Ep. 504 ¿Es la Embolización el Futuro? Hablemos de Emborrhoid con Dr. José Andrés Guirola Ortíz

BackTable Vascular & Interventional

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<div class="span index">1</div> <span><a class="" data-remote="true" data-type="html" href="/series/this-is-womans-work-with-nicole-kalil">This Is Woman's Work with Nicole Kalil</a></span>

1
This Is Woman's Work with Nicole Kalil

구독 취소

8 hours 전8h ago

구독 취소

주마다+

Together, we're redefining what it means, looks and feels like, to be doing "woman's work" in the world today. With confidence and the occasional rant. From boardrooms to studios, kitchens to coding dens, we explore the multifaceted experiences of today's woman, confirming that the new definition of "woman's work" is whatever feels authentic, true, and right for you. We're shedding expectations, setting aside the "shoulds", giving our finger to the "supposed tos". We're torching the old playbook and writing our own rules. Who runs the world? You decide. Learn more at nicolekalil.com

약 1년 전 34:10

MP3•에피소드 홈

En este episodio del BackTable, Dr. José Andrés Guirola Ortíz, radiólogo

intervencionista, aborda la embolización como tratamiento para las hemorroides,

mediante la técnica Emborrhoid y comparte su valoración de la embolización como

técnica de futuro.

---

SYNPOSIS

En primer lugar, la Dra. Sara Lojo Lendoiro le invita a explicar qué son las hemorroides

y porqué y cuando hay que tratarlas. Además, el Dr. Guirola Ortíz analiza la historia de

las hemorroides, sus síntomas y opciones de tratamiento. También se discuten las

indicaciones, técnicas y posibles complicaciones de la embolización hemorroidal, así

como el futuro de esta técnica dentro de la radiología intervencionista.

---

TIMESTAMPS

00:00 - Introducción al BackTable y Dr. Ortíz

01:56 - Entendiendo las Hemorroides: Historia y Conceptos Básicos

03:39 - Síntomas y Causas de las Hemorroides

07:36 - Opciones de Tratamiento para las Hemorroides

12:50 - Explicación de la Técnica de Embolización

19:25 - Complicaciones y Seguimiento

29:05 - Futuro de la Embolización y Conclusión

533 에피소드

#BackTable #Fitness #Podcasting Education #Medicine #Christoph Becker

BackTable Vascular & Interventional

Ep. 504 ¿Es la Embolización el Futuro? Hablemos de Emborrhoid con Dr. José Andrés Guirola Ortíz

BackTable Vascular & Interventional

14 subscribers

published 약 1년 전

MP3•에피소드 홈

En este episodio del BackTable, Dr. José Andrés Guirola Ortíz, radiólogo

intervencionista, aborda la embolización como tratamiento para las hemorroides,

mediante la técnica Emborrhoid y comparte su valoración de la embolización como

técnica de futuro.

---

SYNPOSIS

En primer lugar, la Dra. Sara Lojo Lendoiro le invita a explicar qué son las hemorroides

y porqué y cuando hay que tratarlas. Además, el Dr. Guirola Ortíz analiza la historia de

las hemorroides, sus síntomas y opciones de tratamiento. También se discuten las

indicaciones, técnicas y posibles complicaciones de la embolización hemorroidal, así

como el futuro de esta técnica dentro de la radiología intervencionista.

