BackTable Vascular & Interventional

BackTable

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. 3D AGO

    Ep. 577 Microwave Ablation for Liver Tumors: Techniques & Outcomes with Dr. Driss Raissi

    Is microwave ablation only for simple liver tumors, or can it be a versatile ‘Swiss Army knife’ for a wide range of complex cases? In this episode, Dr. Driss Raissi of the University of Kentucky returns to BackTable to join host Dr. Chris Beck for a deep dive into advanced and unconventional microwave ablation techniques. They cover strategies for tackling a wide range of cases, from desmoid tumors to enterocutaneous fistulas.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Raissi shares his ‘pre-burn’ technique that desiccates tissue and reduces complications like capsular burst and bleeding. He elaborates on his method for tackling large liver tumors with a single probe through overlapping ablations, needle placement techniques and his ‘lung seal technique’ to prevent pneumothorax. Dr. Raissi also shares how his previous experience in the ICU promotes close communication with anesthesiologists and how he ups his ablation game through collaboration, optimizing conditions for safe and effective ablation.The episode explores a series of unique, real-world applications beyond the usual scope of IRs. Dr. Raissi walks us through his novel approach to challenging cases, including cauterization of enterocutaneous fistulas, endometriomas and desmoid tumors. He also compares using microwave or cryoablation for renal cell carcinoma, explaining thought processes based on lesion location and the need for speed and simplicity. The discussion provides an overview of ablation physics and careful techniques that expand treatment possibilities for IR patients.---TIMESTAMPS00:00 - Introduction 04:08 - Advanced Techniques for Liver Tumor Ablation06:06 - Pre-Burning Ablation and Ablating a Range of Lesions16:38 - Lung Ablation22:00 - Partnering with Anesthesia28:53 - Managing Postoperative Pain and Nerve Injuries29:42 - Treating Enterocutaneous Fistulas, Endometriomas & Desmoid Tumors38:49 - Adrenal Gland Ablation: A Case Study44:50 - Microwave vs. Cryoablation for Renal Cell Carcinoma49:06 - Preventing Pneumothorax in Lung Ablation

    52 min
  2. SEP 26

    Ep. 576 Biliary Endoscopy Techniques: Managing Strictures & Drains with Dr. Ahsun Riaz

    So you’ve placed the biliary drain—are your patients getting the follow up that they need? In this episode, Dr. Ahsun Riaz from Northwestern University joins host, Dr. Christopher Beck, for a deep dive into biliary strictures—how to manage them effectively and navigate the potential complications of this challenging chronic condition.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Riaz takes us inside his journey of building a specialized hepatobiliary service at Northwestern, highlighting innovative practices like endoscopic techniques and radiofrequency ablation. He unpacks the nuances of distinguishing benign from malignant strictures, shares technical pearls for patient management, and emphasizes the power of collaboration with Gastroenterology to improve long-term patient outcomes. He outlines key technical considerations, including the use of the Hudson loop and strategic equipment selection to address intra-procedural challenges. He further emphasizes the importance of comprehensive patient care—ensuring appropriate follow-up, minimizing drain duration, and prioritizing quality of life as essential components of optimal management.---TIMESTAMPS00:00 - Introduction01:28 - Biliary Drain Management04:18 - Approach to Biliary Strictures19:20 - Endoscopic Evaluation and Techniques27:53 - Practical Tips and Experiences with Endoscopy30:39 - Post-Procedure Follow-Up and Patient Outcomes31:16 - Learning from the Hudson Roof Technique32:48 - Innovations in Benign Stricture Management36:48 - Endobiliary Ablation: Equipment and Procedure40:23 - The Double Dragon Technique Explained46:02 - Considerations for Malignant Biliary Stenting52:37 - Future Innovations and Collaborative Care

    57 min
  3. Ep. 575 Physician Employment Models: Exploring Benefits & Challenges with Dr. Ryan Trojan

    SEP 23

    Ep. 575 Physician Employment Models: Exploring Benefits & Challenges with Dr. Ryan Trojan

    Could hospital employment be your path to practicing 100% interventional radiology (IR)? In this episode of BackTable, host Dr. Ally Baheti sits down with Dr. Ryan Trojan, an interventional radiologist at INTEGRIS Health in Oklahoma City, to discuss the pros and cons of hospital employment contracts in IR.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISThe physicians take a deep dive into the evolving employment models in the IR landscape. Dr. Trojan shares his journey from a private IR-DR blended practice to becoming directly employed by a hospital, highlighting the financial challenges, contract negotiations, and administrative dynamics along the way. He explains the growing loss of IR talent to lucrative diagnostic contracts and emphasizes the importance of advocating for IR’s value to hospital systems, from decreasing length of stay to supporting ECMO, trauma, and transplant services. The discussion covers financial security, administrative support, and the benefits of having aligned goals with the hospital in order to grow an IR practice. Dr. Trojan also addresses common misconceptions about IR and private practice, detailing how the landscape is likely to change over the coming years, and offers advice on navigating employment contracts. ---TIMESTAMPS00:00 - Introduction03:02 - Transition to Hospital Employment12:15 - Advocating for IR’s Value16:07 - Contract Structures and Compensation Models25:07 - Benefits and Downsides of the Employed Model28:27 - Negotiating Contracts and Fair Market Value41:12 - Conclusion---RESOURCESDr. Trojan’s contact information:ryan.trojan@integrishealth.org

