BackTable Vascular & Interventional BackTable
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- Salud y forma física
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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Ep. 452 The 'Woundosome' Concept with Dr. Lorenzo Patrone
In this episode, Dr. Ally Baheti interviews interventional radiologist Dr. Lorenzo Patrone about his recent multidisciplinary editorial entitled "The 'Woundosome' Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia.”
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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SYNPOSIS
Dr. Patrone explains his interest in critical limb ischemia (CLI) and describes how he reached out to colleagues around the world with the intention of drafting a paper that summarizes research in below-the-ankle interventions and increases awareness of the woundosome concept.
He explains the woundosome concept, which aims to understand how each patient’s foot vasculature influences the effectiveness of below-the-ankle interventions and tissue healing. Understanding each patient’s anatomy, having adequate imaging of the foot, obtaining pedal acceleration times, and using micro-oxygen sensors are strategies to assess wound perfusion, which is integral for treatment planning and prognosis. He illustrates these techniques in a case study of a non-healing wound.
Finally, Dr. Patrone shares some technical tips for below-the-ankle interventions, including the benefits of ipsilateral antegrade access, sheath selection, and strategic contrast administration.
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TIMESTAMPS
00:00 - Introduction
02:25 - Multidisciplinary and Global Collaboration
05:59 - Explaining the Woundosome Concept
07:51 - Understanding Wound Perfusion
10:20 - Assessing the Effectiveness of Revascularization
20:09 - Case Example with Pictures
28:07 - Technical Tips for CLI Interventions
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RESOURCES
Find Your Algorithm (FYA):
https://fya-congress.com/
The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia:
https://journals.sagepub.com/doi/10.1177/15266028241231745?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Vascular imaging of the foot: the first step toward endovascular recanalization (Manzi):
https://pubmed.ncbi.nlm.nih.gov/21997985/
BASIL-2 Trial:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00462-2/fulltext
BackTable VI Ep. 90- Pedal Acceleration Time for Limb Salvage with Jill Sommerset and Dr. Mary Constantino:
https://www.backtable.com/shows/vi/podcasts/90/pedal-acceleration-time-for-limb-salvage
The First-in-Man "Si Se Puede" Study for the use of micro-oxygen sensors (Montero-Baker):
https://pubmed.ncbi.nlm.nih.gov/26004327/
PEDRA Perfusion Monitoring:
https://www.pedratech.com/
Armada XT Balloon:
https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/peripheral-dilatation-catheters/armada-14.html -
Ep. 451 Comprehensive DVT Care: CLOUT Study Impacts with Dr. Nicolas Mouawad and Dr. Raja Ramaswamy
In this episode of the BackTable Podcast, vascular surgeon Dr. Nicolas Mouawad and interventional radiologist Dr. Raja Ramaswamy share their insights on the changing landscape of deep vein thrombosis (DVT) management, steps of mechanical thrombectomy, and current research on DVT interventions.
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Inari Medical
https://www.inarimedical.com/
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SYNPOSIS
The guests start by describing their typical referral patterns, noting that most cases come through the emergency department. In terms of workup, it is important to distinguish between acute and chronic DVTs and classify the thrombosis location as either proximal (femoral vein or higher) or distal. Anticoagulation, usually with direct oral anticoagulants, is always started, with efficacy largely determined by patient compliance.
Regarding endovascular intervention, thrombolysis may be an effective adjunctive treatment if the clot occurred within a two-week timespan, but it carries a bleeding risk and requires ICU monitoring. On the other hand, mechanical thrombectomy is an option for both acute and chronic clots, allows for intervention in patients with high bleeding risk, and does not require post-procedural hospitalization. Both physicians emphasize that interventions should be employed if there are long-term benefits of avoiding post-thrombotic syndrome and pulmonary embolism.
The physicians walk through a typical mechanical thrombectomy procedure, which involves the thrombectomy device, venogram, intravascular ultrasound, and possible stent placement. Finally, they discuss recent data, including the ATTRACT Trial for thrombolytics and the CLOUT Registry and Trial for ClotTriever use. Notably, they mention the DEFIANCE Trial as a current prospective randomized clinical trial for ClotTriever use in the iliofemoral region.
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TIMESTAMPS
00:00 - Introduction
03:48 - DVT Referral Patterns and Treatment Algorithms
08:55 - Choosing an Anticoagulation Regimen
11:01 - DVT Interventions
13:54 - Patient Scenarios and Treatment Decisions
22:29 - Post-Thrombotic Syndrome
26:16 - Mechanical Thrombectomy Technique
35:45 - Postoperative Care
39:09 - The Evolution of Mechanical Thrombectomy
43:38 - ATTRACT Trial
46:20 - CLOUT Trial
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RESOURCES
Inari ClotTriever System:
https://www.inarimedical.com/clottriever-system
ATTRACT Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa1615066
CLOUT Trial:
https://pubmed.ncbi.nlm.nih.gov/35218955/
DEFIANCE Trial:
https://evtoday.com/news/inari-medical-begins-defiance-randomized-clinical-trial-of-clottriever-system-in-dvt -
Ep. 450 The Hidden Struggles: Supporting Mental Health in Medicine Together, Not Alone with Dr. Jenanan Vairavamurthy
Trigger warning: This episode contains discussions about suicide.
In this episode of the BackTable podcast, interventional radiologist Dr. Jenanan Vairavamurthy shares about the tragic loss of his physician brother to suicide and discusses his own mental health journey. He highlights the immense pressures and challenges that medical training and practice impose on providers.
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SYNPOSIS
The discussion emphasizes the need for mental health awareness and the importance of creating supportive environments within the medical community. He advocates for open conversations about mental health struggles and urges those in leadership positions to prioritize the well-being of colleagues and trainees. This powerful conversation aims to destigmatize mental health issues in the medical field and encourages medical providers to seek and provide support for each other.
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TIMESTAMPS
00:00 Introduction
04:11 Assessing Personal Mental Health
06:31 Personal Tragedy and Mindset Shift
11:49 The Realities of Wellness in Medicine
21:59 Creating Supportive Environments Within Medicine
25:58 Navigating Personal and Professional Challenges
35:15 Building and Leading Supportive Networks
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RESOURCES
Physician Support Line:
https://www.physiciansupportline.com/ -
Ep. 449 Percutaneous Transmural Arterial Bypass: Updates on Technique and Data with Dr. Peter Soukas
In this episode, interventional cardiologist Dr. Peter Soukas joins us to discuss percutaneous transmural arterial bypass (PTAB) using the DETOUR system, a novel percutaneous treatment for extensive and complex blockages in the superficial femoral artery (SFA).
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Endologix
https://endologix.com/
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SYNPOSIS
Dr. Soukas shares his extensive experience and insights into PTAB development, benefits, patient selection, and procedural details. The idea behind PTAB is to create an SFA-to-popliteal artery bypass through endovascular means, using a system of overlapping stent grafts within the femoral vein as a conduit. When planning the procedure, it is important to consider the location of reentry into the popliteal artery, avoid calcified zones, and meet femoral vein size criteria. Additionally, we explore the advantages of PTAB over other endovascular options and traditional open surgical bypass, which carry a higher likelihood of restenosis and longer recovery times, respectively.
We also discuss the types of training and support available for physicians interested in adopting this technique, cost and reimbursement aspects, and the future direction of PTAB, including ongoing post-market studies.
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TIMESTAMPS
00:00 Introduction
02:38 Dr. Soukas’ Career in Vascular Medicine
05:19 Introduction to PTAB
13:00 Landing Zones
19:37 Stent Graft Sizing
23:14 Patient Selection and Adjunctive Medical Therapy
28:04 Procedural Risks
29:18 Navigating PTAB Implementation
32:20 Opportunities for Learning PTAB
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RESOURCES
PTAB with the DETOUR System:
https://endologix.com/ptab/detour/
Brown Vascular and Endovascular Fellowship:
https://brownmedicine.org/3/cardiology-vascular-endovascular-fellowship/
COMPASS Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa1709118
VOYAGER Trial:
https://www.nejm.org/doi/full/10.1056/NEJMoa2000052
DETOUR 2 Trial:
https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext -
Ep. 448 Below the Ankle Expertise: Distal Pedal Access with Dr. Marta Lobato
In this episode, Dr. Marta Lobato explores advanced endovascular techniques in below the knee (BTK) and below the ankle (BTA) interventions for critical limb ischemia (CLI). She introduces various skills that were developed and used by her team, such as the telescopic needle, buddy needle, balloon-assisted puncture, and vasodilation to prevent artery spasm. Dr. Lobato is a vascular surgeon at Hospital de Cruces in Barakaldo, Spain.