---

TIMESTAMPS

00:00 - Introducción al BackTable y Dr. Ortíz

01:56 - Entendiendo las Hemorroides: Historia y Conceptos Básicos

03:39 - Síntomas y Causas de las Hemorroides

07:36 - Opciones de Tratamiento para las Hemorroides

12:50 - Explicación de la Técnica de Embolización

19:25 - Complicaciones y Seguimiento

29:05 - Futuro de la Embolización y Conclusión

533 에피소드

#BackTable #Fitness #Podcasting Education #Medicine #Christoph Becker

همه قسمت ها

BackTable Vascular & Interventional

1
Ep. 521 Surgery for HCC: What’s its Role Today? 46:11

3일 전46:11

나중에 재생

리스트

46:11

Is surgery truly the "cure" for hepatocellular carcinoma (HCC), and when is it a viable option? In this episode, Dr. Sabeen Dhand leads a roundtable discussion with interventional radiologist Dr. Siddharth Padia and transplant/hepatobiliary surgeons Dr. John Seal and Dr. Gabriel Schnickel, delving into the complexities of surgical treatments for HCC and the evolving landscape of liver resection and transplantation. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125741 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The doctors begin by discussing how they manage patient expectations regarding both palliative and curative treatments, highlighting the risk of recurrent HCC as a new lesion. They then outline key factors that influence their recommendations for liver transplant versus resection, such as the extent of underlying liver disease, the function of the future liver remnant, body habitus, overall health, and organ availability. The surgeons also review various surgical approaches to liver resection and recent advancements in liver transplantation, including living donor transplants and the ability to refer patients for downstaging procedures. Dr. Padia explains the original role of Y90 as a bridging treatment to downstage tumors and promote hypertrophy in the non-diseased liver segments, preparing the organ for surgical resection. However, Y90 treatment can also lead to the formation of adhesions, which may complicate future surgeries. Finally, the doctors discuss strategies to improve care coordination between community physicians and transplant centers to optimize patient outcomes. --- TIMESTAMPS 00:00 - Curative vs. Palliative Treatment 04:03 - Choosing Between Transplantation and Resection 05:47 - Liver Resection Types 07:27 - Bridging Role of Y90 12:14 - Evolving Landscape of Liver Transplantation 20:59 - Patient Counseling in Minimally Invasive Procedures 28:40 - Considerations for Surgery After Y90 33:32 - Coordination Between Specialists 40:08 - Immunotherapy as a Bridge to Transplant --- RESOURCES CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf…

BackTable Vascular & Interventional

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Ep. 520 Frontiers in Musculoskeletal Embolization with Dr. Yuji Okuno 38:44

6일 전38:44

나중에 재생

리스트

38:44

Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/mvp --- SYNPOSIS The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization. Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide. --- TIMESTAMPS 00:00 - Introduction 01:54 - Origins of Embolization for Pain 04:15 - Basic Science Research Discoveries and Clinical Trials 09:02 - Temporary Embolic Materials 15:28 - Techniques for Embolization 17:33 - Plantar Fasciitis Treatment 24:04 - Future of Embolization in Sports Injuries 28:11 - Diagnostic Imaging in Embolization 36:10 - Global Expansion and Collaborations…

BackTable Vascular & Interventional

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Ep. 519 Transplantation for HCC: Who, When, and How? 45:00

10일 전45:00

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45:00

The process of liver transplantation involves many complexities, and each patient's path to transplant is unique. To offer insider perspectives on this process, Dr. Zachary Berman sits down with transplant and hepatobiliary surgeon Dr. John Seal, as well as transplant hepatologists Dr. Heather Patton and Dr. Steve Young. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125740 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The panel begins by discussing the multidisciplinary pre-transplant evaluation process, which assesses factors such as liver function, comorbidities, surgical risk, and the availability of psychosocial support. Once a patient is listed for transplant, they enter a system that prioritizes those with the highest Model for End-Stage Liver Disease (MELD) score. During the waiting period, several comorbidities should be carefully monitored. Dr. Seal explores the impact of portal vein hypertension and portal vein thrombosis, explaining how these conditions may necessitate intraoperative thrombectomy or bypass. Dr. Patton and Dr. Young focus on considerations for using anticoagulation in patients with a high baseline bleeding risk and selecting the appropriate anticoagulant for patients listed for transplant. For patients with hepatocellular carcinoma (HCC), eligibility for MELD exception points may depend on factors such as time spent on the waiting list, adherence to the Milan criteria, and the presence of extrahepatic complications of liver disease. The panel also discusses bridging therapies to transplant, including Y90 and TACE. In the peri-transplant phase, they highlight innovations such as living donor transplants, liver perfusion pumps, and the use of hepatitis C- and HIV-positive organs. Finally, the discussion turns to post-transplant considerations, including surgical complications, organ rejection, immunosuppression, predictors of HCC recurrence, and long-term surveillance. --- TIMESTAMPS 00:00 - Introduction 01:16 - Current Landscape of Liver Transplantation 03:22 - Transplant Evaluation Process 09:48 - Timeline from Listing to Transplantion 11:16 - Treating Portal Vein Thrombosis and Hypertension 18:44 - MELD Exception Points 22:05 - Bridging Therapies 25:34 - Peri-Transplant Considerations 30:53 - Post-Transplant Period 37:39 - Repeat Transplantation --- RESOURCES Model for end-stage liver disease (MELD) and allocation of donor livers (Wiesner et al, 2003): https://www.gastrojournal.org/article/S0016-5085%2803%2950022-1/fulltext Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis- Milan Criteria (Mazzaferro et al, 1996): https://pubmed.ncbi.nlm.nih.gov/8594428/ Validation of the prognostic power of the RETREAT score for hepatocellular carcinoma recurrence using the UNOS database (Mehta et al, 2019): https://pmc.ncbi.nlm.nih.gov/articles/PMC6445634/ CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf…

