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BackTable Vascular & Interventional

BackTable Inc.

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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  • 24 episodes
  • Avg 55 min
  • English

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  • Friday · 32 min

    Ep. 678 Medicare Audits Explained: Impact on Physicians & Practices with Jason Greis

    What do you actually do when a Medicare audit letter lands in your inbox? On this episode of BackTable Podcast, Dr. Ally Baheti interviews healthcare attorney Jason Greis, partner at Benesch, to demystify the audit process and the rising scrutiny on interventional practices. They discuss why audits are accelerating, which procedures are under the microscope, and how enforcement economics and AI-driven review are reshaping the landscape for OBLs and ASCs. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protection https://www.radpad.com/ --- Timestamps 00:00 - Introduction 02:32 - Audit Hotspots in Endovascular Work 05:00 - AI Oversight and Proactive Compliance 13:35 - The Alphabet Soup of Audit Types 19:16 - Responding to an Audit and the Appeals Ladder 24:48 - Employment Status, Liability and AI Downcoding 30:29 - Final Advice and Wrap Up --- More about this episode The conversation covers the “alphabet soup” of audit types, the five-step appeals process, and strategies for proactive compliance and documentation. The discussion walks through personal liability, employment status, the risks of algorithmic downcoding by commercial payers, and why practices must balance when to fight and when to let an audit go. The episode closes with actionable advice on protecting your practice, the dangers of putting patient data into AI tools, and why trade organizations are the first line of defense. --- Resources OIG: Utilization Trends and Medicare Part B Billing for Office-Based Peripheral Vascular Procedures Raise Questions About Program Integrity (OEI-01-24-00250) https://oig.hhs.gov/reports/all/2026/utilization-trends-and-medicare-part-b-billing-for-office-based-peripheral-vascular-procedures-raise-questions-about-program-integrity/ CMS Wasteful and Inappropriate Service Reduction (WISeR) Model https://www.cms.gov/priorities/innovation/innovation-models/wiser CMS Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) https://www.cms.gov/fraud CMS Medicare Fee-for-Service Appeals: The Five Levels https://www.cms.gov/medicare/appeals-grievances/fee-for-service CMS Medicare Fee-for-Service Compliance Programs (TPE, RAC, SMRC, CERT) https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs BackTable VI Ep. 478: ASC vs. OBL: Legal Insights Explained https://www.backtable.com/shows/vi/podcasts/478/asc-vs-obl-legal-insights-explained --- 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

  • September 22 · 55 min

    Ep. 677 Pulmonary Embolism: Catheter-Based Therapy & Importance of Blood Return with Dr. Jay Giri and Dr. Julie Bulman

    As new guidelines redefine risk stratification for pulmonary embolism (PE), emerging technologies are also changing what it means to achieve procedural success. On this episode of the BackTable Podcast, interventional radiologist Dr. Julie Bulman (BIDMC) and interventional cardiologist Dr. Jay Giri (Penn Medicine) join host Dr. Chris Beck to discuss the evolving frameworks and technologies redefining standards for catheter-directed treatment of intermediate- and high-risk PE. They discuss the role of multidisciplinary PERT teams, patient selection, the impact of new thrombectomy devices, and why autologous blood return is a growing consideration for procedural success. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Endovascular Engineering (E2) E2Helo.com --- Timestamps 00:00 - Introduction 03:42 - Referral Patterns and PERT Scope 05:25 - PE Workup Essentials 07:26 - Targeted Assessment of Acuity 11:36 - Reliability of the Walk Test 14:35 - PE Treatment Pathways 19:26 - Procedural Walkthrough 24:15 - Catheter Sizing 30:05 - Adjunct Aspiration Device Features 35:09 - Blood Return Process and Safety 40:03 - Helo Study Early Results 45:09 - Determining Procedural Endpoints 50:20 - Future Trials and Technologies 53:48 - Final Thoughts and Closing Remarks --- More about this episode The discussion highlights how PERT teams use updated guidelines and thorough clinical evaluation to guide patient classification and treatment pathway selection. Dr. Bulman and Dr. Giri outline their criteria for choosing anticoagulation, catheter-directed lysis, or mechanical clot removal, and compare the techniques and learning curves for medium- versus large-bore thrombectomy devices. They explore the significance of autologous blood return during aspiration thrombectomy, noting how new reinfusion systems can reduce blood loss and influence procedural decision-making. Dr. Bulman also presents early Helo Thrombectomy System study data demonstrating the benefits of mechanized aspiration with minimal complications. The episode closes with a critical look at defining true functional procedural endpoints beyond pulmonary arterial pressures and offers a preview of upcoming trial data, such as HI-PEITHO and PEERLESS II, that could further advance PE management. --- Resources 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults https://doi.org/10.1161/CIR.0000000000001415 Ultrasound-Facilitated, Catheter-Directed Thrombolysis in Intermediate-High Risk Pulmonary Embolism (HI-PEITHO) https://clinicaltrials.gov/study/NCT04790370 PEERLESS II study https://clinicaltrials.gov/study/NCT06055920 Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism (PRAGUE-26) https://doi.org/10.1056/nejmoa2608012 Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3) https://clinicaltrials.gov/study/NCT04430569 --- 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

