280 episodes

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.

BackTable Vascular & Interventional BackTable

    • Health & Fitness
    • 4.8 • 98 Ratings

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.

    Ep. 269 Innovating on Educational Meetings (on site at Paris Vascular Insights) with Dr. Lorenzo Patrone and Dr. Isabelle Van Herzeele

    Ep. 269 Innovating on Educational Meetings (on site at Paris Vascular Insights) with Dr. Lorenzo Patrone and Dr. Isabelle Van Herzeele

    • 21 min
    Ep. 268 Atherectomy Basics with Dr. Omar Saleh and Dr. Srini Tummala

    Ep. 268 Atherectomy Basics with Dr. Omar Saleh and Dr. Srini Tummala

    In this episode, host Dr. Sabeen Dhand interviews Drs. Srini Tummala and Omar Saleh about atherectomy in peripheral arterial disease, including indications, technique, and device selection.

    ---

    CHECK OUT OUR SPONSORS

    BD Rotarex Atherectomy System
    https://www.bd.com/rotarex

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

    ---

    SHOW NOTES

    We begin by overviewing the definition of atherectomy and the types of devices. Atherectomy is a procedure that involves the removal of plaque or thrombus and is categorized as a vessel preparation procedure. It is often done before angioplasty and stenting. The goal of the procedure is to obtain luminal gain, meaning that the diameter of the lumen of an artery becomes closer to its original size. There are a variety of devices that allow for different techniques in atherectomy, including rotational, orbital, laser, and directional. They all offer a degree of plaque modification or debulking of the lesion to improve outcomes for angioplasty with or without stenting.

    Next, we discuss indications for atherectomy. Both Dr. Saleh and Dr. Tummala begin a peripheral arterial case by doing a full lower extremity angiogram to guide their next steps. They also rely heavily on intravascular ultrasound (IVUS), as this helps determine if the lesion is made of thrombus, calcified, or soft plaque. The type of plaque they find via IVUS as well as the primary location of the plaque will determine which device they will proceed with. There is some controversy regarding atherectomy in regard to its indications and efficacy, mostly due to the lack of randomized control trials and overall data scarcity. Despite this, both Dr. Saleh and Dr. Tummala use atherectomy as vessel prep when they plan on treating a lesion with percutaneous transluminal angioplasty (PTA), either alone or followed by a stent.

    Finally, we discuss each operator’s advice for those new to atherectomy or treating peripheral arterial disease (PAD), their most used devices, and their thoughts on performing atherectomy in the subintimal plane (outside of the true vessel lumen). Both operators frequently use rotational excisional atherectomy devices and orbital devices. The specific device varies depending on their setting (OBL vs. hospital), but they recommend choosing a couple of devices and learning how to use them well. When it comes to atherectomy in the subintimal space, both Dr. Tummala and Dr. Saleh recommend against doing this, as it is not an indication for any of the devices, and it risks complications such as the device getting stuck. To avoid doing atherectomy in the subintimal plane, they IVUS as far down the vessel as they can to determine if there are any segments that are subintimal. In legs with only a single runoff vessel or no runoff, they are more conservative with atherectomy due to the risk of embolizing smaller vessels and causing even worse flow to the extremity.

    ---

    RESOURCES

    Liberty 360 Trial:
    https://csi360.com/clinical-evidence/liberty-360/

    BD Rotarex Rotational Atherectomy System:
    bd.com/rotarex

    • 52 min
    Ep. 267 Treatment Algorithms for Severe Venous Disease with Dr. Raghu Kolluri

    Ep. 267 Treatment Algorithms for Severe Venous Disease with Dr. Raghu Kolluri

    In this episode, Dr. Aaron Fritts interviews Dr. Raghy Kolluri, the system medical director of Vascular Medicine at OhioHealth, about his workup and treatment algorithm for severe venous disease.

    ---

    CHECK OUT OUR SPONSOR

    Medtronic Abre Venous Stent
    https://www.medtronic.com/abrevenous

    ---

    SHOW NOTES

    To start, Dr. Kolluri reviews the CEAP (Clinical, Etiological, Anatomical, Physiological) classification of venous disorders and describes how patients commonly get referred to his practice. The majority of his patients fall into the C4 through C6 category (presenting with skin changes, lipodermatosclerosis, and/or recurrent ulcerations) and get referred by podiatrists and wound care clinics. Dr. Kolluri feels that treating severe venous disease is very rewarding because he has the opportunity to manage outcomes from a vascular and overall clinical standpoint.