BackTable Vascular & Interventional

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Ep. 518 Long-Term Outcomes of Prostatic Artery Embolization (PAE) with Dr. Shivank Bhatia 54:27

13일 전54:27

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리스트

54:27

Do we finally have definitive data on the efficacy of prostate artery embolization (PAE)? Dr. Shivank Bhatia (interventional radiologist at University of Miami) joins host Dr. Michael Barraza to discuss the findings from his prospective 1,075 patient study on the long-term outcomes of PAE, the largest longitudinal, single-center, single-operator, prospective study in the United States. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ Medtronic MVP https://www.medtronic.com/mvp --- SYNPOSIS Dr. Bhatia begins by sharing his early years of training, and the steps he took to become an expert in all things PAE. He also covers how he helped build the PAE program at University of Miami, sharing several pearls for young IRs and trainees that are interested in bringing new service lines to their institutions. Dr. Bhatia then talks through the details of the study that he spearheaded, and encourages everyone to tune in - physicians and patients alike. --- TIMESTAMPS 00:00 - Introduction 05:12 - Building a PAE Program 18:55 - PAE Procedure Technicalities 22:30 - Post-Procedure Meds and Care 25:13 - Study Details and Patient Demographics 27:36 - Procedure Time and Technical Success 28:32 - Safety and Efficacy of PAE 38:06 - PSA Levels and Prostate Cancer 40:42 - Urinary Retention and Treatment Prioritization 45:17 - Re-Intervention Rates and Medication Independence --- RESOURCES Pisco et al (2011) - Prostatic arterial embolization to treat benign prostatic hyperplasia: https://pubmed.ncbi.nlm.nih.gov/21195898/ Bhatia et al (2024) - Prostatic Artery Embolization: Mid- to Long-Term Outcomes in 1,075 Patients: https://pubmed.ncbi.nlm.nih.gov/39532156/…

BackTable Vascular & Interventional

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Ep. 517 Complex HCC Patients and the "Grey Zone": What to Do When You Don’t Know What to Do 39:35

17일 전39:35

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39:35

Treatment of hepatocellular carcinoma (HCC), like that of many other cancers, spans a spectrum from curative to palliative intent. To explore the "grey zone" of treatment goals for intermediate-stage HCC patients, Dr. Sabeen Dhand interviews a panel of experts in the field: medical oncologists Dr. Adam Burgoyne and Dr. Lingling Du, along with interventional radiologists Dr. Kirema Garcia-Reyes and Dr. Zachary Berman. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125739 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The discussion begins with an explanation of the Barcelona-Clinic Liver Cancer (BCLC) staging system. While this system takes into account helpful factors such as liver function, performance status, and tumor burden, it fails to fully capture the true heterogeneity of the HCC patient population. Additional considerations include tumor biology, response to previous treatments, and the location of metastases. The specialists then share their experiences in treating patients with comorbid gastrointestinal cancers and mixed tumors, discuss the benefits of an interventional oncology clinic setting, and highlight virtual opportunities for connecting with tumor boards. They also offer advice on patient education regarding treatment options. --- TIMESTAMPS 00:00 - Introduction to BCLC Staging 03:02 - Impact of Performance Status 06:29 - Predictors of Survival in HCC 09:51 - Palliative versus Curative Treatment Intent 13:55 - Comorbid and Mixed Gastrointestinal Cancers 16:51 - Adverse Effects of Treatment 20:37 - Interventional Oncology in the Clinic Setting 23:06 - Navigating Multiple Provider Viewpoints 28:01 - Complex Case Examples --- RESOURCES BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (Reig et al, 2022): https://www.journal-of-hepatology.eu/article/S0168-8278(21)02223-6/fulltext CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf…

BackTable Vascular & Interventional

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Ep. 516 Dialysis Procedures: New Tools for Better Outcomes with Dr. Ari Kramer and Dr. Omar Davis 1:12:12