    43 min
  4. Ep. 574 MRI Guided Interventions: Techniques, Benefits, & Clinical Applications with Dr. Clifford Weiss and Dr. David Woodrum

    SEP 19

    Ep. 574 MRI Guided Interventions: Techniques, Benefits, & Clinical Applications with Dr. Clifford Weiss and Dr. David Woodrum

    Should MRI-guided interventions be on your radar? Find out why the future of interventional radiology might lie in MRI guidance with experts Dr. Clifford Weiss from Johns Hopkins University and Dr. David Woodrum from the Mayo Clinic.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISThe physicians join host Dr. Chris Beck to explore the benefits of MRI guided procedures, including superior imaging capabilities and reduced radiation exposure. Dr. Weiss and Dr. Woodrum detail the challenges and barriers to adoption, like the intricate set up needed to protect equipment from a strong magnetic field. They highlight the significant technological advancements and collaborations between MRI and device companies that are set to make MRI guided interventions more accessible and practical for everyday use. They also discuss the reimbursement paradigm for MRI guided biopsies and how similar the algorithm is to CT guided procedures.The episode closes with unique insights for young physicians on training opportunities and the promising future of MRI guided interventions for trainees looking to bring a different approach to their future practices.---TIMESTAMPS00:00 - Introduction05:13 - The Advantages of MRI in Interventional Radiology13:44 - Technical Insights and Challenges of MRI Guided Procedures18:46 - Future Prospects and Industry Developments in MRI Guided Interventions31:01- Development of Hybrid MRI Rooms48:19 - Economic Considerations and Reimbursement52:33 - Community Support for MRI Interventions56:41 - Conclusion and Final Thoughts---RESOURCESInternational Society for Magnetic Resonance in Imaging:https://www.ismrm.org/

    1 hr
  5. Ep. 572 How to Perform Mesocaval Shunts: Techniques & Outcomes with Dr. Omar Chohan and Dr. Harris Chengazi

    SEP 12

    Ep. 572 How to Perform Mesocaval Shunts: Techniques & Outcomes with Dr. Omar Chohan and Dr. Harris Chengazi

    Before the advent of TIPS, mesocaval shunts were considered a less popular option for managing portal hypertension. But today, could they serve as a lifeline when no other choices remain? This week on BackTable, Drs. Omar Chohan and Harris Chengazi (Great Lakes Medical Imaging) join host Dr. Chris Beck to discuss the evolving role of endovascular mesocaval shunts, covering patient selection, clinical decision-making, and technical pearls. --- SYNPOSIS In this episode, the hosts delve into the specialized procedure of meso-caval shunts, focusing on its applications for patients with portal hypertension who have no other viable options. This discussion includes detailed case studies, such as one involving a woman with autoimmune hepatitis and another with pancreatic cancer, showcasing the practical challenges and innovative solutions in creating these shunts. In each case, they detail the rationale for patient selection, difficult anatomy, procedural steps, and resolution of symptoms like recurrent ascites and variceal bleeding. The episode emphasizes the importance of pre-procedure planning, collaboration, and precise imaging, utilizing advanced tools like the 4D CT scanner. The conversation also highlights the compassionate motivation behind these complex procedures, aimed at improving patients' quality of life. --- TIMESTAMPS 00:00 - Introduction 03:07 - Historical Context and Indications06:49 - Case 1: Patient with Refractory Ascites34:00 - Case 2: Recurrent GI Bleeding41:16 - Case 3: TIPS Consult - Pancreatic Cancer and Duodenal Varices47:44 - Lessons, Pearls, and Tips56:13 - Final Thoughts --- RESOURCES A Case Series of Dr. Chengazi's Mesocaval Shunts on X:https://x.com/chengazimd/status/1966337167879438571 Episode 573 Portal Hypertension Treatment Strategies:https://www.backtable.com/shows/vi/podcasts/473/portal-hypertension-treatment-strategies-ir-hepatology-perspectives TIPS University Freshman Year:https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup TIPS University Sophomore Year:https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique TIPS University Junior Year:https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access TIPS University Senior Year:https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure

    1h 13m

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About

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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