How are new aspiration thrombectomy systems and real-time hemodynamic monitoring enabling safer, more effective pulmonary embolism treatment? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Maya Serhal and Dr. David Dexter for a deep dive into modern pulmonary embolism (PE) management, with a focus on advances in large-bore aspiration thrombectomy. They discuss evolving PE triage algorithms, real-world procedural strategies, and the clinical impact of next-generation aspiration systems on safety, efficiency, and patient recovery. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Imperative Care https://imperativecare.com/ --- Timestamps 00:00- Introduction02:03- PE Response Workflow05:32- Symphony Device07:07- Sizing and Blood Loss10:00- Multi-Port Hemodynamics14:45- Procedure Endpoints17:01- IVUS Guided Strategy20:02- ProHelix and Lollipopping25:48- Case Studies34:12- Closing Thoughts --- More about this episode The conversation explores multidisciplinary PE response workflows, lab and imaging triggers for escalation, and technical considerations in catheter sizing, blood loss management, and real-time hemodynamic monitoring. Dr. Dexter reviews his use of intravascular ultrasound for precise clot localization, and Dr. Serhal shares practical tips for adjusting aspiration power to avoid complications. Together, they discuss procedural endpoints, mechanical assist devices for difficult clots, and present case examples demonstrating rapid improvement in hemodynamics and oxygenation. The episode emphasizes the importance of teamwork, patient selection, and ongoing innovation in optimizing PE care. --- Resources American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolismhttps://ashpublications.org/bloodadvances/article/4/19/4693/463998/American-Society-of-Hematology-2020-Guidelines-for Prospective Multicenter IDE Study of the Next-Generation Precision Aspiration Thrombectomy System for Intermediate-Risk Pulmonary Embolism: The SYMPHONY-PE Trialhttps://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.125.015815 Is There a Golden Hour for Thrombectomy in Intermediate-Risk Pulmonary Embolism? Insights From SYMPHONY-PEhttps://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.126.016573--- 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

Are you building a business that can thrive without you, or just creating a job you can never leave? In this episode of BackTable Women’s Health, host Dr. Karen Toubi sits down with Dr. Nneka Una (Unachukwu), a board-certified pediatrician, founder of Ivy League Pediatrics, and creator of EntreMD, to discuss the mindset and skills needed to build a truly sustainable medical practice. The conversation explores why physician entrepreneurship is essential in today’s evolving healthcare landscape, the difference between building yourself a job and building a resilient business, and practical strategies for long-term growth. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction04:47 - From Employee to Owner05:53 - Skills That Changed Everything07:35 - The Wake Up Call10:44 - Why Doctors Resist Business15:06 - Profit as Patient Care18:20 - Job vs. Business Entity21:13 - CEO Hat and Team Systems25:14 - Exit Value and Sellability29:00 - More Profit: More Time Off30:24 - Fear Before Breakthrough35:32 - Choose Service Over Perfection39:11 - Invest in Your Potential46:26 - MEAT Week Priorities48:40 - Three-Part Daily Rhythm55:02 - Advice for Burned-Out Docs59:29 - Wrap Up --- More about this episodeDr. Una shares how doctors can overcome resistance to “business,” why every practice needs a strong business engine, and how to balance profitability with ethical, people-centered care. She explains how to shift from employee to physician-CEO, tackle imposter syndrome, and develop systems that give your practice true staying power. The discussion provides actionable advice on hiring, team management, building exit value, and creating the freedom to take more time off without sacrificing patient care or financial stability. --- ResourcesEntreMD https://entremd.com/about-us/ The Profitable Private Practice Playbook https://entremd.com/method-book/ --- 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