20일 전1:12:12

나중에 재생

리스트

1:12:12

Given the challenges that our dialysis patients face, how can we as providers stay sharp with the latest access techniques to help ensure the best possible outcomes? Dr. Omar Davis (interventional nephrologist) and Dr. Ari Kramer (general surgeon) join host Dr. Chris Beck to discuss advanced approaches to AV access and share their experiences with the FLEX Vessel Prep device. --- This podcast is supported by: VentureMed FLEX Vessel Prep https://www.venturemedgroup.com/ --- SYNPOSIS The doctors begin by describing how they create dialysis access and what they account for during the procedure. They then focus on the role of the FLEX VP system, its benefits, and how they use it in practice, touching on the latest clinical data. Dr. Kramer and Dr. Davis also stress the importance of mental health in dialysis care and share ways that we can better support our patients through difficult diagnoses and treatments. In fact, one of their patients, Fred Hill, authored the book “Dialysis Is Not Your Life,” which offers a unique perspective for patients feeling overburdened by dialysis, and the healthcare providers who treat them. The episode concludes with case presentations and practical guidance on when to use the FLEX Vessel Prep system. --- TIMESTAMPS 00:00 - Introduction 07:00 - AV Access and Procedures 10:58 - Case Walkthrough 14:19 - Balloon Angioplasty and IVUS 24:43 - Flex VP Device and Vessel Prep 35:03 - Algorithm and Reimbursement Challenges 39:51 - Device Usage and Techniques 46:58 - Clinical Data and Outcomes 01:01:59 - Case Studies --- RESOURCES Fred Hill, “Dialysis Is Not Your Life” Founder and Author: https://www.dialysisisnotyourlife.com/meet-founder.php “Dialysis Is Not Your Life” Book: https://www.amazon.com/DIALYSIS-NOT-YOUR-LIFE-Redefine/dp/B09L4XGGNX Novel Device Prior to Balloon Angioplasty for Dysfunctional Arteriovenous Access: Analysis of a Real-World Registry by Race and Sex Cohorts: https://www.openaccessjournals.com/articles/novel-device-prior-to-balloon-angioplasty-for-dysfunctional-arteriovenousaccess-analysis-of-a-realworld-registry-by-race-and-sex-16852.html FLEX Vessel Prep 12 Month AV Registry Data and 12 Month Belong PAD Data Shows Benefit to Micro-incisions Before Balloon or DCB Treatment: https://www.venturemedgroup.com/wp-content/uploads/2022/12/VEITH-Data-FINAL.pdf Angioplasty with novel, easy-to-use, bladed Flex Vessel Prep system “could replace standard of care”: https://www.youtube.com/watch?v=iRpkrURx1mc Surgical AVF Articles Atlas Condensed - sAVF Overview - Creation Maturation and Difficulties: https://docs.google.com/document/d/1f26FT65s03oZjjeZhBVy8auz0h8PTNvX3CWU5Xi_H5c/edit?usp=share_link Surgical AVF Articles Asif A, Early Arteriovenous fistula failure: https://drive.google.com/file/d/1zZEWgxsdBM4MKCQFjw0U04ra_hB9Ey_N/view?usp=share_link Surgical AVF Articles Asif A - Best Vascular Access in the Elderly - Time for Innovation: https://drive.google.com/file/d/1IpH-KnZyfN5Rqm_kxLnERnEJD6vcjAO8/view?usp=sharing Surgical AVF Articles EV Today - Managing Cephalic Arch Stenosis: https://drive.google.com/file/d/17yVd2M706YCtX-xTK6teesgZqzVIgUoN/view?usp=share_link VentureMed 2024 FLEX Vessel Prep System Reimbursement Guide: https://www.venturemedgroup.com/wp-content/uploads/2024/04/MMA-CTO-15690_FlexVesselPrepSystem-BillingGuide_Lv6-003.pdf BackTable VI Podcast Episode #139 - AV Fistula & Graft Maintenance with Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/139/av-fistula-graft-maintenance BackTable VI Podcast Episode #292 - Dialysis Interventions with Drug-Coated Balloons, Covered Stents and More with Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/292/dialysis-interventions-with-drug-coated-balloons-covered-stents-more…

BackTable Vascular & Interventional

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Ep. 515 Curative Intent Therapies for HCC: Today and Tomorrow 52:23