    Next, Dr. Kolluri walks through a typical workup. He emphasizes the importance of taking a thorough history, with special focus on past DVT, trauma, and foreign body placement (stents, filters, DeWeese clips). These characteristics could be evidence for deep venous disease. On the other hand, a venous ulcer with a more benign history signifies superficial venous disease. An ultrasound venous insufficiency study, as well as CT venogram, will determine location and severity of disease. If both superficial and deep venous disease are present, Dr. Kolluri will first address the deep disease.

    He outlines Varithena, radiofrequency ablation, endovascular laser ablation, and foam sclerotherapy as treatment options. Varithena and foam sclerotherapy are endovascular options for patients with tortuous veins. However, Varithena should not be used in patients at high risk for venous thromboembolism, as there is less precise control over treatment. Most commonly, Dr. Kolluri relies on radiofrequency ablation. He also describes his method for laser ablation and foam sclerotherapy with sodium tetradecyl sulfate. Additionally, Dr. Kolluri shares his innovative Sclerotherapy-Assisted Phlebectomy (SAP) technique and how it increases accuracy and minimizes blood loss. He emphasizes that phlebectomy of the saphenous vein should not be overused, as it can preclude the possibility of future bypasses. Overall, his background in thrombosis and anticoagulation helps him customize treatment for each individual patient.

    The doctors focus on a central theme that venous insufficiency is a chronic and progressive disease, and continued follow up is essential. This involves management of co-existing conditions like lymphedema, peripheral arterial disease (PAD), and infected ulcers. Collaboration with other medical and surgical specialties, occupational therapists, and the patients themselves is essential for ensuring that patients can make appropriate lifestyle changes and follow up throughout their disease course. Finally, Dr. Kolluri shares insight on the push to make vascular medicine an ABIM-certified specialty.

    ---

    RESOURCES

    Ep. 111- Underutilization of Foam Sclerotherapy:
    https://www.backtable.com/shows/vi/podcasts/111/underutilization-of-foam-sclerotherapy

    CEAP Classification of Venous Disorders:
    https://www.ncbi.nlm.nih.gov/books/NBK557410/

    Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers:
    https://www.jvascsurg.org/article/S0741-5214(10)02617-0/fulltext

    American Vein and Lymphatic Society (AVLS):
    https://www.myavls.org/annual-congress-2022.html

    Foam Sclerotherapy Augmented Phlebectomy (SAP) Procedure for Varicose Veins: Report of a Novel Technique:
    https://www.ejvesreports.com/article/S2405-6553(18)30044-6/fulltext

    OSU Lymphedema Center:
    https://cancer.osu.edu/for-patients-and-caregivers/learn-about-cancers-and-treatments/specialized-treatment-clinics-and-centers/lymphedema-center-of-excellence

    The clinical characteristics of lower extremity lymphedema in 440 patients:
    https://pubmed.ncbi.nlm.nih.gov/31992537/

    • 57 min
    Ep. 266 Practice Building in a Traditional IR/DR Practice with Dr. David Johnson

    Ep. 266 Practice Building in a Traditional IR/DR Practice with Dr. David Johnson

    In this episode, host Dr. Michael Barraza interviews interventional radiologist Dr. David Johnson about practice building in an IR/DR group, including factors that make a good job, and how he formed one of the largest PAE practices in the Southeast.

    ---

    CHECK OUT OUR SPONSOR

    Viz.ai
    https://www.viz.ai/

    ---

    SHOW NOTES

    Dr. Johnson found his current job, his first out of fellowship, via a job board. His wife, an ER physician, was looking for a job at the same time, which complicated their search slightly. They ultimately found their current positions by being flexible and understanding that no job is perfect. Dr. Johnson believes that when searching for a job, “you can't let the best be the enemy of the good.” What he was looking for in a job was a practice where he could do a lot of IR in a situation where he could build the IR practice that he wanted. He notes that this is something you should try to find out beforehand during the job search because, at some practices, it’s very difficult to change the way things work and the types of procedures they do. One of the most important things to consider and something he recommends to anyone looking for an IR job is the potential for growth. He cautions that this is a long game you must be ready to play. You can't expect to come in and change or build a practice in 2-3 years.

    After he found his footing and established himself in his new job, he began to grow his practice by finding out what the need was in his community. He started by marketing multiple service lines and seeing which would stick. He did this so that he could feel things out and see which physicians ended up referring to him, and which didn’t. It can be hard to balance practice building while in a combined DR/IR practice due to your DR responsibilities, due to quotas and RVUs. He says that you need to keep your mind on the long game in this situation. He did this by talking to at least one clinician every day about a patient he could help in some way. He figured that if he did this for two years, he would slowly get his name out and build a referral base. Most of these calls were low yield, but it paid dividends for him in the long run. About 1-2 years in, he began getting calls from physicians that he had talked to asking if he could do something for a patient.

    Finally, Dr. Johnson speaks on how he approached prostate artery embolization (PAE), a procedure that previously didn’t exist in Fort Myers, FL, and used it to turn his practice into one of the biggest PAE centers in the Southeast. He thought of the procedure as a challenge, which he was looking for, and he knew there was a need in the community, so it was something he realized could grow. He didn’t know how to do PAE, but he turned to the STREAM Meeting to learn the technique. He stresses that this was not a fast process. It took 18 months from when he attended STREAM to when he got his first patient on the table. His first patients were self-referred. He built referrals by doing the procedure well and garnering good outcomes. Importantly, he provided good consults and follow-ups, always making sure to include a follow-up with their urologist to whom they reported the good results. To help his clinic run successfully, he had to hold himself accountable to ensure things got done. He relies heavily on digital reminders as well as a great medical assistant who does most of his scheduling. For his PAE patients, who often experience post-PAE syndrome, it is important to him to be available for them; he doesn't want them to feel abandoned. He gives them his cell phone and tells them to call him day or night. It is important to him to be more than just the technician. He wants to be there for them, to be the first person they call, to be their physician. He also believes closing the loop with referring providers is crucial to maintain rapport and a strong stream of new referrals.

    ---

    RESOURCES

    STREAM Meeting:
    https://www.thestreammeeting.com

    • 50 min
    Ep. 265 The TheraSphere Story with Dr. Riad Salem and Peter Pattison

    Ep. 265 The TheraSphere Story with Dr. Riad Salem and Peter Pattison

    In this crossover episode between BackTable VI and BackTable Innovation, Dr. Chris Beck interviews Dr. Riad Salem (Chief of Interventional Radiology at Northwestern University) and Peter Pattison (President of Interventional Oncology at Boston Scientific) about how TheraSpheres for Y90 radioembolization became a mainstay in the IR toolkit for HCC and where the technology is heading next.

    ---

    CHECK OUT OUR SPONSOR

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

    ---

    EARN CME

    Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/PvWJlD

    ---

    SHOW NOTES

    To begin, Peter outlines how the original concept of TheraSpheres began at the University of Missouri, as a collaboration between Drs. Delbert Day and Gary Ehrhardt, who combined their ceramic and nuclear chemistry expertises to create radioactive glass beads and published a paper in 1987. After animal and human testing, the product was licensed to the company Nordion, where Peter worked. The product was given a humanitarian device exemption (HDE) from the FDA, which allowed TheraSpheres to be used for investigational purposes.

    In the late 1990s, Dr. Salem was in his early interventional oncology career and heard about TheraSpheres. He recognized the enormous potential that this technology had to ensure known amounts of radioactive doses were delivered to the tumor and minimize adverse effects. In fact, he noticed that his Y90 patients had less pain, post-embolization syndrome, and hospitalization than his transarterial chemoembolization (TACE) patients. In the mid 2000s, he collected and submitted data to various conferences and journals, but he was met with criticism from the IR world, which was more comfortable with TACE, since it was the current standard of care.

    In 2011, Nordion decided to run a clinical trial, EPOCH, which eventually showed that the addition of TARE to systemic therapy for colorectal metastases to the liver led to longer progression free survival.

    Dr. Riad has focused his efforts on training more IRs on the methodology of Y90, since this was an important step to increasing adoption and minimizing missteps with the new technology. He believes that the advent of Y90 has resulted in better angiography, since IRs are more cognizant of off-target embolization. Dr. Salem also petitioned at the US Nuclear Regulatory Committee to allow IRs to become the authorized users for Y90 injection and advocated to add TARE to the National Comprehensive Cancer Network guidelines for liver cancer. Both of these developments allowed TARE to become more widely adopted.

    Finally, Peter discusses the competition that TheraSpheres has faced from TACE and SIRSpheres (resin-based radioembolization). He shares exciting new developments that have occurred since acquisition by Boston Scientific. These include exploration for the extra-hepatic use of TheraSpheres in glioblastoma and prostate cancer.