How do you decide between a dedicated aortic scaffold and kissing stents in complex aortoiliac bifurcations? On this episode of the BackTable Podcast, Dr. Sabeen Dhand and Dr. Eric Secemsky discuss the management of a female smoker presenting with rapidly progressive bilateral hip pain, ultimately revealed to be severe aortoiliac arterial disease. The case highlights the value of noninvasive vascular studies, CTA, and IVUS for precise diagnosis and procedural planning, as well as the nuanced decision-making process between different device options. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:56 - Patient History05:42 - CTA and Angio Findings09:30 - Strategy Access and IVUS13:17 - IVUS Sizing and Lesion Review16:38 - IVL Angioplasty Technique18:28 - Stenting and Final Result22:50 - Post-procedure Meds and Outcome24:34 - Wrap Up --- More about this episode Dr. Secemsky reviews access strategy, lesion sizing, and the use of intravascular lithotripsy to reduce rupture risk in heavily calcified arteries. The doctors explain their rationale for choosing kissing covered stents over a dedicated aortic scaffold, details the technical steps of ballooning and stenting, and discusses the transition from dual antiplatelet therapy to rivaroxaban and aspirin postprocedure. The episode concludes with key insights into device selection, procedural technique, and patient-centered decision-making for successful aortoiliac interventions. --- 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

What do new interventional radiologists wish they had known before starting residency? On this reflective episode of BackTable, Dr. Neil Jain is joined by chief residents Dr. Aesha Patel and Dr. Gregg Khodorov as they look back on six years of IR/DR training. They share what they wish they’d known as applicants, from the growing emotional weight of complications near graduation to the essential role of co-residents, support networks, and the evolving balance between confidence and competence. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:34 - Rapid Fire Reflections07:20 - Complications and Confidence12:01 - Applicant Misconceptions16:54 - Defining a Great Program26:38 - Lessons Learned Over Time29:12 - Pearls and Hard-Won Lessons33:09 - Valuing Bread-and-Butter Cases35:24 - Complications and Empathy41:03 - Memorable Attending Phrases 43:06 - Habits for the Future47:34 - Mentorship and Craftsmanship52:42 - IR Culture and Professional Pride57:44 - The Future of IR Training01:08:34 - Closing Thoughts --- More about this episode They discuss how their definition of a “good case” has evolved, the importance of mastering bread-and-butter procedures, and the impact of habits like detailed note-taking, patient-centered communication, and taking ownership of complications. The episode highlights ideas for future training improvements and offers advice on valuing patient interactions, embracing growth, and developing sound clinical judgment under pressure. Throughout, the conversation underscores the personal and professional growth that comes from these challenges and the lasting value of camaraderie and mentorship in interventional radiology. --- Resources Perspective on the New IR Residency Selection Process: 4-year Experience at a Large, Collaborative Training Programhttps://www.sciencedirect.com/science/article/pii/S1076633221000568 Diversity in Interventional Radiology Residency Programshttps://www.sciencedirect.com/science/article/abs/pii/S1546144025002765 Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residencyhttps://www.sciencedirect.com/science/article/abs/pii/S107663322300051X --- 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

A bone biopsy can reach the target and still miss the diagnosis. In this episode of the BackTable Podcast, host Dr. Neil Jain is joined by Dr. Peter Thurlow to discuss how lesion selection, imaging review, trajectory planning, and device choice determine whether a targeted bone biopsy produces a useful sample without compromising future treatment. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byVarian https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction04:17 - Approaching Focal Bone Lesions06:17 - Differentiating Lesions and Pain Management13:13 - Settling on Bone Biopsy Imaging16:55 - Understanding Pre-Op Imaging from Lesion Characteristics 21:50 - Maintaining Communication Across Specialties24:21 - Which Devices To Select and Navigating Challenges32:28 - Trajectory Paths and Surgical Considerations35:30 - How to Avoid and Mitigate Biopsy Complications41:30 - Wrap Up --- More about this episode The conversation begins with a systematic approach to evaluating focal bone lesions, including the likelihood of malignancy, lesion location, number of lesions, and selection of an appropriately sized sampling device. Dr. Thurlow reviews anesthesia and pain-management strategies for both superficial and deeper osseous targets, as well as the respective roles of MRI and CT in procedural planning. For challenging lesions, he explains why needle-guidance technology may be preferable to adjusting gantry tilt and outlines how imaging findings and biopsy strategy should be tailored to lesion type, with particular attention to the difficulties associated with blastic lesions. The doctors also discuss the importance of communication with pathology, surgery, oncology, and other collaborating specialties before proceeding. Dr. Thurlow shares his preferred biopsy devices, considerations for selecting a safe trajectory, and ways to account for potential future surgical approaches. The episode concludes with practical strategies for avoiding complications, minimizing tissue injury, and obtaining an adequate diagnostic sample. --- 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

Genicular artery embolization (GAE) continues to gain traction worldwide, but is the evidence catching up to the hype? In this episode of BackTable Bone and Sports Podcast, host Dr. Kavi Krishnasamy welcomes Dr. Peter Minko, an interventional radiologist from Düsseldorf, Germany, to discuss GAE’s evolving evidence, techniques, and international practice patterns. Dr. Minko highlights forthcoming clinical trials and emphasizes the need for high-quality research to guide patient care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction03:13 - The Embolization Landscape in Germany07:25 - The Basics of GAE Patient Workup 13:49 - The Unideal Patient Candidate for GAE16:55 - Measuring Outcomes Beyond Clinical Scores23:14 - Procedure Specifics: Minko’s Choice36:28 - Discussing the Future of Temporary vs. Permanent Embolics43:47 - Collateral Flow Strategy and Procedure Wrap-Up49:05 - Post-Procedure Rehab Guidelines52:00 - Repeat GAE Treatment Algorithm 58:00 - Safety and Outcomes in Post-TKA Patients01:04:11 - GAE and Associations with the Hospital Anxiety and Depression Scale (HADS)01:09:40 - Call for Better Trials and Evidence in GAE01:14:11 - Case Presentation: GAE Transpedal Access Case01:21:05 - Case Presentation: “Three Stop Shop” Anastomosis 01:27:08 - Case Presentation: AV Fistula… Due to Arthroscopy?01:32:03 - Case Presentation: Popliteal Agenesis 01:38:14 - Dr. Minko’s Perspective on the Future of MSK Embolization01:40:55 - Wrap Up --- More about this episodeThe doctors break down procedural specifics, including embolic materials, access site and catheter choices, and strategies for patient selection and contraindications. They discuss post-procedure rehabilitation, approaches to repeat GAE, and unique considerations for patients with prior total knee arthroplasty. The discussion also features interesting case presentations, explores the future of temporary versus permanent embolics, and examines the importance of robust study design in advancing MSK embolization. Dr. Minko shares his perspective on the direction of the field and the collaborative effort needed to move GAE evidence and practice forward. --- ResourcesDr. Peter Minkohttps://www.researchgate.net/profile/Peter-Minko --- 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

What is the emerging role of bioresorbable scaffolds in treating tibial artery disease, and how do they compare with traditional stenting and drug delivery approaches? In this episode of the BackTable Podcast, Dr. Sabeen Dhand interviews interventional cardiologist Dr. Sahil Parikh at Columbia to explore the evolution of tibial artery stenting, drug-eluting technology, and the latest evidence behind bioresorbable scaffolds. The discussion highlights patient selection, treatment algorithms, technical considerations, and the impact of drug delivery choices on patient outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Abbott Cardiovascular https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system.html --- Timestamps 00:00 - Introduction04:00 - Bioengineering Origins08:29 - Paclitaxel vs. Limus 13:43 - When to Stent Tibials 16:14 - Stepwise Tibial Algorithm 18:46 - Stent Platforms and Costs 23:09 - Bifurcation Stenting Basics 26:35 - Fracture and Crush Risks 30:10 - Device Selection: Born for Tibials 33:27 - Materials and Drug Kinetics 36:57 - How to Deploy Safely 40:46 - Cost and Reimbursement Reality 43:21 - Market Growth and Competitors 48:02 - Paclitaxel Mortality Scare 51:13 - Final Takeaways and Access --- More about this episode Dr. Parikh reviews the differences between paclitaxel and sirolimus or limus agents, the historical dominance of paclitaxel in peripheral devices, and why peripheral therapy has lagged behind coronary interventions. He outlines a practical tibial treatment algorithm emphasizing crossing (often with retrograde access), imaging to assess calcium, lesion preparation (including IVL, specialty balloons, and atherectomy when needed), proper sizing, and bailout stenting for recoil or dissection, and addresses the unique challenges of distal placement, bifurcations, and occasional fractures. The discussion covers the evolution and rationale, absorption timeline, and clinical data for bioresorbable scaffolds, as well as reimbursement, emerging alternatives, and the ongoing debate over paclitaxel safety. Dr. Parikh also shares his perspective on the future of drug delivery, the need for payer support, and strategies for ensuring the best patient care across diverse clinical settings. --- Resources US Esprit™ BTK System Product Information (https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system.html?utm_medium=podcast&utm_source=backtable&utm_campaign=us-endo-esprit-btk&utm_division=vas&utm_product=esprit-btk&utm_content=kol&utm_type=other) US Esprit™ BTK System Important Safety Information (https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system/important-safety-information.html) Drug-Eluting Resorbable Scaffold versus Angioplasty for Infrapopliteal Artery Disease(https://pubmed.ncbi.nlm.nih.gov/37888915/) --- 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

With multiple training pathways, how can you determine which is the right choice for your career and clinical goals? In this episode of BackTable Podcast, Dr. Neil Jain sits down with interventional radiologist Dr. John Cieslak to compare the Early Specialization in Interventional Radiology (ESIR), integrated IR/DR, and independent IR routes. The conversation highlights practical differences in training structures, procedural exposure, and the key factors that influence career decisions for aspiring IRs. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:47 - Early Life and Science Roots 03:58 - Surgery to IR Pivot 05:51 - Radiology Training and ESIR Setup 08:59 - Three IR Training Pathways 11:53 - ESIR Pros Cons and Case Exposure 14:27 - Competency and Hiring Perceptions 20:12 - Job Market Academic vs Hospital 23:08 - Early Attending Surprises 26:00 - Integrated Versus ESIR 29:10 - Boosting Your Application 31:24 - Rapid Fire IR Questions 34:46 - Future Of IR 36:46 - Wrap Up And Credits --- More about this episode Dr. Cieslak shares his own journey, from early exposure to hospital science and a long academic path to switching from surgery to radiology and ultimately landing in IR. They outline the practical pros and cons of each pathway, including the flexibility and breadth of ESIR, the directness of integrated training, and the realities of re-matching and job market considerations. The discussion covers early attending challenges like building referrals and making independent decisions, the importance of multidisciplinary teamwork, and advice for residents and students interested in IR. The Drs. also discuss the evolution of IR procedures, the impact of program variability, and why persistence and exposure are vital for success in the field. --- 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