24일 전52:23

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52:23

For hepatocellular carcinoma (HCC) patients who are not candidates for liver transplant or resection, lesion ablation can be a curative treatment. With multiple ablation options available and still under investigation, it can be challenging to navigate the differences between them. In this episode, Dr. Tyler Sandow hosts a discussion with interventional radiologists Dr. Kirema Garcia-Reyes, Dr. Sabeen Dhand, and Dr. Kevin Burns on the various ablation options for HCC and when to use each one. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125738 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The doctors first discuss Barcelona-Clinic Liver Cancer (BCLC) Stage A patients, where lesion size and location are key factors in deciding between ablation and transarterial therapies. They then compare cryoablation and microwave ablation, highlighting that cryoablation offers better visualization and control of the ablation zone, while microwave ablation is more effective for treating larger lesions. Dr. Burns introduces histotripsy, a noninvasive treatment that uses ultrasound energy to mechanically ablate tumors. He shares his experiences as an early adopter of this technology and discusses how intraoperative cone beam CT can help treat lesions located near critical structures or those poorly visualized on ultrasound. Finally, Dr. Garcia-Reyes and Dr. Berman provide insights into patient selection, pre-procedural imaging, and technical tips for Y90. --- TIMESTAMPS 00:00 - Introduction 02:04 - Ablation vs Y90 in BCLC A Patients 05:58 - Same-Day Y90 15:55 - Y90 for Large Tumors 17:51 - Ideal Cases for Cryoablation 19:38 - Explanation of Histotripsy 32:09 - Procedural Specifics for Histotripsy 38:21 - Technical Tips for Y90 --- RESOURCES Including the Hollow Viscera (Stomach or Bowel) within the Ice Ball during Cryoablation: A Review of Adverse Events (Abramyan et al, 2024): https://www.jvir.org/article/S1051-0443(24)00681-X/abstract CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf…

BackTable Vascular & Interventional

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Ep. 514 Deep Sedation in IR: Intro to Ketamine with Dr. Amy Deipolyi 33:02

27일 전33:02

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리스트

33:02

When deep sedation is required, it can be challenging to implement due to the difficulty of scheduling dedicated anesthesia coverage in the IR suite. Dr. Amy Deipolyi (interventional radiologist and Division Chief at Charleston Area Medical Center, WY) joins host Dr. Ally Baheti to explain an alternative approach to deep sedation through the use of ketamine. --- This podcast is supported by: Medtronic Abre Stent https://www.medtronic.com/en-us/healthcare-professionals/products/cardiovascular/deep-venous-stents/abre-venous-self-expanding-stent-system.html --- SYNPOSIS Dr. Deipolyi begins by sharing how she built a dedicated, academic IR program at a level 1 trauma center in West Virginia. The doctors then discuss the advantages of ketamine for deep sedation in the IR suite, and how Dr. Deipolyi gained administrative approval and implemented the change to achieve an alternative approach to deep sedation for interventional procedures. The discussion also includes how ketamine compares to traditional agents such as fentanyl and Versed. The episode concludes with Dr. Deipolyi’s practical advice to fellow IR’s interested in providing their patients deep sedation via ketamine and her ongoing and future research and outreach efforts. --- TIMESTAMPS 00:00 - Introduction 02:04 - Dr. Deipolyi’s Practice 14:32 - Overcoming Hurdles and Gaining Support 20:12 - Application and Patient Experiences 26:01 - Future of Deep Sedation in IR 28:55 - Conclusion…

BackTable Vascular & Interventional

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Ep. 513 Combination Therapy and Clinical trials for Advanced HCC: What They Really Mean 47:32

