BackTable Vascular & Interventional

We talk with Dr. Shamit Desai about resources and tips for endovascular and interventional specialists to continue building clinical and procedural skills beyond training.---CHECK OUT OUR SPONSORSRapidAIhttp://rapidai.com/?utm_campaign=Evergreen&utm_source=Online&utm_medium=podcast&utm_term=Backtable&utm_content=SponsorMedtronic AV DCBhttps://www.medtronic.com/avdata---SHOW NOTESIn this episode, host Dr. Aaron Fritts and interventional radiologist Dr. Shamit Desai discuss resources and tips for IRs to continue building clinical and procedural skills beyond residency and fellowship training.The doctors start by recognizing that every training program has specific focuses, which influence the skills that IRs have when they first emerge from the program. With the breadth of IR procedures available today, there are many service lines that are not addressed in formal training. However, Dr. Desai believes that any graduating IR has a foundation of proficient catheter skills and they have the potential to learn most image guided procedures.Dr. Desai emphasizes that a big part of building a new skill set is having the support to learn the skills and let it flourish. He recounts his path to learning how to treat kyphoplasty and PAD and the integral role that IR mentors and device companies played in helping him develop knowledge and confidence. Dr. Desai also advises listeners to branch out into reading journals from other specialties. WIth PAD, he highly recommends learning from the Journal of Vascular Surgery (JVS), which can provide valuable perspective on clinical management. We also highlight national conferences that are tailored specifically to educate on certain procedures.Additionally, Dr. Desai emphasizes that it is important for each IR to identify their true passion. Passion fuels the drive to learn as much as possible about a procedure, which leads to better outcomes for patients. It is also important to have clinical infrastructure in place before marketing the service line to patients and referrers, in order to create a quality patient experience.---RESOURCESEp. 198- Privademics and Advantages of Lesser Known Community Programs with Dr. Shamit Desai and Dr. Saud Ahmed:https://www.backtable.com/shows/vi/podcasts/198/privademics-advantages-of-lesser-known-community-programsEp. 210- Modern Vertebral Augmentation with Dr. Doug Beall:https://www.backtable.com/shows/vi/podcasts/210/modern-vertebral-augmentationVertebral Augmentation by Dr. Douglas Beall:https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156Medtronic OsteoCool System:https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.htmlVascupedia:https://vascupedia.com/Dr. Srini Tummala’s YouTube Channel:https://www.youtube.com/c/DrTummalasVascularChannel?app=desktopJournal of Vascular Surgery (JVS):https://www.jvascsurg.org/SIR Y90 Course:https://www.sirweb.org/learning-center/meetings/y-90-the-complete-course/SIR LEARN Conference:https://www.sirweb.org/learning-center/meetings/2022-learn-and-active-meeting/AMP (Amputation Prevention) Symposium:https://www.amptheclimeeting.com/NCVH (New Cardiovascular Horizons) Conference:https://ncvh.org/meeting/ncvh-2022/OEIS (Outpatient Endovascular and Interventional Society) Conference:https://oeisociety.com/

Dr. Merve Ozen, an interventional radiologist specializing in women's health, and Dr. Mark Hoffman, a minimally invasive gynecologic surgeon, explore the dynamic collaboration in treating uterine fibroids and pelvic pain. They discuss the evolution of a combined clinic that enhances surgical referrals and patient options. With insights into minimally invasive techniques like uterine fibroid embolization, they emphasize the importance of integrated care and teamwork in providing comprehensive, patient-centered solutions for women's health.

