BackTable Vascular & Interventional

BackTable
  • 4.8 (145)
  • Medicine
  • Updated Weekly

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. 2h ago

    Ep. 657 Advanced Techniques in Y90 Cancer Treatment with Dr. Beau Toskich and Dr. Juan Gimenez

    What do you do when Y-90 doesn’t deliver the results you expected? In this episode of the 2026 HCC Creator Weekend™, host Dr. Tyler Sandow is joined by Drs. Beau Toskich and Juan Gimenez to discuss the technical challenges and troubleshooting strategies that can make or break a Y-90 radioembolization case. Together, they explore innovative approaches like the PREDATr technique, share tips for reducing complications, and offer guidance on optimizing outcomes for patients with complex liver tumors. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction04:24 - Treatment Nonresponse Troubleshooting06:12 - Navigating Y90 Through Replaced Arteries09:09 - Mitigating Vasospasm in Embolization13:31 - What is ‘PREDATr’?21:12 - Dual Balloon Microcatheter System23:37 - Gelfoam Techniques and Application26:06 - Embolization Agents Preferences36:16 - Concerns with Cystic Artery Treatment and Biliary Stents42:15 - Prophylactic Antibiotics 44:29 - Utilizing High Lung Shunts49:28 - Wrap Up and Credits --- More about this episode The conversation begins with case-based examples of HCC radioembolization, focusing on how to assess treatment response and troubleshoot nonresponsive cases. They discuss how to interpret SPECT findings, identify missed tumor supply with cone-beam CT, and overcome obstacles such as vasospasm, extrahepatic feeders, and challenging arterial anatomy. They introduce the PREDATr technique (proximal radioembolization enabled by distal angiozone truncation) and explain how tools like gelfoam, balloons, and retrievable coils can preserve healthy liver tissue and improve microsphere delivery. The episode also addresses managing biliary stents, using antibiotic prophylaxis, and strategies for handling high lung shunts, making it a practical resource for anyone navigating the complexities of Y-90 treatment. --- 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

    52 min

  2. 4d ago

    Ep. 656 Advanced Practices in Uterine Fibroid Embolization with Dr. Francis Kang and Dr. Neil Resnick

    Are new technologies and teamwork the key to better fibroid treatment? In this episode of the BackTable Podcast, Drs. Francis Kang and Neil Resnick join host Dr. Chris Beck to share how multidisciplinary treatment planning is reshaping uterine fibroid management, from patient selection and referral patterns to procedural techniques that improve outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byTriSalus Life Scienceshttps://trinavinfusion.com/ --- Timestamps00:00 - Introduction06:18 - Multidisciplinary Care of Fibroids15:45 - Treatment Decisions21:56 - Managing Asymptomatic Fibroids25:43 - Collaborative vs. Competitive Practices30:01 - UFE Procedure Approaches34:32 - Comparing Embolic Sizes and Amounts37:44 - Changes in Speed Using TriNav Catheters40:53 - Tactile Feedback at Stasis42:28 - Embolization Target Regions44:45 - Encountering and Troubleshooting Collaterals47:30 - Post-Op Pain Regiments57:28 - Wrap Up --- More about this episodeThe conversation begins with the importance of strong partnerships with OBGYN colleagues and how multidisciplinary planning leads to better outcomes for patients. They explore patient selection and education, especially for those considering surgical versus minimally invasive treatment options. Drs. Kang and Resnick compare procedural approaches, including when to use femoral versus transradial access, nerve blocks, and embolic particle selection. They also discuss strategies to achieve optimal embolization endpoints and practical tips for handling collateral vessels, avoiding non-target embolization, and managing post-procedural pain and recovery. The episode concludes with a look at newer technologies like the TriNav Catheter and its impact on embolization speed, operator confidence, and early imaging outcomes.--- 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

    59 min

  3. Jun 16

    Ep. 655 Managing Large Liver Tumors: Strategies and Challenges with Dr. Beau Toskich, Dr. Chris Malone, and Dr. Tyler Sandow

