BackTable Vascular & Interventional

BackTable
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  • VARJE VECKA

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. Ep. 641 Understanding BCLC Updates & Guidelines with Dr. Neil Mehta and Dr. Riad Salem

    −2 D

    Ep. 641 Understanding BCLC Updates & Guidelines with Dr. Neil Mehta and Dr. Riad Salem

    With recent updates to the Barcelona Clinic Liver Classification (BCLC), how should multidisciplinary teams adapt their treatment strategies to accommodate the newest evidence? In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, Dr. Neil Mehta of UCSF and Dr. Riad Salem of Northwestern Medicine join host Dr. Tyler Sandow to explore the complexities of hepatocellular carcinoma (HCC) therapies and the practical application of the latest global algorithms in balancing standardized therapeutic algorithms with individual patient factors. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:54 - HCC Case Discussion08:05 - Guest Introductions10:37 - BCLC Committee and 2025 Update15:54 - CUSE and Tumor Board Goals17:46 - Bridging vs Curative Y9022:37 - Patient Factors in Treatment Algorithms26:41 - Liver Function and Hyperbilirubinemia Trends30:25 - HCC Treatment Decision Ownership34:36 - Radiation Segmentectomy vs Surgical Resection37:35 - BCLC B Heterogeneity41:51 - Improving HCC Risk Stratification43:48 - Final Thoughts and Closing Remarks --- More about this episode The discussion begins with an inside look at the consensus process behind the 2025 BCLC updates, highlighting the official inclusion of Y90 radioembolization as a recognized therapeutic option. The experts introduce the "CUSE" (Complexity, Uncertainty, Subjectivity, and Emotion) framework to provide a structured approach to the subjective considerations that modulate purely data-based algorithms in multidisciplinary decision-making. Dr. Salem and Dr. Mehta speak on the nuances of surgical resection versus radiation segmentectomy in a case-based discussion, highlighting how factors such as portal hypertension, patient age, and etiology of cirrhosis should influence treatment pathways. Finally, they underscore the paradigm shift toward pursuing complete pathonecrosis (CPN) as a primary curative goal, regardless of bridging status, and reiterate that success in HCC care is driven by continuous communication and collaboration between physicians and patients. --- Resources BCLC 2026 Updatehttps://doi.org/10.1016/j.jhep.2025.10.020 ---BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    47 min

  2. −6 D

    Ep. 640 Hepatic Arteriography and C-Arm CT-Guided Liver Ablation with Dr. M.L.J. Smits

    When a liver tumor is hard to see, the limits of conventional image guidance can become the limits of treatment. In this episode of the BackTable Podcast, Netherlands interventional oncologist Dr. Maarten (M.L.J.) Smits shares a step-by-step walkthrough of the new hepatic arteriography and C-arm CT–guided ablation (HepACAGA) technique, punctuated with a real-world case series at the end. Find out how intra-arterial contrast, cone-beam CT, and 3D needle guidance can improve tumor conspicuity, targeting accuracy, and ablation margin assessment within a single angiography suite. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:55 - Netherlands Tech Access04:31 - Origin of HepACAGA07:14 - Why Use a Catheter?11:24 - Tools and Setup13:13 - Catheters and Devices17:06 - Contrast Protocol Basics22:51 - Targeting and Needle Guidance31:09 - Patient Selection35:56 - Extra Benefits and Multimodal39:58 - Workflow and Outcomes46:14 - Evidence and Early Studies51:41 - Rethinking Size Cutoffs57:54 - HCC Case Walkthrough01:02:27 - Hard-to-See Metastasis01:06:22 - Margin Driven Reablation01:11:04 - Bleeding and Embolization01:16:05 - Renal ACAGA Expansion01:23:31 - Adoption and Next Steps --- More about this episode Dr. Smits explains the origins of HepACAGA and why catheter-based contrast delivery can meaningfully change ablation planning, particularly for small lesions, poorly visualized tumors, and cases where ultrasound or conventional CT guidance may be insufficient. He walks through the practical setup, including catheter positioning, contrast dilution, timing protocols, needle navigation, apnea/end-expiration technique, and built-in fusion for immediate ablation verification. He also describes how the angio suite environment supports multimodal treatment, including intraprocedural embolization when bleeding occurs or when additional transarterial therapy is needed. The episode also examines early outcomes from Dr. Smits’ group, including a reported reduction in local recurrence from approximately 25% to 5%, with a modest increase in procedure time. Case examples include HCC, small colorectal liver metastases, margin-driven re-ablation, hemorrhage management, and extension of the ACAGA concept to renal tumors (RenACAGA). --- Resources Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablationhttps://pubmed.ncbi.nlm.nih.gov/37704863/ Renal Arteriography and C-arm CT-Guided Ablation (RenACAGA) for Thermal Ablation of Challenging Renal Tumorshttps://pubmed.ncbi.nlm.nih.gov/40295401/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    1 tim 27 min