In this episode of our Health Equity Series, guest host Dr. Vishal Kumar interviews emergency medicine resident Dr. Jamal Jefferson about the presence of law enforcement in emergency rooms and challenges with patient privacy and trust in the healthcare system.The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/1zdevF---SHOW NOTESIn this episode, guest host Dr. Vishal Kumar interviews emergency medicine resident Dr. Jamal Jefferson about the presence of law enforcement in emergency rooms and its effects on patient privacy and trust in the healthcare system.Dr. Jefferson explains the role that the emergency department plays in his community. He outlines its medical role, as well as its extension into “social emergency medicine.” This term refers to the fact that the ED can be an important access point to services that could improve social determinants of health. Overall the ED often sees community members in their most vulnerable states, and it has the opportunity to track trends in community needs.Next, the doctors discuss how healthcare providers can be unknowingly complicit in further injustices to their patients. Dr. Jefferson urges physicians to think about the ramifications of their actions. For example, using a 5150 code to place a patient on psychiatric hold could affect court decisions and child custody outcomes in the future. Furthermore, when patient belongings are being itemized in a public space such as the ED, this routine procedure could trigger a downstream search/seizure, interrogation, and detainment of the patient.Dr. Jefferson emphasizes the importance of being an active participant in protecting patient privacy. In his patient encounters, he separates the police from the doctor-patient relationship and dispels the idea that the medical team will report protected health information to the police. He explicitly lets patients know that the preceding events that brought them to the hospital do not have an impact on how he will treat them. Additionally, the negative experience of a single patient will send a ripple effect through the community. The patient’s friends and family members may trust the ED less, which delays care and increases morbidity and mortality.Finally, the doctors highlight important research and court rulings over the criminalization of patients.---RESOURCESA National Evaluation of the Effect of Trauma-Center Care on Mortality:https://www.nejm.org/doi/full/10.1056/nejmsa052049Police Brutality and Black Health: Setting the Agenda for Public Health Scholars:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388955/Policing the Emergency Room (Harvard Law Review):https://harvardlawreview.org/2021/06/policing-the-emergency-room/Weapons Use Among Hospital Security Personnel:https://cdn.ymaws.com/www.iahss.org/resource/collection/48907176-3B11-4B24-A7C0-FF756143C7DE/2014_Weapons_use_among_hosptial_security_personnel.pdfFerguson vs. Charleston:https://supreme.justia.com/cases/federal/us/532/67/#WhiteCoatsForBlackLives — Addressing Physicians’ Complicity in Criminalizing Communities:https://www.nejm.org/doi/full/10.1056/NEJMp2023305

Dr. Ziv Haskal, a tenured professor of interventional radiology at the University of Virginia and co-founder of the guest conference on embolization, discusses the innovative use of glue in vascular procedures. He explains how to prepare glue for portal vein embolization and type 2 endoleaks, and shares his unique glue bullet technique. Haskal highlights the versatility of glue by manipulating its viscosity for various applications, offering insights on overcoming challenges and enhancing training for interventional radiologists.

Jacob Fleming interviews interventional pain specialist and former Super Bowl champion John S. Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/1DSmJG---SHOW NOTESIn this episode, host Dr. Jacob Fleming interviews interventional pain specialist and former Super Bowl champion Dr. John Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care.Dr. Michels describes his first career as an NFL player with the Green Bay Packers and how it taught him to be comfortable with external pressures and delayed gratification. He recounts the knee injury that led to an early retirement from the field, as well as interactions with radiologists, surgeons, and rehabilitation specialists that got him thinking about entering the field of medicine. He ended up pursuing a diagnostic residency at Baylor University, and then an additional interventional pain fellowship at the University of California at Irvine.Throughout his training, he recognizes that there is great synergistic benefit when specialists team up to provide multidisciplinary care and teach each other different skills. For example, he refined his physical exam skills by working with a PM&R physician, and he also taught other physicians how to read imaging.Dr. Michels believes that the most gratifying part of his career is the opportunity to diagnose, treat, and follow up with patients. In his Dallas-based independent OBL, he splits his time between clinic and procedural days. He enjoys seeing the impact that his interventions have on patients, and he is committed to providing alternatives to opioid use. Dr. Michels encourages more radiologists to explore the field of interventional pain, which is now recognized as a radiology subspecialty by the American Board of Radiology. Overall, when imaging is combined with physical examination and history-taking, the patient will enjoy the benefits of better diagnosis and care.---RESOURCESDr. John Michel’s Website:https://www.johnmichelsmd.com/Interventional Spine & Pain:http://www.spinedallas.com/ABR Pain Medicine Subspecialty:https://www.theabr.org/radiation-oncology/subspecialties/pain-medicineUC Irvine Pain Fellowship:https://anesthesiology.uci.edu/education-fellowships-pain-medicine.shtml

Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, tells us about his experiences with geniculate artery embolization (GAE) practice building in the office-based lab (OBL).---CHECK OUT OUR SPONSORAthletic Greenshttps://www.athleticgreens.com/backtablevi---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/oIF49Q---SHOW NOTESIn this episode, host Dr. Michael Barraza interviews Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, about building office based labs (OBLs), the untapped potential of the geniculate artery embolization (GAE) market, and how to build patient referrals for new OBLs.We begin by discussing why Dr. Wood chose to do geniculate artery embolization (GAE) in his OBLs. He says that GAE makes a great procedure for an office setting because it is relatively easy, only requiring a C arm with digital subtraction angiography (DSA). It is also a quick procedure with little side effects and low rates of complications. He says that patients who get GAE are a unique patient population because they know they have arthritis, and have exhausted conservative measures or declined treatment options that they have been offered, which are often quite invasive.Dr. Wood says his GAE patients are mostly self-referred. He has marketing liaisons for local clinics, but what he has found most effective is TV commercials in English and Spanish, because this reaches the populations that need the most help. His patient population for GAEs consists mostly of self referred patients, as well as referrals from PCPs and occasionally orthopedic or sports medicine providers.Regarding how Dr. Wood evaluates which patients to treat, he says that he began by using the point of maximal tenderness as described by Sandeep Bagla and required MRI before patient selection. He now uses primarily X-ray and only treats pain rated at least 5 out of 10. He does not do GAE in patients who have had knee surgery or with a history of significant PAD or calcification seen on preoperative X-ray. He generally tells patients they can expect up to a 70% improvement of pain after geniculate artery embolization.---RESOURCESBackTable Ep. 27: Geniculate Artery Embolization for OA with Dr. Sandeep Bagla and Dr. Ari Isaacsonhttps://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritisBackTable Ep. 85: Genicular Artery Embolization for OA with Dr. Jafar Golzarianhttps://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oaBagla GAE Publication:https://pubmed.ncbi.nlm.nih.gov/31837946/Padia GAE Publication:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542160/

Dr. Aparna Baheti talks with Nicholas Petruzzi and Donald Garbett about their experiences in building an office-based lab (OBL) within their existing IR/DR practices. Learn how they campaigned and collaborated to get their colleagues on board, and the unique challenges of building and operating an OBL.---CHECK OUT OUR SPONSORBoston Scientific Nextlabhttps://www.bostonscientific.com/en-US/nextlab.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-nextlab-hci&utm_content=n-backtable-n-backtable_site_nextlab_1&cid=n10008040---SHOW NOTESIn this episode, host Dr. Ally Baheti interviews interventional radiologists Dr. Nick Petruzzi and Dr. Don Garbett about their own experiences with pitching and building an office-based lab (OBL) within their existing practices.First, each doctor describes how they arrived at the idea of an OBL. For Dr. Garbett, the main motivation was a drive to follow up with patients. On the other hand, Dr. Petruzzi was frustrated by the lack of adequate equipment and bureaucratic steps that his hospital required him to follow to request more equipment.Next, we shift to a discussion about how each of them got their practice partners to philosophically and financially buy into the OBL idea. Both doctors wrote and presented pro formas to delineate the net benefits. Additionally, Dr. Petruzzi proved that an OBL would be profitable by doing a few cases with trial periods for different C-arms. Dr. Garbett worked with his practice’s revenue cycle manager and accountant to verify his financial projections. Both emphasize the importance of group culture and the value of colleagues who are open-minded to expansion.Finally, we talk about unforeseen obstacles that have risen on their OBL journeys so far. Dr. Petruzzi describes his conversations with hospital systems, in which he had to advocate for IRs to be listed as referring doctors. Dr. Garbett cites concerns about billing and coding, which can be very complex for a third-party group to handle. We end with updates from each guest about the current status of their OBL and their next steps.---RESOURCESVascular Institute of Atlantic Medical Imaging:https://www.vi-ami.com/Radiology Associates:https://www.rapc.com/