  • September 18 · 47 min

    Ep. 676 Use of Tunneled Catheters for Ascites & Effusions Management with Dr. Marco Ertreo

    When is it time to move from repeat drainage to a tunneled catheter for managing pleural effusions or ascites? On this episode of BackTable Podcast, Dr. Neil Jain interviews Dr. Marco Ertreo, interventional radiologist and IR residency program director at Strong Memorial Hospital, University of Rochester, about best practices for tunneled catheter management in both the chest and abdomen. They discuss the triggers for placing a tunneled catheter, patient selection, placement technique, home drainage protocols, complication management, and the unique considerations for malignant versus cirrhotic ascites. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 06:39 - Indications and Pleural Catheter Placement Technique 12:10 - Tunneling, Cuff Position and Exit Site Selection 17:42 - Home Drainage, Volume Limits and Complications 26:13 - Peritoneal Catheters, TIPS Candidacy and Catheter Choice 35:16 - Avoiding Bowel and Varices 43:42 - Key Takeaways and Closing Remarks --- More about this episode Dr. Ertreo shares practical details about pocket selection, access points, catheter testing, and choosing Tenckhoff catheters for abdominal cases to avoid proprietary systems. The conversation covers volume limits, complication counseling, criteria for removal, and the psychological impact of living with a long-term drain. They discuss when to consider TIPS for cirrhotic patients, the importance of early conversations with patients and referring providers, and why multidisciplinary teamwork and family support are essential for long-term success. --- Resources Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial https://pubmed.ncbi.nlm.nih.gov/30037711/ Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline https://www.atsjournals.org/doi/10.1164/rccm.201807-1415ST Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions, Part II: Recommendations https://pubmed.ncbi.nlm.nih.gov/31229333/ Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases (AASLD) https://pubmed.ncbi.nlm.nih.gov/33942342/ --- 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

  • September 15 · 1 hr 23 min

    Ep. 675 Advancements & Challenges in GAE Practice with Dr. Amin Astani and Dr. Anish Ghodadra

    As interest in genicular artery embolization grows, what does it actually take to build a sustainable GAE practice? On this episode of the BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Anish Ghodadra and Dr. Amin Astani to share their blueprint for building a successful genicular artery embolization (GAE) practice. They discuss patient selection, imaging workup, scoring tools, and procedural techniques, including access strategies, device choice, and embolic selection. The conversation also covers follow-up protocols, defining treatment success, and how to set patient expectations. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Varian https://www.siemens-healthineers.com/ --- Timestamps 00:00 - Introduction 04:00 - GAE Workup and Patient Scoring 05:28 - KL Score and MRI Debate 10:15 - Patient Selection and Contraindications 15:11 - Access Strategy and Closure Techniques 19:54 - Catheters, Wires, and Embolic Choices 28:19 - Cone Beam CT Workflow 31:37 - Managing Collaterals 34:26 - Follow-Up and Repeat GAE 38:42 - Defining Success and Setting Expectations 44:25 - Technique Nuances and Flow Modulation 50:28 - Building Referral Networks 56:56 - Keeping Referrers Engaged 59:46 - Direct-to-Patient Marketing 01:04:57 - Leveraging Social Media and Reviews 01:12:42 - Tracking Leads and Insurance Coverage 01:19:47 - Final Thoughts and Next Steps --- More about this episode Beyond technique, the discussion dives into practical strategies for growing a GAE practice: referral pathways, engaging physical therapists and orthopedic surgeons, direct-to-patient marketing, digital outreach, and tracking outcomes. The guests share experience-driven tips on handling insurance hurdles, building relationships with referring providers, and using data to demonstrate value. The episode wraps with reflections on negative trial results, the evolving landscape of GAE, and what it takes to keep a practice thriving in a competitive environment. --- Resources Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trial https://doi.org/10.1007/s00330-026-12505-8 Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Pain https://doi.org/10.1007/s00270-026-04410-w --- 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