    How is Y90 radioembolization rewriting the rules for managing large HCC tumors and creating new curative-intent therapeutic pathways where palliation was once deemed the only option? In this episode of the 2026 HCC Creator Weekend™, interventional radiologists Dr. Chris Malone (WashU), Dr. Tyler Sandow (Ochsner Health), and Dr. Beau Toskich (Mayo Clinic Florida) join host Dr. Zach Berman for a case-based discussion on advanced dosimetric strategies and embolization approaches for large and complex HCC lesions. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Boston Scientific. --- Timestamps 00:00 - Introduction01:59 - Case 1: Ablative Dosing to Solitary Tumor04:38 - Post-Treatment Residual Arterial Enhancement07:35 - Case 2: Tumor with Multiple Feeding Arteries10:02 - Role of Combination with Immunotherapy13:01 - Case 3: Large Caudate Tumor16:03 - Approach to Extrahepatic Arterial Supply19:14 - Case 4: Tumor Adjacent to Viscera21:32 - Does Microsphere Count Matter?24:10 - Case 5: Radioembolization in HCC Downstaging28:18 - Dosing Paradigms for Large Tumors33:06 - Case 6: Pressure-Augmented Delivery35:16 - Case 7: Multifocal Disease and Satellite Lesions37:47 - Palliative Dosimetry vs. Radiation Lobectomy40:11 - Significance of Complete Pathonecrosis43:25 - Closing Remarks --- More about this episodeThe physicians discuss systematic approaches to patient selection, the nuances of MIRD single-compartment versus multi-compartment dosing, and the critical role of precise mapping and particle dynamics in optimizing treatment for heterogeneous tumors. The panel also examines how to navigate the risks and situational challenges of delivering high radiation doses to large central and multifocal tumors. They address practical concerns such as responding to post-treatment imaging changes, managing long-term risks like biliary strictures, and ensuring the safety of treating disease near mobile viscera. The specialists highlight the power of Y90 in successful downstaging, citing evidence of its superior potential to achieve complete pathological necrosis (CPN) at explant when compared with other modalities. Ultimately, they advocate for a bold, collaborative approach within the multidisciplinary tumor board, encouraging providers to employ combination therapies and advanced technologies to optimize patient outcomes and expand the boundaries of curable HCC. --- Resources Yttrium-90 Radioembolization for the Treatment of Solitary, Unresectable HCC: The LEGACY Studyhttps://doi.org/10.1002/hep.31819 A US Study to Evaluate Transarterial Radioembolization (TARE) in Combination With Durvalumab and Bevacizumab Therapy in People With Unresectable Hepatocellular Carcinoma Amenable to TARE (EMERALD-Y90)https://clinicaltrials.gov/study/NCT06040099 TheraSphere With Durvalumab and Tremelimumab for HCC (ROWAN)https://clinicaltrials.gov/study/NCT05063565 Personalized versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trialhttps://doi.org/10.1016/S2468-1253(20)30290-9 Downstaging Outcomes for Hepatocellular Carcinoma: Results From the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) Consortiumhttps://doi.org/10.1053/j.gastro.2021.07.033 --- 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

    45 min

  4. Jun 12

    Ep. 654 Advances in PE Treatment Guidelines with Dr. Jay Giri and Dr. Trevor Cummings

    Will new PE guidelines redefine risk and therapy in pulmonary embolism (PE) care? In this episode of the BackTable podcast, host Dr. Michael Barraza is joined by interventional cardiologist Dr. Jay Giri and emergency physician Dr. Trevor Cummings to break down the latest changes in PE management. They discuss how multidisciplinary pulmonary embolism response teams (PERT) are implementing these guidelines at their institutions, the introduction of a more nuanced A-E risk stratification system, and the challenges of enrolling experienced centers into clinical trials as device innovation accelerates. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Stryker Peripheral Vascular, formerly Inari Medicalhttps://www.inarimedical.com/flowtriever-system --- Timestamps 00:00 - Introduction 01:24 - Building a PERT Team04:59 - Trials Shaping PE Care 10:20 - Why New Guidelines Now 14:06 - New Risk Categories Explained 19:51 - Applying Guidelines Locally 23:34 - What Is C1 Risk 27:52 - New D Category Explained 30:33 - Evidence for Aggressive Therapy 33:31 - How PERT Teams Communicate 38:22 - Upcoming PE Trials Pipeline 43:42 - Program Growth and High Risk Trials 45:46 - Closing Remarks --- More about this episode The conversation highlights the growth of catheter-directed lysis and mechanical thrombectomy, the rationale and practical impact of the new Category D for incipient cardiopulmonary failure (including normotensive shock), and the incorporation of PESI, sPESI, and Hestia for risk assessment. Additional topics include decision-making for low-risk patients, lactate and biomarkers for identifying higher-risk cases, communication strategies within PERT teams, AI-enabled risk stratification, and a preview of upcoming trials (PEITHO, PRAGUE-26, PEERLESS-2, PE-TRACT, and PERSEVERE) that are set to further transform PE care. --- Resources Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement From the American Heart Associationhttps://pubmed.ncbi.nlm.nih.gov/21422387/ Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Associationhttps://pubmed.ncbi.nlm.nih.gov/36688837/ Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Associationhttps://pubmed.ncbi.nlm.nih.gov/31585051/ Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolismhttps://pubmed.ncbi.nlm.nih.gov/41910345/ PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolismhttps://pubmed.ncbi.nlm.nih.gov/39132600/ Rationale and design of the PE-TRACT trial: A multicenter randomized trial to evaluate catheter-directed therapy for the treatment of intermediate-risk pulmonary embolismhttps://pubmed.ncbi.nlm.nih.gov/39638275/ Reduced-Dose Intravenous Thrombolysis for Acute Intermediate–High-risk Pulmonary Embolism: Rationale and Design of the Pulmonary Embolism International THrOmbolysis (PEITHO)-3 trialhttps://pubmed.ncbi.nlm.nih.gov/34560806/ Design and rationale of the PERSEVERE study: a randomized controlled trial of large-bore mechanical thrombectomy versus the standard of care for high-risk pulmonary embolism https://pubmed.ncbi.nlm.nih.gov/41453591/ Design and rationale of PRAGUE-26: a multicentre, randomised trial of catheter-directed thrombolysis for intermediate-high risk acute pulmonary embolismhttps://pubmed.ncbi.nlm.nih.gov/40464677/ --- 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