4 weeks 전47:32

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47:32

In the past five years, the use of immunotherapeutic agents for advanced cancers has emerged as a promising alternative to tyrosine kinase inhibitors and chemotherapy, making it an exciting time to be practicing oncology. In this episode, Dr. Tyler Sandow interviews oncology experts about the landscape of advanced hepatocellular carcinoma (HCC) and the current state of immunotherapy treatments. He is joined by medical oncologists Dr. Jonathan Mizrah, Dr. Lingling Du, and Dr. Adam Burgoyne, as well as interventional oncologist Dr. Zachary Berman. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125737 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS Drs. Burgoyne and Mizrahi provide a primer on immunotherapy and explain how they communicate the principles of this treatment to their patients. Dr. Du discusses the Imbrave clinical trial and how recent studies have shown improved overall survival when immunotherapeutic agents are used, especially when multiple agents targeting various pathways are employed. When choosing between different regimens, the doctors consider factors such as the patient's underlying liver function, symptom burden, and prior treatments. Importantly, the doctors also discuss contraindications to immunotherapy, including a history of organ transplant, autoimmune disease, and poor performance status—all of which put patients at high risk for deterioration with this treatment. The treatment of patients with poor liver function remains controversial, as underlying cirrhosis may prevent the recovery of liver function. Dr. Berman outlines recent clinical trials studying the effects of transarterial chemoembolization (TACE) combined with immunotherapy. Finally, the doctors discuss the future of HCC treatment and the benefits of continued innovation in both interventional and medical oncology. --- TIMESTAMPS 00:00 - Introduction to Immunotherapy 04:32 - Notable Clinical Trials 13:39 - HCC Etiology and Immunotherapy Outcomes 18:43 - Contraindications for Immunotherapy 23:05 - Adverse Effects from Treatment 25:14 - Combination Therapy 36:22 - Considerations for Immunotherapy Dosing 40:26 - The Future of HCC Treatment --- RESOURCES Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma, IMbrave150 Trial (Finn et al, 2020): https://pubmed.ncbi.nlm.nih.gov/32402160/ Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma, HIMALAYA Trial (Abou-Alfa et al, 2022): https://evidence.nejm.org/doi/full/10.1056/EVIDoa2100070 Nivolumab versus sorafenib in advanced hepatocellular carcinoma (CheckMate 459): a randomised, multicentre, open-label, phase 3 trial (Yau, 2022): https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00604-5/abstract Nivolumab (NIVO) plus ipilimumab (IPI) vs lenvatinib (LEN) or sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC): First results from CheckMate 9DW (Galle, 2024): https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA4008 Randomized Phase 3 LEAP-012 Study: Transarterial Chemoembolization With or Without Lenvatinib Plus Pembrolizumab for Intermediate-Stage Hepatocellular Carcinoma Not Amenable to Curative Treatment (Llovet, 2022): https://pubmed.ncbi.nlm.nih.gov/35119481/ EMERALD-1: A phase 3, randomized, placebo-controlled study of transarterial chemoembolization combined with durvalumab with or without bevacizumab in participants with unresectable hepatocellular carcinoma eligible for embolization (Lencioni, 2024): https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432 CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf…

BackTable Vascular & Interventional

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Ep. 512 The "Alzate Maneuver”: Flipping Retrograde Access with Dr. Gregg Alzate 49:34

5 weeks 전49:34

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49:34

Proximity to innovation often gives rise to further innovation. This trend is especially true in interventional radiology. Dr. Gregg Alzate (interventional radiologist in San Diego, California) joins host Dr. Ally Baheti to share his career pearls for early and mid-career IRs, and how he came to pioneer the Alzate Retrograde Antegrade Maneuver (A-RAM). --- This podcast is supported by: Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Alzate starts by sharing his early influences, including his time with interventional radiology giant Dr. Harold Coons. The doctors also cover the importance of proper vessel access techniques, innovative approaches to limb salvage, and how to address complex chronic total occlusions (CTOs). Dr. Alzate then goes on to give us a thorough walkthrough of the A-RAM. The episode concludes with Dr. Alzate’s closing thoughts on being open to adopt new techniques, the impact of strong mentorship, and importance for consuming and sharing knowledge. --- TIMESTAMPS 00:00 - Introduction 03:05 - Dr. Alzate’s Journey 25:52 - A-RAM Technique 34:26 - CTO’s and Heavy Calcium 40:16 - Moral Injury in Medical Practice 43:35 - Honoring Dr. Harold Coons 46:23 - Closing Thoughts and Reflections --- RESOURCES Ohki, Takao et al. “Long-term results of the Japanese multicenter Viabahn trial of heparin bonded endovascular stent grafts for long and complex lesions in the superficial femoral artery.” Journal of vascular surgery vol. 74,6 (2021): 1958-1967.e2. https://www.jvascsurg.org/article/S0741-5214(21)01011-9/fulltext Kedora, John et al. “Randomized comparison of percutaneous Viabahn stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral arterial occlusive disease.” Journal of vascular surgeryvol. 45,1 (2007): 10-6; discussion 16. https://www.jvascsurg.org/article/S0741-5214(06)01612-0/fulltext…

BackTable Vascular & Interventional

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Ep. 511 How to Simplify Dosing: Understanding Y-90 Dosimetry from Simple to Complex 54:16

5 weeks 전54:16

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리스트

54:16

Of all the topics covered during interventional radiology training, dosimetry education is often delayed until after IRs enter clinical practice. In this episode, Drs. Tyler Sandow and Sabeen Dhand host a roundtable discussion with experts on the dosimetry fundamentals that all Y90 operators should understand. They are joined by interventional radiologists Drs. Zachary Berman, Kirema Garcia-Reyes, and Siddharth Padia, who provide their expert insights. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125736 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The group agrees that dosimetry is not a one-size-fits-all approach. Dosing strategies depend on factors such as tumor size, perfusion territory, underlying liver function, the choice between glass versus resin spheres, and treatment intent. These considerations are illustrated with real-life case examples. The doctors also explore voxel-based dosimetry, a method for calculating the amount of radiation absorbed by different parts of the tumor. They stress the importance of learning how to perform accurate dosage calculations. Finally, the conversation touches on data from major Y90 trials, current guidelines, and the evolving perspective on Y90 as a potential curative treatment, rather than merely a bridging therapy. --- TIMESTAMPS 00:00 - Introduction 01:59 - Dosimetry Education During Training 05:46 - Benefit of Individualized Dosing 11:01 - Complications from High Doses 15:19 - Dosage Calculation Cases 22:51 - Duration of Response to Y90 25:00 - Dosing Based on Treatment Intent 29:11 - Challenging Case Example 42:31 - Voxel-Based Dosimetry 45:15 - Using Dosimetry Software --- RESOURCES LEGACY Trial (Salem et al, 2021): https://pmc.ncbi.nlm.nih.gov/articles/PMC8596669/ Voxel-based tumor dose correlates to complete pathologic necrosis after transarterial radioembolization for hepatocellular carcinoma (Pianka et al, 2024): https://pubmed.ncbi.nlm.nih.gov/38913189/ RAPY90D Trial (Kappadath et al, 2023): https://jnm.snmjournals.org/content/64/supplement_1/P268 Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group (Salem et al, 2023): https://pubmed.ncbi.nlm.nih.gov/36114872/ International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres (Levillain, 2021): https://link.springer.com/article/10.1007/s00259-020-05163-5) CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf…

BackTable Vascular & Interventional

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Ep. 510 Robotics Revolution in Interventional Radiology with Dr. Sean Tutton and Dr. Raj Narayanan 55:28

6 weeks 전55:28

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리스트

55:28

Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego. --- This podcast is supported by: Quantum Surgical https://www.quantumsurgical.com/ --- SYNPOSIS Dr. Narayanan begins by sharing his initial interest in robotic applications for tumor ablations, aiming to maximize efficiency in his practice. Dr. Tutton then highlights the advantages of robotics for probe placement, especially in challenging cases. The two doctors discuss the logistics of the robotic system, including setup, imaging, and access choices. They also reflect on the learning curve associated with robotics and how it gradually enhances procedural efficiency while reducing mental fatigue. This improvement allows them to take on more complex cases with confidence. Overall, both experts agree that robotics has the potential to democratize minimally invasive procedures, offering new opportunities for skill development and advancement within the field of interventional radiology. --- TIMESTAMPS 00:00 - Introduction to the Podcast 03:30 - Developing an Interest in Robotics 10:44 - Integration of Robotics in the Procedural Suite 13:27 - Logistics of Robot System 18:38 - Planning for Percutaneous Access 22:39 - Future Implications of Robotics on Training Programs 35:51 - Efficiency and Volume Management with Robotics 40:39 - Learning Curves for Robotic Procedures 48:09 - Conclusion and Final Thoughts --- RESOURCES Quantum Surgical Epione Robot: https://www.quantumsurgical.com/epione/ ACCLAIM Trial: https://www.sio-central.org/ACCLAIM-Trial…

BackTable Vascular & Interventional

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Ep. 509 Multidisciplinary HCC Care: Improving the Patient Experience with Combined Clinic 44:32

6 weeks 전44:32

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리스트

44:32

Welcome to the first episode of BackTable Tumor Board, and our first recording session at our new in-person studio! Guest host Dr. Tyler Sandow (interventional radiologist) leads a multidisciplinary discussion about patient care coordination in hepatocellular carcinoma (HCC) diagnosis and treatment, with insights from his colleagues at Ochsner Health– Dr. Steven Young (hepatologist), Dr. Jonathan Mizrahi (medical oncologist), and Deondra Bonds-Adams (patient navigator). Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125735 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The team speaks on the value of having multiple specialties weigh in on treatment conversations that are tailored to each patient’s medical history and risk factors, such as underlying cirrhosis and portal hypertension. Deondra highlights the importance of assessing the patient’s understanding of their disease and the role of physician extenders and schedulers in patient education. Dr. Young discusses the value of outreach clinics and streamlining the transplant evaluation process. Finally, Dr. Mizrahi gives advice on building referral networks and establishing early contact with transplant centers. --- TIMESTAMPS 00:00 - Introduction 00:46 - Multidisciplinary Tumor Board 06:00 - Patient Experience in Treatment Pathways 10:10 - Barriers to Treatment 16:03 - Benefits of IR Clinic 19:33 - HCC Screening and Risk Factors 24:08 - Building Referral Networks 30:34 - Strategies for Effective Scheduling 35:43 - The Future of HCC Treatment --- RESOURCES CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf…