    ---

    RESOURCES

    BackTable Ep. 223- Portal Vein Recan #ReCanDoIt with Dr. Riad Salem:
    https://www.backtable.com/shows/vi/podcasts/223/portal-vein-recan-recandoit

    Therapeutic Use of 90Y Microspheres:
    https://pubmed.ncbi.nlm.nih.gov/3667306/

    A phase I dose escalation trial of yttrium-90 microspheres in the treatment of primary hepatocellular carcinoma:
    https://pubmed.ncbi.nlm.nih.gov/1327493/

    Hepatic radioembolization with yttrium-90 containing glass microspheres: preliminary results and clinical follow-up:
    https://pubmed.ncbi.nlm.nih.gov/7931662/

    Humanitarian Device Exemption:
    https://www.fda.gov/medical-devices/premarket-submissions-selecting-and-preparing-correct-submission/humanitarian-device-exemption

    EPOCH Trial:
    https://ascopubs.org/doi/full/10.1200/JCO.21.01839

    Radioembolization with 90Yttrium Microspheres: A State-of-the-Art Brachytherapy Treatment for Primary and Secondary Liver Malignancies:
    https://www.jvir.org/article/S1051-0443(07)60901-4/fulltext

    • 1 hr 1 min
    Ep. 264 The Halo Effect with Dr. Sandeep Bagla

    Ep. 264 The Halo Effect with Dr. Sandeep Bagla

    In this episode, cohosts Dr. Aparna Baheti and Dr. Aaron Fritts interview interventional radiologist Dr. Sandeep Bagla about “The Halo Effect”, including how to recognize when you are being subjected to bias, and how to critically evaluate bad outcomes to improve your practice and enhance patient safety.

    The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/FSZCxF

    ---

    CHECK OUT OUR SPONSORS

    Accountable Physician Advisors
    http://www.accountablephysicianadvisors.com/

    Accountable Revenue Cycle Solutions
    https://www.accountablerevcycle.com/

    ---

    SHOW NOTES

    Dr. Bagla begins by describing the halo effect. The halo effect describes the tendency for people to overestimate the value of individual positive attributes when evaluating the whole. Thiis can happen when we form our opinions of people, techniques, and even medical devices. The opposite is also true, named the horn effect, where we tend to overestimate negative attributes. They are both forms of bias. In interventional radiology, the halo effect can impact case outcomes by contributing to operator tunnel vision and the reluctance to waver from the desired way of executing a procedure.

    For Dr. Bagla, the idea of the halo effect came about while working with new colleagues, many of whom do things differently than he did. He realized that in IR, physicians do things a certain way because that’s how they learned in training, whether it really is the safest and best way, or just the most familiar. He also sees the horn effect occur often when people start using a new device. If the device doesn’t work well for them the first time, many often refuse to use it in the future based on that first experience. He summarizes by noting that in IR, there are so many opportunities to become biased, whether through the halo effect or the horn effect.

    Lastly, Dr. Bagla reviews how he works to avoid these inherent biases. The first step in overcoming this bias is to understand its presence. Next, you must stop and realize that what you are doing is not working, whether due to the procedural approach, the device, or the way you are using the device. Dr. Bagla believes we must be critical of ourselves and try to think outside of our preferred wire, catheter, or device. In order to do this, you must go through the steps and review your checklist in order to determine which step the problem occurred at. Only by doing this can you avoid falling victim to these biases that are so prevalent in medicine.

    ---

    RESOURCES

    BackTable Episode 195: Disclosures of Conflicts of Interest
    https://www.backtable.com/shows/vi/podcasts/195/disclosures-of-conflicts-of-interest

    • 1 hr 2 min

Customer Reviews

4.8 out of 5
98 Ratings

98 Ratings

CTAgony ,

Top class show

Love to hear real world stories with great educational content

rog_iR ,

Great podcast

Great podcast

Tntb8406 ,

Great educational content

Awesome content on a variety of clinical topics pertinent to IR and practice building.

Top Podcasts In Health & Fitness

Scicomm Media
Jay Shetty
Ten Percent Happier
Peter Attia, MD
Aubrey Gordon & Michael Hobbes
Lysa TerKeurst

You Might Also Like

Society of Interventional Radiology
Freakonomics Radio + Stitcher
Dr. Jim Dahle of the White Coat Investor
TED
Freakonomics Radio + Stitcher
Guy Raz | Wondery