  3. 28 APR.

    Ep. 638 Navigating Prostate Artery Embolization in the OBL Setting with Dr. Charles Nutting

    BackTable Vascular & Interventional

    39 min

  4. 24 APR.

    Ep. 637 Navigating Healthcare & Surgery in Conflict Areas with Dr. Ahmad Hussain

    Vascular trauma care looks a lot different when the OR is improvised, supplies are limited, and limb salvage decisions cannot wait. On this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Ahmad Hussain, a Southern California private-practice “hired gun” who volunteered on a WHO/UN-coordinated humanitarian mission to Gaza after an orthopedic colleague requested vascular surgeons due to widespread limb loss. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:02 - Why Volunteer In Gaza?07:41 - Logistics and Crossing Into Gaza10:45 - Hospital as Refugee Camp13:34 - First Vascular Trauma Case18:24 - Mass Casualty Triage23:20 - Kids Guiding Doctors27:09 - Evacuation Uncertainty32:03 - Would You Go Back?37:55 - How to Volunteer39:30 - Show Wrap Up and Credits --- More about this episode Dr. Hussain describes entering through the Rafah border with suitcases of medical supplies, working in a hospital functioning as a refugee camp for tens of thousands, and treating shrapnel-related vascular trauma with limited imaging (mainly ultrasound and X-ray), scarce anesthesia, and minimal surgical resources, relying heavily on skilled local medical students and residents. He recounts mass-casualty triage, the emotional impact of caring for injured children, bonding with the children who assisted the volunteers, and the dangerous, militarized evacuation via Israel with U.S. embassy assistance. He says he wants to return, but notes tightened restrictions and dwindling aid, and he recommends other organizations, noting any specialty of medical professionals should consider volunteering. --- Resources Gift of Disability Alleviation (GODA)https://indushospital.ca/appeal/gift-of-disability-alleviation-goda/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    42 min

  5. 21 APR.

    Ep. 636 Shoulder Embolization for Adhesive Capsulitis & Tendinopathy with Dr. Yan Epelboym

    For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:42 - Dr. Yan Epelboym’s Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts --- More about this episode The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization. --- Resources Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/ Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050 --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    1 tim 12 min

  6. 17 APR.

    Ep. 635 Methodical Approach to Adrenal Vein Sampling with Dr. Zoe Miller

    Your guide to better planning, access, and sampling. In this episode of the BackTable Podcast, we revisit every IR’s favorite procedure with Dr. Zoe Miller, Assistant Professor of Clinical Interventional Radiology and Associate Program Director at the University of Miami. Together with host Dr. Ally Baheti, Dr. Miller walks through a methodical approach to adrenal vein sampling to help you overcome common procedural challenges and reliably point your patients towards the proper therapies. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:26 - Preprocedural Workup Basics06:21 - Planning CT Utility and Protocol08:46 - Access Strategy10:36 - Procedure Day Preparation12:12 - Catheters and Side Holes15:44 - Adrenal Vein Selection Techniques18:50 - Troubleshooting Right Adrenal Vein Selection24:34 - Sample Acquisition Coordination27:38 - Aspiration Flow Optimization29:34 - Preventing Reintervention and Vessel Damage34:06 - Post-Procedure Follow-Up35:46 - AVS in Cushing Syndrome39:38 - Mentorship and Sourcing Knowledge39:25 - Closing Remarks --- More about this episode The physicians outline the key aspects of the pre-procedural workup, from setting expectations with patients to the utility of CT in operative planning. Dr. Miller provides a detailed exploration of strategies and tools for achieving safe access of the adrenal veins, particularly on the right side, and obtaining adequate samples. She emphasizes the importance of collaboration, both within the IR team and with other specialists, to ensure maximal procedural yield and to ultimately provide patients with valuable guidance in their treatment. The episode concludes with a discussion of the challenges presented by co-secreting tumors in hormone level assessment as well as the value of seeking out data and the experiences of mentors in developing your own best practices as an IR. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    43 min

  7. 14 APR.