As endovascular technologies evolve, how are IRs maximizing control while minimizing metal in modern venous embolization? In this episode of the BackTable Podcast, Dr. Harris Chengazi joins host Dr. Sabeen Dhand to discuss the clinical impact, deployment techniques, and imaging advantages of modern vascular point embolization devices, focusing on targeted venous occlusion and variceal obliteration. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Okami Medicalhttps://okamimedical.com/ --- Timestamps 00:00 - Introduction02:22 - Multidisciplinary Vascular Practice Model05:51 - Understanding Plugs in Embolization08:34 - Comparing Plugs, Coils, and Liquid Embolics13:48 - LOBO Occlusive Device16:12 - Plug Sizing and Vessel Measurement20:45 - Deliverability and Catheter Selection24:28 - Limitations of Point Embolization29:03 - PARTO Access and Technique32:46 - Other LOBO Use Cases34:33 - LOBO Deployment Mechanism36:23 - Cost Effectiveness of Embolics41:08 - Final Thoughts and Closing Remarks --- More about this episode Dr. Chengazi shares insights from incorporating vascular plugs into his embolization practice after training predominantly with coils. He highlights the features that distinguish modern devices like the LOBO from traditional plugs, including their unique nitinol weave, rapid occlusion, and predictable sizing and landing configuration. The physicians explore the utility and limitations of plugs in clinical scenarios including retrograde transvenous variceal obliteration, antegrade variceal embolization during TIPS creation, and tract embolization following percutaneous procedures. Dr. Chengazi furthermore shares specific procedural pearls for point embolization of varices, explaining how to facilitate deployment using a parallel access technique as well as how to position multi-lobed plugs across venous outflow segments to reliably treat large shunts with a single device. Finally, the physicians review the benefits of reduced imaging artifact on follow-up scans compared to traditional coil packs and liquid embolics as well as the impact of modern plug technology on healthcare costs, reinforcing the value of evidence-based device selection for optimal patient outcomes. --- Resources Kundaragi NG, et al. Measurement of Inferior Vena Cava to Shunt Distance in Deciding Access Route for Balloon-Occluded Retrograde Transvenous Obliteration Procedure: A Pilot Study. Am J Interv Radiol. 2018 Sep 19;2(16):1-9.https://dx.doi.org/10.25259/AJIR-22-2018 --- 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

How is portal vein embolization (PVE) pushing the boundaries of liver tumor resectability, and what does it take to induce hypertrophy without compromising the remnant liver? In this episode of the BackTable Podcast, interventional radiologist Dr. David Madoff of Yale University joins Dr. Michael Barraza to discuss the pathophysiological rationale, technical considerations, and emerging clinical paradigms of performing PVE to augment the future liver remnant (FLR) prior to resection and reduce the risk of postoperative liver failure. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protectionhttps://www.radpad.com/ --- Timestamps 00:00 - Introduction02:14 - IO Practice and Research07:25 - PVE Indications and Adequate FLR12:55 - Referrals and Patient Selection17:27 - PVE vs. Y90 Radiation Lobectomy22:12 - Liver Venous Deprivation25:31 - Measuring FLR Function30:11 - Procedural Planning and Technique36:36 - Preferred Embolic Agents and Challenges46:58 - Ipsilateral vs. Contralateral Access50:52 - Complications, Medications, and Follow-Up55:45 - Final Thoughts and Closing Remarks --- More about this episode The physicians dissect the anatomic and oncologic benchmarks used to select PVE candidates, including FLR volumetric thresholds for normal, steatotic, and cirrhotic livers. Dr. Madoff walks through his procedural technique, detailing catheter maneuvers and embolic administration, emphasizing the importance of evaluating for anatomic variants, and explaining the benefits of using an ipsilateral approach to protect the FLR. The doctors critique ongoing debates in hepatic augmentation, assess the complementary relationship between PVE and Y90 radioembolization, and discuss the outcomes and risks associated with different embolic agents. They stress the importance of patient selection and assessment protocols that go beyond static volumetric measurements to incorporate functional parameters for better prediction of regenerative kinetics and clinical outcomes. The episode concludes with a review of postprocedural follow-up and potential complications, highlighting the importance of considering pathophysiologic dynamics of both the tumor and the anticipated liver remnant to ensure successful treatment. --- Resources DRAGON Trialhttps://www.dragontrial.com/ Three hundred and one consecutive extended right hepatectomies: Evaluation of outcome based on systematic liver volumetryhttps://doi.org/10.1097/SLA.0b013e3181b674df Portal vein embolization with N-butyl-cyanoacrylate improves liver hypertrophy compared to microparticles – A Swedish multicenter cohort studyhttps://doi.org/10.1016/j.heliyon.2023.e21210 --- 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