In this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback, interventional radiologist, about distal femoropopliteal disease, including the unique pathophysiology of this area, which stents work best at the adductor canal and the trifurcation, and tips for early operators.---CHECK OUT OUR SPONSORVeryan BioMimics 3D® Vascular Stent Systemhttps://www.veryanmed.com/usa/products/biomimics-3d-vascular-stent-system/---SHOW NOTESIn this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback, interventional radiologist, about distal femoropopliteal disease, including the unique pathophysiology of this area, which stents work best at the adductor canal and the trifurcation, and tips for early operators.We begin by discussing peripheral arterial disease (PAD) pathophysiology, specifically in the challenging areas around the adductor canal (Hunter’s canal). Dr. Rundback describes how the femoral artery has twists and turns around this area and that it can experience compressive forces up to 15-20% during motions such as flexion of the knee. Due to this being the most dynamic location of the femoral artery, this is often where plaque rupture will happen, resulting in critical limb ischemia (CLI) and requiring urgent intervention.The two discuss how traditional rigid stents do not work well in this area due to the dynamic nature of the region and the fact that the artery is tortuous and can cause rigid stents to fracture or cause intimal hyperplasia due to turbulent flow. Drug coated balloon (DCB) angioplasty generally does not work for this region due to poor durability. They discuss the utility of the Tack device, a scaffold with minimal metal which is better suited for focal dissections. Dr. Rundback emphasizes the importance of intravascular ultrasound (IVUS) during all distal femoropopliteal cases due to the complexity of the region and patient-to-patient variation. He uses IVUS to choose which device and what size to use because measuring on angiography is not accurate in these cases.Finally, they discuss the Supera and BioMimics stents, including the indications, benefits, and ease of deployment of each. Dr. Rundback says that Supera, a woven nitinol stent, gives it the benefit of thermal memory. The difficulty with this stent is the need for aggressive vessel preparation and plaque modification, generally requiring lengthy angioplasty and possibly atherectomy. The BioMimics stent can rotate, curve, and shorten, which is optimal for this region to maintain swirling or helical blood flow rather than causing turbulent flow. The BioMimics stent is also very easy to deploy, and Dr. Rundback generally chooses this stent in locations where he can’t adequately prep the vessel.---RESOURCESBioMimics 3D stent:https://www.veryanmed.com/international/products/biomimics-3d-vascular-stent-system/Supera™ Stent:https://www.cardiovascular.abbott/int/en/hcp/products/peripheral-intervention/supera-stent-system/overview.htmlTack device:https://www.usa.philips.com/healthcare/product/HCIGTDTCKESYSTM/tack-endovascular-system-dissection-repair-device

In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/XssSys---SHOW NOTESIn this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps. This is the final installment of our 4-part BackTable VI series on osteoporosis treatment.We begin by discussing insufficiency fractures outside of the vertebral body. Dr. Beall discusses how he has treated insufficiency fractures of the pelvis, sacrum, acetabulum, tibia, and calcaneus. He prefers to use a combination of rebar screws and cement, and he enjoys finding innovative solutions for patients without good options for pain relief. He discusses how he recently used this technique for an SI joint fusion.Next, we discuss two exciting innovations that will propel the field of interventional spine forward in the coming years. First, they discuss disc augmentation with hydrogels such as PVA (polyvinyl alcohol), PEG (polyethylene glycol), and PVP (polyvinyl povidone) which can be used to augment the annulus and nucleus without any requirement for ablation or regeneration. Secondly, Dr. Beall discusses the possibilities of interspinous process devices such as the Minuteman® fusion device. He hopes that technology is moving from spacers (the current method) to anterior column support. He believes that this is possible via Kambin’s Triangle (the space between the exiting nerve root, superior articular process, and transverse process).Finally, we discuss Dr. Beall’s newest book, ‘Intrathecal Pump Drug Delivery’. He attributes the small number of IRs doing this procedure to a lack of familiarity and a “how-to guide”. For this reason, he published his book, which includes types of medications used in intrathecal pumps, medication concentrations, trialing doses, and how the pump is used. He welcomes all IRs interested in learning how to incorporate intrathecal pumps into their practice to reach out to him and follow him on social media to keep up to date on training courses and webinars about this topic.---RESOURCESDr. Douglas Beall LinkedIn:https://www.linkedin.com/in/douglas-beall-604ba68Dr. Douglas Beall Twitter: @DougBeallMinuteman® interspinous-interlaminar fusion device:https://spinalsimplicity.com/minuteman/Douglas Beall Books:Intrathecal Pump Drug DeliveryVertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation