BackTable Vascular & Interventional

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The BackTable Podcast is a resource for interventional radiologists, vascular surgeons, interventional cardiologists, and other interventional and endovascular specialists to learn tips, techniques, and the ins and outs of the devices in their cabinets. Listen on BackTable.com or on the streaming platform of your choice. You can also visit www.BackTable.com to browse our open access, physician-catered knowledge center for all things vascular and interventional; now featuring practice tools, procedure walkthroughs, and expert guidance on more than 40 endovascular procedures.

  1. 19 HR AGO

    Ep. 626 Single Stick Vascular Access: Techniques & Benefits Explained with Dr. Kevin Wong

    With the single-stick technique proving to be an effective addition to the venous line placement toolkit, what is stopping IRs from venturing beyond the traditional dual-incision approach? In this episode of the BackTable Podcast, pediatric interventional radiologist Dr. Kevin Wong of USA Health joins host Dr. Ally Baheti to review the single-stick technique for central venous access, a method widely utilized in pediatric practice. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:35 - Origins of Single-Stick Access03:10 - Setup and Bending the Needle07:17 - Tunneling to the IJ10:06 - Line Positioning and Measurement14:45 - Wire Handling Considerations18:55 - Clinical Advantages of Single-Stick Access21:27 - Femoral Single-Stick Tips23:41 - Common Mistakes and Pitfalls27:39 - Needle-Free Lidocaine Administration30:48 - Closing Remarks --- More about this episode Delving into the origins, technical nuances, and clinical advantages, the physicians explore how the single-stick technique can reduce the risk of infection and minimize interference with other lines and tubing to improve patient care. The discussion provides a detailed technical breakdown of the procedure, offering a masterclass on navigating the curves up the neck as well as the equipment selection and sizing necessary to facilitate the process. With the aid of visual slides and demonstrations, Dr. Wong steps us through the specifics of bending the access needle, maneuvering tools to adapt to anatomical configurations, and handling ultrasound movement to confirm and maintain a safe trajectory throughout the procedure. The conversation emphasizes the tactile “feel” and attention to forces acting on the wire that are required to appropriately position the catheter.Recognizing the logistical constraints that make it challenging for attendings to regularly adopt alternative procedural techniques, this episode serves as an accessible primer for clinicians looking to broaden their options for venous access with this effective, patient-centric technique.

    33 min

  2. 3 DAYS AGO

    Ep. 625 Managing Acute Arterial Thrombosis: Devices & Approaches with Dr. Shang Loh and Dr. Khanjan Nagarsheth

    The advent of newer thrombectomy devices has turned what were once hours-long surgical cutdowns into endovascular cases that last under an hour. In this episode of BackTable, host Dr. Sabeen Dhand is joined by Dr. Shang Loh from the University of Pennsylvania and Dr. Khanjan Nagarsheth from the University of Maryland to discuss the evolution of arterial thrombectomy devices and modern techniques for acute arterial occlusions. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/artix-system --- SYNPOSIS The episode highlights major technological advancements over the past decade, including the development of mechanical and computer-assisted thrombectomy systems. The physicians review key features of newer devices, such as the ability to combine aspiration with stent retrievers, the use of PTFE baskets to reduce distal embolization, and the advantage of maintaining wire access throughout the case. They share strategies for managing specific cases, including acute femoral-popliteal occlusions with distal reconstitution, intraoperative ischemic pain due to flow arrest, trauma-related thrombosis, and cases complicated by extensive calcification and chronic vascular disease. As vascular surgeons, they also discuss the ongoing role of open approaches, outlining when surgical cutdown is indicated and where they prefer endovascular first. The conversation further explores challenges such as acute limb ischemia, stent thrombosis, and visceral artery thrombosis, emphasizing the importance of staying current with rapidly evolving technologies to improve procedural efficiency and patient outcomes. --- TIMESTAMPS 00:00 - Introduction02:04 - Evolution of Arterial Thrombosis Treatment04:11 - New Devices and Techniques10:42 - Case Studies and Practical Applications24:26 - Techniques and Devices for Thrombectomy25:33 - Managing Flow and Patient Safety27:25 - Surgical vs. Endovascular Approaches29:25 - Dealing with Complications and Failures37:50 - Visceral Thrombosis and Advanced Techniques41:09 - Future of Thrombectomy Devices44:27 - Closing Remarks

    45 min

  3. 13 MAR

    Ep. 624 Integrating Spinal Cord Stimulation in Vascular Disease Management for CLTI with Dr. Mary Costantino and Jill Sommerset

    Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral artery disease. While many patients can be treated with endovascular or surgical revascularization, a subset of individuals remain ‘no-option’ candidates when conventional therapies fail or distal targets are absent. In this episode of BackTable, host Dr. Ally Baheti speaks with Dr. Mary Costantino, interventional radiologist at Advanced Vascular Centers, and Jill Sommerset, vascular technologist and Director of Clinical Education and Training at Aveera Medical, about the emerging role of spinal cord stimulation (SCS) as a potential therapy for patients with no-option CLTI. --- SYNPOSIS This episode explores where spinal cord stimulation may fit within the treatment landscape for advanced CLTI, particularly for patients who are not candidates for revascularization or deep venous arterialization (DVA). Dr. Costantino describes how interest in the therapy developed through multidisciplinary collaboration and early physiologic observations using pedal acceleration time (PAT) measured with duplex ultrasound alongside angiography. A representative case highlights immediate, setting-dependent improvements in PAT following stimulation, and the group reviews early trends from a small patient cohort suggesting improved distal perfusion in individuals with severe infrapopliteal disease. The conversation also addresses practical barriers to adoption, including site-of-service and reimbursement challenges and the difficulty of implanting permanent stimulators in patients with active wounds. Jill Sommerset adds perspective from the vascular lab, discussing ultrasound-based methods to quantify physiologic changes after DVA and how similar perfusion metrics may help evaluate spinal cord stimulation. The episode concludes with a discussion of the potential role of neuromodulation in this population and the need for larger datasets to better define its clinical impact. --- TIMESTAMPS00:00 - Introduction02:02 - Why CLTI Needs Options06:25 - First No Option Case11:06 - Trial Turns Flow On14:38 - Timing and Reimbursement19:59 - Early Results and Adoption22:45 - How Spinal Cord Stimulation Might Improve Flow26:46 - Patient Selection and Access30:24 - Treatment Algorithm and Timing32:37 - Quality of Life and Mobility37:57 - Implant Delays and Coordination39:41 - Data --- RESOURCES Paper on Maturation after DVAhttps://www.sciencedirect.com/science/article/pii/S1078588426000523

    42 min

  4. 10 MAR

    Ep. 623 CLTI: Lithotripsy and Endovascular Techniques for Below the Knee Interventions with Dr. Paul Foley

    Below-the-knee (BTK) arterial disease remains one of the more challenging areas in vascular care, particularly in patients with chronic limb-threatening ischemia (CLTI), where heavy calcification complicates endovascular treatment. As new calcium-modifying technologies emerge, an important question remains: what evidence supports their use in BTK interventions? In this episode of BackTable Vascular & Interventional, host Dr. Sabeen Dhand speaks with vascular surgeon Dr. Paul Foley of Doylestown Health about the Disrupt BTK II clinical trial from Shockwave Medical, which evaluates the performance of peripheral intravascular lithotripsy (IVL) in heavily calcified BTK disease. --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS Dr. Foley begins by outlining his training and the evolution of his vascular surgery practice, setting the stage for a broader discussion on how BTK interventions have changed over the past decade. The conversation explores shifts in access strategies, procedural approaches, and the unique characteristics of calcification encountered in CLTI. Because BTK calcium differs from calcification seen elsewhere in the peripheral vasculature, imaging and device selection play a particularly important role when planning IVL-based therapies. Dr. Foley reviews the design and outcomes of the Disrupt BTK II trial, where devices such as the Shockwave M5+ and S4 catheters were used to modify calcified plaque, demonstrating encouraging safety and performance signals. The discussion then turns to emerging technologies, including Shockwave’s Javelin catheter, designed to deliver focused pressure waves to fracture dense calcium within peripheral arteries. Dr. Foley describes how the device fits into BTK workflows, including technique considerations and its use alongside adjunctive therapies such as balloon angioplasty. The episode also addresses the ongoing skepticism surrounding IVL in BTK disease, emphasizing the need for careful patient selection, procedural precision, and continued multidisciplinary collaboration as the field works to refine treatment strategies and improve outcomes for patients with peripheral artery disease (PAD). --- TIMESTAMPS 00:00 - Introduction08:20 - Evolution of Below-the-Knee Treatments11:10 - Differences in BTK Calcification13:13 - Imaging and Technology in BTK Interventions15:18 - Disrupt BTK II Trial Data and Results23:17 - Introduction to the Javelin Device26:39 - Technique Considerations with Javelin28:36 - Comparing Javelin and E831:17 - Future Directions for Lithotripsy Technology35:30 - Skepticism Around IVL in BTK Disease38:47 - Final Thoughts --- RESOURCES Disrupt BTK II Trialhttps://www.jvascsurg.org/article/S0741-5214(24)02063-9/fulltext

    44 min

  5. 6 MAR

    Ep. 622 Intratumoral Immunotherapy Injections for Melanoma with Dr. Jennifer McQuade and Dr. Rahul Sheth

