BackTable Vascular & Interventional BackTable

In this episode, interventional cardiologist Dr. Peter Soukas joins us to discuss percutaneous transmural arterial bypass (PTAB) using the DETOUR system, a novel percutaneous treatment for extensive and complex blockages in the superficial femoral artery (SFA).

---

CHECK OUT OUR SPONSOR

Endologix
https://endologix.com/

---

SYNPOSIS

Dr. Soukas shares his extensive experience and insights into PTAB development, benefits, patient selection, and procedural details. The idea behind PTAB is to create an SFA-to-popliteal artery bypass through endovascular means, using a system of overlapping stent grafts within the femoral vein as a conduit. When planning the procedure, it is important to consider the location of reentry into the popliteal artery, avoid calcified zones, and meet femoral vein size criteria. Additionally, we explore the advantages of PTAB over other endovascular options and traditional open surgical bypass, which carry a higher likelihood of restenosis and longer recovery times, respectively.

We also discuss the types of training and support available for physicians interested in adopting this technique, cost and reimbursement aspects, and the future direction of PTAB, including ongoing post-market studies.

---

TIMESTAMPS

00:00 Introduction
02:38 Dr. Soukas’ Career in Vascular Medicine
05:19 Introduction to PTAB
13:00 Landing Zones
19:37 Stent Graft Sizing
23:14 Patient Selection and Adjunctive Medical Therapy
28:04 Procedural Risks
29:18 Navigating PTAB Implementation
32:20 Opportunities for Learning PTAB

---

RESOURCES

PTAB with the DETOUR System:
https://endologix.com/ptab/detour/

Brown Vascular and Endovascular Fellowship:
https://brownmedicine.org/3/cardiology-vascular-endovascular-fellowship/

COMPASS Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa1709118

VOYAGER Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa2000052

DETOUR 2 Trial:
https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext

In this episode, Dr. Marta Lobato explores advanced endovascular techniques in below the knee (BTK) and below the ankle (BTA) interventions for critical limb ischemia (CLI). She introduces various skills that were developed and used by her team, such as the telescopic needle, buddy needle, balloon-assisted puncture, and vasodilation to prevent artery spasm. Dr. Lobato is a vascular surgeon at Hospital de Cruces in Barakaldo, Spain.

---

CHECK OUT OUR SPONSOR

Reflow Medical
https://www.reflowmedical.com/

---

SYNPOSIS

The discussion covers the importance of visualizing the fifth metatarsal for effective lateral views in X-rays, the intricacies of accessing the lateral and medial plantar arteries, and the significance of starting with easier procedures before attempting more complex interventions. Additionally, Dr. Lobato highlights the role of social media in learning about innovative medical practices.

---

TIMESTAMPS

00:00 - Introduction
05:54 - Below the Knee and Ankle Interventions
15:35 - Complexities of Zone 2 and 3 Access
23:12 - Buddy Needle Technique for Calcified Arteries
30:12 - Advanced Techniques for Supporting the Wire
34:13 - Vasodilator Use
37:12 - Balloon-Assisted Techniques
41:02 - Advancing Your Endovascular Skills

---

RESOURCES

Tips and Tricks for Simple and Complex Below-the-Ankle Punctures:
https://pubmed.ncbi.nlm.nih.gov/38441118/

Buddy Needle Technique to Facilitate Retrograde Puncture of Heavily Calcified Tibial Vessels:
https://pubmed.ncbi.nlm.nih.gov/28587566/

Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach:
https://pubmed.ncbi.nlm.nih.gov/34989276/

Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures:
https://pubmed.ncbi.nlm.nih.gov/36415934/

The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia:
https://pubmed.ncbi.nlm.nih.gov/38523459/

New antioxidant therapy for hard-to-heal neuroischaemic diabetic foot ulcers with deep exposure:
https://pubmed.ncbi.nlm.nih.gov/37029973/

Percutaneous endovascular arteriovenous fistula creation for hemodialysis access using "off-the-shelf" conventional devices:
https://pubmed.ncbi.nlm.nih.gov/33251393/

In this episode, Dr. Mark Little shares his insights about genicular artery embolization (GAE), implications for patients with knee osteoarthritis, possible applications in other MSK interventions, and the importance of research for advancing the field. Dr. Little is a consultant diagnostic and interventional radiologist at Berkshire Imaging and Visiting Professor at the University of Reading in England.

---

CHECK OUT OUR SPONSOR

Varian, a Siemens Healthineers company
https://www.siemens-healthineers.com/

---

SYNPOSIS

The doctors also discuss challenges and considerations in patient selection, particularly concerning patients with comorbid peripheral arterial disease, and they further emphasize the need for high-quality research and collaboration within the IR community to continue improving MSK embolization practices.