  5. Jun 9

    Ep. 653 Radiation Lobectomy Techniques & Downstaging for HCC with Dr. Beau Toskich and Dr. Chris Malone

    How can targeted liver radiation unlock surgical or transplant options for tough hepatocellular carcinoma (HCC) cases? In this episode of BackTable 2026 HCC Creator Weekend™ host Dr. Kavi Krishnasamy is joined by interventional radiologists Dr. Beau Toskich and Dr. Chris Malone to explore how downstaging and radiation lobectomy with Y-90 are creating new surgical and transplant opportunities for patients with limited future liver remnants. They discuss Y-90’s role as a “test of time” for tumor biology, strategies to prevent post-hepatectomy liver failure, and the ongoing challenge of recurrence even after R0 resection in cirrhotic livers. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction01:31 - Rad Lobectomy Goals and Case Discussion06:09 - Selective vs Lobar Dosing07:51 - PVE Versus Y9009:35 - Downstaging to Transplant13:03 - Patient Selection Factors19:22 - Radseg vs. Lobar Strategy22:12 - Percent Liver Treated Debate26:38 - Particle Density and Catheter Bias28:04 - Downstaging Evidence MERIT LT36:20 - Operating After Y9041:25 - Hypertrophy Timing and Readiness43:03 - Wrap Up --- More about this episode The discussion features a case of massive right-lobe HCC in a non-cirrhotic patient, with stepwise Y-90 dosing and selective retreatment leading to complete response and marked liver hypertrophy. The doctors compare radiation lobectomy with portal vein embolization (PVE), explore dosimetry advances from studies like DOSISPHERE and MERITS-LT, and stress the importance of careful mapping and patient selection. Additional topics include the pros and cons of different downstaging methods, functional imaging to assess risk, the impact of lab values and portal hypertension, and the practicalities of timing surgery after Y-90. --- Resources Long-Term Overall Survival After Selective Internal Radiation Therapy for Locally Advanced Hepatocellular Carcinomas: Updated Analysis of DOSISPHERE-01 Trialhttps://jnm.snmjournals.org/content/early/2024/01/10/jnumed.123.266211 Downstaging hepatocellular carcinoma before liver transplantation: A multicenter analysis of the "all-comers" protocol in the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) consortiumhttps://pubmed.ncbi.nlm.nih.gov/37532179/ --- 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

    45 min

  6. Jun 5

    Ep. 652 Central Venous Recanalization: Techniques & Challenges with Dr. Gian Paolo Zamboni