    When standard-of-care checkpoint blockade fails in metastatic melanoma, how can oncologists and interventional radiologists join forces to turn around patient outcomes? In this episode of the BackTable Podcast, medical oncologist Dr. Jennifer McQuade and interventional radiologist Dr. Rahul Sheth join host Dr. Tyler Sandow to discuss the growing evidence for intratumoral oncolytics as a therapeutic strategy for frontline immunotherapy-refractory melanoma and the interdisciplinary work that is required for successful implementation in practice. --- SYNPOSIS The physicians review how engineered viral vectors, particularly RP1, complement checkpoint blockade through direct tumor lysis and immune activation, and summarize the IGNYTE trial data supporting their use in patients with metastatic melanoma refractory to anti-PD-1 and anti-CTLA-4 agents. The discussion then shifts to practical administration, highlighting the central role of interventional radiology in delivering these therapies to visceral and deep-seated lesions under image guidance. The doctors go on to address the nuances of patient and lesion selection, injection technique, and response assessment, including the importance of recognizing pseudo-progression. They place particular emphasis on the need for multidisciplinary collaboration and stakeholder buy-in efforts on the part of IRs seeking to integrate intratumoral oncolytic injections into their scope of practice. The episode concludes with a forward-looking discussion on the potential for expansion of oncolytic platforms into other solid tumors, underscoring this field as a growing, IR-forward frontier in cancer treatment. --- TIMESTAMPS 00:00 - Introduction02:28 - Immunotherapy Basics06:51 - How Oncolytic Viruses Work11:01 - IGNYTE Trials and Why IR Matters18:14 - T-VEC vs RP1 Indications and Logistics21:57 - Physician Communication and Multidisciplinary Treatment23:06 - RP1 Protocol and Administration Techniques30:28 - RP1 Safety Profile32:46 - Follow-Up Imaging and Response Assessment35:44 - Future Applications Beyond Melanoma41:42 - Final Thoughts and Closing Remarks --- RESOURCESWong MK, et al. RP1 Combined With Nivolumab in Advance Anti-PD-1-Failed Melanoma (IGNYTE). J Clin Oncol. 2025;43(33):3589-3599.https://doi.org/10.1200/jco-25-01346 IGNYTE-3 Trialhttps://clinicaltrials.gov/study/NCT06264180

    45 min

  6. 3 MAR

    Ep. 621 Techniques for Liver Metastases Ablation: Planning & Execution with Dr. Jonas Redmond

    With data increasingly positioning thermal ablation as a viable alternative to surgery for select liver metastases, the demands on the interventional oncologist have never been higher. Mastering the nuances of patient selection and precise margin assessment is now essential for ensuring effective disease control locally. In this episode of the BackTable Podcast, interventional radiologist Dr. Jonas Redmond of UC San Diego Health joins host Dr. Sabeen Dhand to discuss the current state of microwave ablation (MWA) in the management of oligometastatic liver disease, focusing on tumor assessment, preprocedural planning, and the integration of local and systemic therapies. --- This podcast is supported by: Varian IntelliBlatehttps://www.varian.com/products/interventional-solutions/microwave-ablation-solutions --- SYNPOSIS The conversation delves into the complexities of timing systemic versus local ablative therapies and explores questions surrounding adequate treatment margins. Dr. Redmond goes on to emphasize the need for operators to approach procedures with a high level of adaptability, advocating for interdisciplinary preprocedural planning and thoughtful modality selection. Exploring the complications that could arise from injury to adjacent viscera, the physicians speak to the critical importance of rigorous intraprocedural reassessment and discuss how modern software and robotics are transforming procedural precision and safety. Framing these MWA pearls within the context of recent clinical trials like COLLISION and ACCLAIM, the episode underscores the transition of interventional oncology from providing palliative services to increasingly curative solutions that may offer better prospects for patients with metastatic disease. --- TIMESTAMPS 00:00 - Introduction04:30 - Role of Local Therapy in Systemic Disease09:49 - Patient Selection and Treatment Modalities13:15 - Challenging Lesion Characteristics and Locations19:56 - Y-90 Radioembolization versus Microwave Ablation23:04 - Intraoperative Ablation and Combining Locoregional Modalities29:36 - Complications of Microwave Ablation in the Liver36:43 - Future of Ablation and Liver Metastases Treatment39:25 - Final Thoughts and Closing Remarks --- RESOURCES UC San Diego Health. Cryoablation and Arterial Infusion of SD-101 in Combination with Durvalumab and Tremelimumab.https://clinicaltrials.ucsd.edu/trial/NCT06710223 COLLISION trialhttps://clinicaltrials.gov/study/NCT03088150 ACCLAIM trialhttps://clinicaltrials.gov/study/NCT05265169