---

TIMESTAMPS

00:00 - Introduction
12:28 - Genicular Artery Embolization
24:30 - GENESIS 1 and 2 Studies
41:04 - Future of MSK Embolization

---

RESOURCES

BackTable VI Episode 27 - Geniculate Artery Embolization for Osteoarthritis with Dr. Sandeep Bagla and Dr. Ari Isaacson:
https://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritis

BackTable VI Episode 85 - Genicular Artery Embolization for OA with Dr. Jafar Golzarian:
https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa
GEST MSK Annual Meeting:
https://thegestgroup.com/annual-msk-meeting/

GENESIS 1 - Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis:
https://pubmed.ncbi.nlm.nih.gov/33474601/

GENESIS 2 - Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/37337060/

Dr. Little Genicular Artery Anatomy Paper - Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis:
https://pubmed.ncbi.nlm.nih.gov/34657976/

Dr. Sid Padia’s Knee OA Research (UCLA) - Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis:
https://pubmed.ncbi.nlm.nih.gov/34703964/

Dr. Lars Lönn from Copenhagen Trial - Genicular Artery Embolization as Pain Treatment of Knee Osteoarthritis (GETKO):
https://classic.clinicaltrials.gov/ct2/show/NCT05360329

Dr. Anna Martinez from Spain Shoulder Study - Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment:
https://pubmed.ncbi.nlm.nih.gov/33135118/

Dr. Anna Martinez from Spain Shoulder Study - Clinical Outcomes of Transcatheter Arterial Embolization for Secondary Stiff Shoulder:
https://pubmed.ncbi.nlm.nih.gov/33478903/

En este episodio de nuestro podcast, Dra. Anna Alguersuari Cabiscol, una radióloga intervencionista que dejó su especialidad hace cuatro años, comparte su experiencia personal sobre los desafíos relacionados con la salud mental dentro de la profesión médica.

---

SYNPOSIS

Expone cómo la insatisfacción profesional, el síndrome del impostor y la falta de bienestar mental la llevaron a tomar la decisión drástica de abandonar el intervencionismo. A través de su relato, se discute la relevancia de crear un entorno positivo en el trabajo, invertir en el bienestar mental, y la importancia de enfrentar y superar el estigma asociado con estos temas en el ámbito médico. El episodio también aborda la necesidad de cambiar la percepción del éxito y cómo el apoyo de la comunidad médica y científica es fundamental para mejorar la situación actual.

Finalmente, se destaca el rol crucial de los mentores en todas las etapas de la carrera médica para fomentar un equilibrio entre competencia y confianza, así como promover un entorno laboral saludable y respetuoso.

---

TIMESTAMPS

00:00 - Bienvenido al podcast
07:16 - Redefiniendo el éxito
10:20 - Los cuatro pilares de una vida y un trabajo significativos
28:36 - Crecimiento personal y la importancia de la tutoría
32:22 - Pensamientos finales

In this episode, Dr. Jason Hoffmann shares his harrowing personal experience as a patient with massive portal vein thrombosis - recounting the onset of his symptoms, the subsequent diagnosis, treatment, and recovery, all occurring while he was on-call for his own hospital. Dr. Hoffmann is an interventional radiologist and educator at NYU Langone Health.

---

CHECK OUT OUR SPONSOR

Reflow Medical
https://www.reflowmedical.com/

---

SYNPOSIS

Reflecting on how this experience impacted his approach to medicine and patient care, Dr. Hoffmann discusses the importance of empathy, patient education, and building trust. Additionally, he touches upon his personal and family medical history, and how these events have influenced his medical practice and perspective on patient care.

---

TIMESTAMPS

00:00 - Introduction
05:55 - Dr. Hoffmann’s IR Practice and Passions
09:23 - Physician’s Experience as a Patient
22:47 - New Perspective on Patient Care
28:53 - Closing Thoughts

---

RESOURCES

Combating the Health Risks of Sedentary Behavior in the Contemporary Radiology Reading Room:
https://pubmed.ncbi.nlm.nih.gov/27057784/

En este episodio de BackTable la Dra. Maite Velázquez, hemodinamista del Hospital 12 de Octubre de Madrid, aborda el creciente porcentaje de mujeres que ingresan en el campo de la medicina y, en comparación, el escaso porcentaje de mujeres entre los profesionales que trabajan en entornos con radiación ocupacional, como la radiología vascular intervencionista, hemodinámica o cirugía vascular. Además, se analizan los desafíos existentes alrededor del embarazo de estas profesionales, legislación existente y qué medidas protectoras existen en España y Europa, así como los riesgos reales de radiación para el feto basados en evidencia científica.

---

SYNPOSIS

La Dra. Velázquez disipa mitos, enfatiza la seguridad existente a la hora de mantener la actividad profesional durante el embarazo con las protecciones adecuadas y destaca la brecha de género y el impacto de la escasez de relevo generacional en estas especialidades. La conversación tiene como objetivo informar y reflejar la evidencia científica existente en cuanto al manejo del embarazo mientras se trabaja en ambientes expuestos a la radiación ionizante.

---

TIMESTAMPS

00:00 - Introducción
03:11 - Exposición a la radiación durante el embarazo
07:33 – Evidencia científica y legislación
20:19 - Abordar el impacto profesional del embarazo
26:56 - Combatir conceptos erróneos y promover prácticas seguras
34:59 - Comentarios finales