systems will only see threat-actors when these hackers want to be seen and demand ransom.ChatGPT, AI, and deep-fake technology is also discussed and how it can be used by threat-actors to bolster their ransomware attacks on healthcare. Jason also mentions the need for health systems to invest in cybersecurity insurance and the inverse relation between “secure” and “easy”. Health systems’ responsibility to secure their data is paramount to mitigating and avoiding ransomware.Jason highlights the necessity of training, the fact that people can be the weakest link in security, and how it is critical for everyone to approach their email inbox with a “no-trust” policy. Anti-phishing software can also be a very helpful addition to health systems looking to bolster their cybersecurity. Mr. Newton supplies some helpful training, consultation, and investigation resources from the Cybersecurity and Infrastructure Security Agency.While we hope this discussion may be helpful, there are no guarantees that the information and resources shared will prevent and/or mitigate bad outcomes, and no guarantees or endorsements are made. Although Jason is an attorney, he cannot and does not offer legal advice to external parties and an attorney-client relationship is not established with listeners of this podcast. Please contact your personal or corporate attorney if you require legal advice.---RESOURCESCybersecurity and Infrastructure Security Agency website:https://www.cisa.gov/resources-tools

In this episode, we delve into the career of Dr. Thomas Sos, a renowned figure in the field of Interventional Radiology (IR), and the triumphs and challenges he faced in the formative years of interventional radiology.---CHECK OUT OUR SPONSORPhilips SymphonySuitehttps://www.philips.com/symphonysuite---SHOW NOTESThe episode starts with an introduction to Dr. Sos, whose accomplishments include serving as SIR President from 1986-1987, receiving the SIR Gold Medalist in 2009, authoring 140 publications and 60+ book chapters, as well as winning the SIR Foundations in Leadership and Innovation award this past year.Dr. Sos reflects on his educational journey, starting with his medical degree from Harvard and continuing with diagnostic radiology residency and an IR fellowship at Cornell. As one of Cornell's first IR fellows, he discusses the intensity of his early training and his reasons for choosing this specialty. His fellowship years coincided with the formation of SIR and the rapid evolution of the field, offering him a chance to be part of its groundbreaking developments. He then traces his professional path, highlighting his work at Cornell and Brigham, his role as the youngest IR progressor at Cornell, and his position as the Divisional Chief of Cardiovascular IR.An important turning point in his career was a coronary angioplasty course in Zurich, Switzerland, which led to his collaboration with cardiothoracic surgeons and cardiologists. He remains an active participant in major conferences to share knowledge about angioplasty.Then, Dr. Sos discusses his shifting focus to peripheral vascular disease. As his work in IR began to draw attention, surgeons started acknowledging the growing influence of IR in medicine. This realization resulted in more surgeons learning about angioplasty and a collaboration between SIR and the Society for Vascular Surgery (SVS).