    Ep. 634 Understanding Intravascular Lithotripsy in the OBL with Dr. Nicholas Petruzzi

    What do the 2026 coding changes mean for the financial viability of IVL in the OBL? In this episode of the BackTable Podcast, host Dr. Ally Baheti sits down with Dr. Nicholas Petruzzi to break down how intravascular lithotripsy fits into OBL workflows, and how upcoming lower-extremity revascularization coding updates may impact outpatient economics. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Shockwave Medicalhttps://shockwavemedical.com/ --- Timestamps 00:00 - Introduction02:35 - 2026 Coding Changes Overview05:18 - Where IVL Codes Apply06:35 - Iliac Reimbursement Impact08:50 - IVL vs. Atherectomy11:54 - BTK Reality and Future14:44 - When IVL Is Not Ideal16:05 - Catheters and Setup Basics17:50 - Sizing and Technique Tips23:01 - Javelin Forward Emitter26:25 - Wrap Up --- More about this episode The episode starts with a walkthrough of the key 2026 coding updates, including territory-based coding, new IVL add-on codes for aorto-iliac and fem-pop segments, the introduction of below-the-ankle codes, and the shift toward ‘simple’ versus ‘complex’ designations. From there, the conversation focuses on where IVL makes sense clinically and operationally, particularly as an alternative or complement to atherectomy, with discussion of low embolization risk seen in the DISRUPT PAD trial and the potential to avoid distal protection in select cases. Dr. Petruzzi shares how he approaches IVL in the lab, including catheter selection, sizing, low-pressure technique, and repositioning strategies. They also touch on workflow considerations in the OBL and preview newer concepts like the forward-emitting Javelin device for heavily calcified lesions and situations where device exchange is limited. --- Resources DISRUPT PAD III RCThttps://shockwavemedical.com/en-eu/clinical-evidence/pad-iii-rct/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    26 min

  8. 10 APR.

    Ep. 633 Pelvic Venous Disease: Causes, Symptoms and Treatments with Dr. Deepak Sudheendra

    How do you differentiate between iliac vein compression, gonadal vein reflux, and Nutcracker syndrome in patients with chronic pelvic pain? Dr. Deepak Sudheendra, director and interventional radiologist at 360 Vascular Institute, joins host Dr. Ally Baheti to share his approach to evaluating and managing pelvic venous disease (PVD). --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:43 - PVD Demand at Penn06:42 - Approach & Algorithm12:08 - Variation in Iliac Vein Compression15:58 - Treatment Approaches19:20 - Important Ultrasounds22:15 - Intra-Procedural Workflow31:14 - Iliac Vein Stenting and Avoiding Complications36:31 - Gonadal Vein Embolization and Working with Patients42:20 - Iliac Vein Embolization and Post-Op Care --- More about this episode Dr. Sudheendra's clinical algorithm for diagnosing PVD emphasizes the importance of patient history and specific symptoms over isolated cross-sectional imaging findings. He shares his approach to the pre-procedural workup, highlighting the necessity of a standing venous reflux ultrasound to rule out superficial venous insufficiency. Beyond the technical steps, Dr. Sudheendra emphasizes the "soft skills" of managing a venous practice: counseling patients on conservative treatments like pelvic floor therapy, explicitly setting expectations about postoperative back pain, and avoiding unnecessary bilateral stents in young women. Dr. Sudheendra details his intra-procedural workflow for diagnosing and treating PVD, providing a look into his unique preference for right internal jugular (IJ) vein access to perform venograms and place iliac vein stents. He explains how this approach allows him to consistently check inflow from the lower extremities, and shares his techniques for performing gonadal vein embolizations and accurately sizing iliac vein stents to prevent lifelong complications. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    49 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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