  • September 11 · 56 min

    Ep. 674 Treatment Strategies for Acute and Chronic Limb Ischemia with Dr. Anahita Dua and Dr. Ripal Gandhi

    How do you choose between thrombolysis, mechanical thrombectomy, or open surgery for acute limb ischemia, and what options remain when there’s no vessel to open? On this episode of the BackTable Podcast, host Dr. Chris Beck is joined by vascular surgeon Dr. Anahita Dua (Massachusetts General Hospital) and interventional radiologist Dr. Ripal Gandhi (Miami Cardiac and Vascular Institute) to explore treatment strategies across the full spectrum of limb ischemia. They discuss presentation and referral patterns, the imaging and exam findings that start the clock, single-session mechanical thrombectomy, the evolving role of lysis, procedural endpoints, and deep vein arterialization for chronic limb-threatening ischemia. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Stryker Peripheral Vascular https://www.stryker.com/us/en/peripheral-vascular.html --- Timestamps 00:00 - Introduction 02:27 - Presentation, Referral Patterns, and Imaging 06:07 - Acute Limb Ischemia: Treatment Algorithm 12:16 - Thrombectomy Device Selection 16:09 - Thrombolysis and Applications Beyond Lower Extremity 18:46 - Procedural Endpoints, Closure, and Case Selection 24:43 - Deep Vein Arterialization: Patient Selection and Planning 31:25 - DVA Technique: Imaging, Anesthesia, and Access 34:58 - Step-by-Step DVA Approach 41:56 - Surveillance and Managing Expectations 45:59 - Wound Care and Amputation Decisions 49:40 - Future Directions in PAD 52:43 - Closing Remarks --- More about this episode The conversation moves from acute interventions for the cold leg, where mechanical thrombectomy has become first-line and lysis is held in reserve, to the stepwise management of no-option chronic cases, including pedal access, valve disruption, and inflow for deep vein arterialization. Drs. Dua and Gandhi share practical insights on device selection, preventing distal embolization, and when to consider open embolectomy or hybrid approaches. The episode closes with a discussion of post-procedure surveillance, wound care, and the need for better measures of perfusion to improve limb salvage and patient outcomes. --- Resources Rutherford classification of acute and chronic limb ischemia. https://doi.org/10.1016/S0741-5214(97)70045-4 Global vascular guidelines on the management of chronic limb-threatening ischemia. Conte, Bradbury, Kolh et al., Journal of Vascular Surgery, 2019. https://doi.org/10.1016/j.jvs.2019.02.016 PROMISE II. Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia. Shishehbor et al., New England Journal of Medicine, 2023. https://doi.org/10.1056/NEJMoa2212754 BackTable VI Episode 618, How to Manage Advanced DVA Cases: Techniques and Tips, with Dr. Kumar Madassery and Dr. Sabeen Dhand. https://www.backtable.com/shows/vi/podcasts/618/how-to-manage-advanced-dva-cases-techniques-tips --- 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

  • September 8 · 1 hr 31 min

    Ep. 673 Y90 for Liver-Directed Cancer Treatments: The PROACTIF Study with Dr. Tyler Sandow and Dr. Ryan Hickey