    46 min

  7. 27 FEB

    Ep. 620 Ergonomic Strategies for Radiologists: Preventing Back & Neck Pain with Dr. Keith Horton

    Better habits start now. Poor ergonomics in the angio suite lead to cumulative neck and back injuries, absenteeism, presenteeism, and even early retirement. This episode of the BackTable Podcast offers a guide on on how to improve your ergonomics in the the cath lab, featuring interventional radiologist Dr. Keith Horton and host Dr. Ally Baheti. --- SYNPOSIS Dr. Horton and Dr. Baheti discuss common setup mistakes (especially monitor and ultrasound placement), practical positioning guidance (neutral posture, monitor height/angle, table height at elbow level), lead considerations (two-piece vs one-piece, refitting with body changes, costs vs. injury), and procedural stressors from longer, more complex cases. Horton also reviews evidence and standards (including SIR guidance), highlights surgical ergonomics programs like Duke’s education-and-leadership model with scheduled microbreaks, and describes emerging mitigations such as augmented reality guidance, robotics, and “zero-gravity” lead systems, emphasizing that strain prevention and intentional setup are essential for career longevity. --- TIMESTAMPS 00:00 - Introduction01:43 - Defining Ergonomics04:52 - Common Setup Mistakes07:31 - Neutral Posture Basics09:02 - Lead Fit And Support12:33 - Fighting Bad Room Design14:46 - Augmented Reality Workflow17:11 - Leadless Shielding Options20:53 - Repetitive Strain Tactics25:06 - Future Tech On Horizon27:56 - Maternity Lead Frustrations30:22 - Why Incentives Misalign32:45 - When Ergonomics Fails33:59 - Duke Program Blueprint37:02 - Tools Monitor Table Setup39:05 - Microbreaks That Stick42:46 - Room Setup Realities47:08 - Reminders and Wrap Up

    50 min

  8. 24 FEB

    Ep. 619 Clinical Insights: Managing LUTs in BPH Patients with Dr. Art Rastinehad

    Prostate artery embolization may be performed by interventional radiologists, but its indications are rooted in urologic evaluation. In the second installment of our 2026 PAE University Series, Dr. Chris Beck is joined by Dr. Art Rastinehad of Northwell Health, a urologist with formal interventional radiology training, to share how his dual background informs both when to offer PAE and how to execute it thoughtfully. --- This podcast is supported by an educational grant from Guerbet. --- SYNPOSIS Dr. Rastinehad discusses his path from urology into IR and how that combined training shapes his current hybrid practice. He outlines a practical BPH consult framework grounded in urologic evaluation, emphasizing appropriate imaging, careful patient selection, and the importance of ruling out malignancy before proceeding with embolization. From his perspective, durable outcomes begin with disciplined workup and clear counseling around expectations, including sexual side effects and alternative treatment options. The conversation then turns to procedural strategy. Dr. Rastinehad reviews anatomic considerations, large-gland and technically challenging cases, and his experience incorporating liquid embolics into PAE. He compares glue and particles, detailing workflow decisions, medication strategy, and post-procedure management. Throughout, he highlights scenarios where PAE may not be the most appropriate intervention and how other BPH tools may better serve the patient. The episode concludes with a discussion of the future of PAE, including questions of training, collaboration between specialties, and reimbursement; underscoring the value of cross-specialty insight in contemporary BPH care. --- TIMESTAMPS 00:00 - Introduction01:26 - Interventional Urologist with IR Roots04:13 - Leaving Urology for IR: Fellowship Life, Case Volume & Mentors08:45 - Building a Hybrid Urology/IR Practice14:32 - PAE Benefits, Sexual Side Effects & Why MRI Matters17:39 - BPH Consult Playbook22:17 - Anatomy Deep Dive24:27 - Edge Cases & Big Glands28:24 - Why Glue?35:39 - Glue vs Particles39:40 - Post-PAE Follow-Up41:28 - Antibiotics and Medications46:18 - Tough Cases50:53 - The Future of PAE --- RESOURCES Early Outcomes of Prostatic Artery Embolization using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Safety and Feasibility Studyhttps://pubmed.ncbi.nlm.nih.gov/39074551/ Dr. Rastinehad’s Websitehttps://drrastinehad.com/

    57 min
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The BackTable Podcast is a resource for interventional radiologists, vascular surgeons, interventional cardiologists, and other interventional and endovascular specialists to learn tips, techniques, and the ins and outs of the devices in their cabinets. Listen on BackTable.com or on the streaming platform of your choice. You can also visit www.BackTable.com to browse our open access, physician-catered knowledge center for all things vascular and interventional; now featuring practice tools, procedure walkthroughs, and expert guidance on more than 40 endovascular procedures.

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