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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SYNPOSIS
The discussion covers the importance of visualizing the fifth metatarsal for effective lateral views in X-rays, the intricacies of accessing the lateral and medial plantar arteries, and the significance of starting with easier procedures before attempting more complex interventions. Additionally, Dr. Lobato highlights the role of social media in learning about innovative medical practices.
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TIMESTAMPS
00:00 - Introduction
05:54 - Below the Knee and Ankle Interventions
15:35 - Complexities of Zone 2 and 3 Access
23:12 - Buddy Needle Technique for Calcified Arteries
30:12 - Advanced Techniques for Supporting the Wire
34:13 - Vasodilator Use
37:12 - Balloon-Assisted Techniques
41:02 - Advancing Your Endovascular Skills
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RESOURCES
Tips and Tricks for Simple and Complex Below-the-Ankle Punctures:
https://pubmed.ncbi.nlm.nih.gov/38441118/
Buddy Needle Technique to Facilitate Retrograde Puncture of Heavily Calcified Tibial Vessels:
https://pubmed.ncbi.nlm.nih.gov/28587566/
Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach:
https://pubmed.ncbi.nlm.nih.gov/34989276/
Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures:
https://pubmed.ncbi.nlm.nih.gov/36415934/
The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia:
https://pubmed.ncbi.nlm.nih.gov/38523459/
New antioxidant therapy for hard-to-heal neuroischaemic diabetic foot ulcers with deep exposure:
https://pubmed.ncbi.nlm.nih.gov/37029973/
Percutaneous endovascular arteriovenous fistula creation for hemodialysis access using "off-the-shelf" conventional devices:
https://pubmed.ncbi.nlm.nih.gov/33251393/ -
Ep. 447 Exploring GAE: Clinical Insights and Outcomes with Dr. Mark Little
In this episode, Dr. Mark Little shares his insights about genicular artery embolization (GAE), implications for patients with knee osteoarthritis, possible applications in other MSK interventions, and the importance of research for advancing the field. Dr. Little is a consultant diagnostic and interventional radiologist at Berkshire Imaging and Visiting Professor at the University of Reading in England.
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Varian, a Siemens Healthineers company
https://www.siemens-healthineers.com/
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SYNPOSIS
The doctors also discuss challenges and considerations in patient selection, particularly concerning patients with comorbid peripheral arterial disease, and they further emphasize the need for high-quality research and collaboration within the IR community to continue improving MSK embolization practices.
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TIMESTAMPS
00:00 - Introduction
12:28 - Genicular Artery Embolization
24:30 - GENESIS 1 and 2 Studies
41:04 - Future of MSK Embolization
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RESOURCES
BackTable VI Episode 27 - Geniculate Artery Embolization for Osteoarthritis with Dr. Sandeep Bagla and Dr. Ari Isaacson:
https://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritis
BackTable VI Episode 85 - Genicular Artery Embolization for OA with Dr. Jafar Golzarian:
https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa
GEST MSK Annual Meeting:
https://thegestgroup.com/annual-msk-meeting/
GENESIS 1 - Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis:
https://pubmed.ncbi.nlm.nih.gov/33474601/
GENESIS 2 - Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/37337060/
Dr. Little Genicular Artery Anatomy Paper - Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis:
https://pubmed.ncbi.nlm.nih.gov/34657976/
Dr. Sid Padia’s Knee OA Research (UCLA) - Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis:
https://pubmed.ncbi.nlm.nih.gov/34703964/
Dr. Lars Lönn from Copenhagen Trial - Genicular Artery Embolization as Pain Treatment of Knee Osteoarthritis (GETKO):
https://classic.clinicaltrials.gov/ct2/show/NCT05360329
Dr. Anna Martinez from Spain Shoulder Study - Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment:
https://pubmed.ncbi.nlm.nih.gov/33135118/
Dr. Anna Martinez from Spain Shoulder Study - Clinical Outcomes of Transcatheter Arterial Embolization for Secondary Stiff Shoulder:
https://pubmed.ncbi.nlm.nih.gov/33478903/