BackTable Vascular & Interventional

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Introducing Backtable Tumor Board 2:09

7 weeks 전2:09

나중에 재생

리스트

2:09

Welcome to the first episode of BackTable Tumor Board, and our first recording session at our new in-person studio! Guest host Dr. Tyler Sandow (interventional radiologist) leads a multidisciplinary discussion about patient care coordination in hepatocellular carcinoma (HCC) diagnosis and treatment, with insights from his colleagues at Ochsner Health– Dr. Steven Young (hepatologist), Dr. Jonathan Mizrahi (medical oncologist), and Deondra Bonds-Adams (patient navigator). --- This podcast is supported by an educational grant from: AstraZeneca https://www.astrazeneca.com/our-therapy-areas/oncology.html With additional support from: Boston Scientific https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology.html --- SYNPOSIS The team speaks on the value of having multiple specialties weigh in on treatment conversations that are tailored to each patient’s medical history and risk factors, such as underlying cirrhosis and portal hypertension. Deondra highlights the importance of assessing the patient’s understanding of their disease and the role of physician extenders and schedulers in patient education. Dr. Young discusses the value of outreach clinics and streamlining the transplant evaluation process. Finally, Dr. Mizrahi gives advice on building referral networks and establishing early contact with transplant centers. --- TIMESTAMPS 00:00 - Introduction 00:46 - Multidisciplinary Tumor Board 06:00 - Patient Experience in Treatment Pathways 10:10 - Barriers to Treatment 16:03 - Benefits of IR Clinic 19:33 - HCC Screening and Risk Factors 24:08 - Building Referral Networks 30:34 - Strategies for Effective Scheduling 35:43 - The Future of HCC Treatment…

BackTable Vascular & Interventional

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Ep. 508 Advancements in Pulmonary Embolus Intervention Techniques: PEERLESS Trial Insights with Dr. Ripal Gandhi and Dr. Zarina Sharalaya 1:11:31

7 weeks 전1:11:31

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리스트

1:11:31

Interventional treatment for pulmonary embolism (PE) has significantly evolved in recent years, largely due to advancements in techniques, knowledge, and device technology. Dr. Zarina Sharalaya (interventional and structural cardiologist) and Dr. Ripal Gandhi (interventional radiologist) join host Dr. Chris Beck to discuss the evolving landscape of PE treatment, comparing large-bore mechanical thrombectomy with catheter-directed thrombolysis and exploring outcomes from the PEERLESS randomized control trial. --- This podcast is supported by: Inari Medical https://cwa.inarimedical.com/inari-learn --- SYNPOSIS Dr. Sharalaya and Dr. Gandhi begin by covering risk stratification and treatment algorithms for their patients with PE. The doctors then go onto discuss the procedure in detail, and best practices and techniques for mechanical thrombectomy. The conversation also focuses on the PEERLESS trial, highlighting how the study showed significant benefits of mechanical thrombectomy, including faster symptom improvement, decreased ICU stay, and reduced readmission rates. Dr. Sharalaya and Dr. Gandhi conclude the episode with a series of case presentations. --- TIMESTAMPS 00:00 - Introduction 08:01 - Pulmonary Embolism Risk Stratification and Treatment Algorithms 14:49 - Procedure Overview 24:25 - Best Practices and Techniques in Thrombectomy 34:31 - Peerless Study Overview and Findings 46:50 - Gender Differences in PE Treatment 47:49 - Future of PE Treatment and Advice 51:55 - Case Presentations and Clinical Insights --- RESOURCES 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): https://pubmed.ncbi.nlm.nih.gov/31504429/ PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism: https://www.jscai.org/article/S2772-9303(24)01053-6/fulltext Large-bore Mechanical Thrombectomy Versus Catheter-directed Thrombolysis in the Management of Intermediate-risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial: https://pubmed.ncbi.nlm.nih.gov/39470698/…