    When hemodialysis-dependent patients exhaust all conventional venous access options, how do IRs navigate complex central occlusions to provide a lifeline? In this episode of the BackTable Podcast, Dr. Gian Paolo Zamboni of Clínica Alemana in Santiago, Chile joins guest host Dr. Neil Jain to discuss workup protocols and advanced technical algorithms for complex central venous recanalization cases. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protectionhttps://www.radpad.com/ --- Timestamps 00:00 - Introduction03:06 - IR Practice and Referrals in Santiago07:19 - Pre-Procedure Workup15:06 - Standard Recanalization Techniques20:14 - Dual-Access Sharp Recanalization24:43 - Needle Maneuvers and Alternatives29:32 - Predilation, IVUS, and Stent Sizing37:42 - Transhepatic Technique and Indications45:45 - Tract Closure, Anticoagulation, and Follow-up50:03 - Advice and Closing Remarks --- More about this episode The physicians review the critical role of pre-procedural planning, emphasizing the necessity of thorough workup with CT venography to accurately assess remaining vascular capital. Dr. Zamboni shares how his group addresses severe central venous occlusions, outlining a structured, stepwise approach that begins with standard maneuvers and progresses to sharp recanalization techniques before opting for dual-access approaches. He outlines critical safety measures, highlighting the importance of performing intraprocedural cardiac ultrasound, pre-dilating with caution, and keeping covered stents on the shelf to prevent fatal cardiac tamponade. For patients who lack viable conventional iliofemoral and IVC access, Dr. Zamboni shares an advanced jugular-to-transhepatic strategy, walking through the steps and nuances of creating a reliable working route, optimizing inflow, and managing post-procedure anticoagulation. Finally, Dr. Zamboni offers invaluable advice for IRs on mastering foundational techniques before tackling advanced cases and building strong, collaborative relationships with referring providers. --- 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

    56 min

  7. Jun 2

    Ep. 651 Radioembolization Workflow: Insights & Best Practices with Dr. Nima Kokabi and Dr. Kirema Garcia-Reyes

    What does it really take to run a high-volume Y-90 program that is efficient, scalable, and patient-centered? In this episode of BackTable 2026 HCC Creator Weekend™, host Dr. Zach Berman is joined by Drs. Nima Kokabi and Kirema Garcia-Reyes to break down the systems, workflows, and strategies that drive successful radioembolization centers. The conversation focuses on overcoming referral and insurance delays, implementing multidisciplinary clinics, and using tools like single-session Y-90 and routine post-treatment dosimetry to reduce treatment times and improve outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction04:46 - Multidisciplinary Model on Radioembolization08:39 - Referral Pathways and Embolization Preferences13:18 - Y-90 Follow Up and Imaging15:51 - Procedure Preparation and Involvement18:00 - Dosimetry Planning and Software ROI22:59 - Analyzing Outcomes and Quality Control26:47 - Various Ways to Expedite Treatments34:04 - Wrap Up and Credits --- More about this episode The doctors discuss the importance of robust internal systems for patient selection, integration of dosimetry planning, and standardized follow-up protocols.They share insights on procedural workflows, including best practices for dosimetry ownership and equipment setup, and highlight the growing role of post-Y-90 dosimetry as both a quality control measure and a billable service. The episode also explores the order-map-treat paradigm, the impact of multidisciplinary tumor boards and clinics, and how single-session strategies are reshaping HCC care by cutting delays, reducing costs, and enhancing the patient experience. --- 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

    36 min

  8. May 29

    Ep. 650 IVC Filters: Indications, Techniques, & Best Practices with Dr. Daniel O'Neal

    Routine doesn’t mean risk-free. What should be considered before, during, and after inferior vena cava (IVC) filter placement? In this episode of the BackTable Podcast, interventional radiologist Dr. Daniel O’Neal (Ohio State University) joins guest host Dr. Jessica Yoon to walk through the workup protocols, technical considerations, and multidisciplinary approaches required for placing and following up on IVC filters. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protectionhttps://www.radpad.com/ --- Timestamps 00:00 - Introduction02:10 - IVC Filter Basics07:37 - Workup and Contraindications12:18 - Pre-Procedural Imaging and Timing14:35 - Procedural Technique18:53 - Cavagram and Variant Anatomy23:18 - Filter Positioning and Deployment30:02 - IVC Filter Complications33:58 - Post-Placement Follow-Up39:14 - Final Thoughts and Closing Remarks --- More about this episode The physicians review the key indications for the procedure, highlighting evidence-based patient selection and emphasizing the need for interventional radiologists to critically assess the clinical workup rather than function merely as technicians. They discuss how a comprehensive pre-procedural workup relies on cross-sectional imaging to identify access obstacles and to plan for adequate filter placement in cases of variant anatomy. Dr. O’Neal also shares technical tips from the suite, including deployment mechanics, positioning considerations, and strategies for preventing common complications. The conversation concludes with the IR’s ongoing responsibility to ensure a robust, multidisciplinary follow-up system with referring specialties, outlining potential strategies to ensure these devices are safely retrieved in a timely manner when no longer indicated. --- 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
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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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