    The key to personalizing Y90 may not just be treating the tumor, but understanding how much radiation a patient can tolerate, where to deliver it, and when to safely push the dose. In this episode of the BackTable Podcast, Drs. Tyler Sandow and Ryan Hickey join host Dr. Kavi Krishnasamy to explore strategies for using Y90 in hepatocellular carcinoma and liver metastases. They combine real-world data from a study of nearly 1,000 patients with insights into methodology and the many variables that influence these procedures. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90. --- Timestamps 00:00 - Introduction 02:36 - Resection After Radioembolization 06:07 - Personal Practices Between HCC and Liver Metases 07:26 - Bridging Radiation Segmentectomy 11:22 - Understanding Portal Vein Tumor Thrombus 14:21 - Preferences in Dosimetry Software 17:57 - Liver Reserve Limits 25:11 - Microsphere Activity and Density 29:16 - Diving into PROACTIF 33:32 - RCTs and Trial Challenges 36:57 - Patient Diversity in PROACTIF 41:42 - Extrahepatic Disease 43:03 - Data Gaps and Takeaways 45:32 - Defining Personalized Dosimetry and Bridging Software 50:15 - Mixed Delivery Approaches and Dose Thresholds 01:01:36 - Response and Local Control 01:04:26 - Treating PVT Subgroups 01:09:03 - Comparison Between Dosing and Survival 01:15:03 - Differences in Patients Quality of Life After Transplantation 01:26:34 - Wrap-Up and Credits --- More about this episode The discussion covers radiation segmentectomy and selective delivery, the nuances of portal vein tumor thrombus levels, and how multidisciplinary collaboration differs between resection and transplant. The doctors dive into the PROACTIF study, focusing on personalized dosimetry, dose escalation, trial challenges, tumor response, and survival outcomes across disease stages. Drs. Sandow and Hickey also explain the limits of Y90, such as lung shunts, liver reserve, and treated liver volume, and highlight how decision-making and tailored techniques are essential for improving outcomes in liver cancer care. --- 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

  • September 1 · 54 min

    Ep. 672 Challenges in Biopsy Techniques for Bone Lesions with Dr. Junjian Huang and Dr. Majid Khan

    What characteristics make bone biopsies unique in both presentation and procedure? In this episode of the BackTable Podcast, Drs. Junjian Huang and Majid Khan join host Dr. Neil Jain to break down the complexities of bone biopsy technique. They discuss key strategies for tackling difficult cases, from understanding referral patterns and pre-procedure planning to selecting the best guidance modality and anticipating complications. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Varian OmniBone https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction 08:06 - Referrals And Pre-Procedure Planning 12:35 - Triaging and Managing Difficult Cases 17:06 - Measuring and Improving Diagnostic Yield 18:58 - Knowing Boundaries Behind Difficult Cases 22:37 - Choosing the Best Guidance Modality 26:16 - The Future with Augmented Reality 28:11 - Tough Case Scenarios and Setup 41:27 - Preventing and Managing Complications 47:49 - Technical Tips for Future IRs 51:40 - Wrap-up and Credits --- More about this episode The conversation covers how to triage complex cases, adjust technique for smaller or hard-to-reach lesions, and benchmark diagnostic success. Drs. Huang and Khan share their preferred imaging guidance, from CT to fluoroscopy, and explore new frontiers like augmented reality. Case scenarios highlight practical problem-solving, and the episode wraps up with technical pearls and complication-prevention tips gained from years of experience in targeted bone biopsy. --- 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

  • August 25 · 56 min

    Ep. 671 Managing Pulmonary Embolism: Guidelines & Clinical Decisions with Dr. Timothy Fernandes and Dr. Robert Lookstein

    Once your PERT is assembled, how do you navigate the evolving pulmonary embolism (PE) literature to improve patient outcomes at all risk levels? In this episode of the BackTable Podcast, interventional radiologist Dr. Robert Lookstein (Mount Sinai) and pulmonary critical care specialist Dr. Timothy Fernandes (UC San Diego) join host Dr. Harris Chengazi to examine the latest evidence and multidisciplinary strategies for managing acute pulmonary embolism. The discussion highlights the complexities of catheter-directed therapies in intermediate- to high-risk PE, evolving guidelines in the face of new trial data, and prioritization of improving patients’ clinical trajectories. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Penumbra https://www.penumbrainc.com/ Timestamps 00:00 - Introduction 03:57 - PERT Structure and Activation 08:24 - PE Risk Stratification Tools 12:02 - Patient Selection for IR Intervention 15:21 - Assessing Clot Chronicity 21:03 - Standardizing Workup 26:38 - Managing Unstable PE 28:31 - STORM-PE and HI-PEITHO Trial Data 35:49 - Guidelines vs. New Evidence 40:12 - Determining Therapeutic Endpoints 45:05 - Upcoming Trials and Future Directions 51:46 - Final Thoughts and Closing Remarks --- More about this episode The physicians explore the nuances of validated PE risk stratification tools, assessing the relationship between various PE scoring systems and the 2026 ACC/AHA classification for acute PE. They emphasize that the integration of clinical assessment, serial lab work, and patient history must take precedence over static imaging alone in guiding care. The doctors go on to review new trial data, including the improved RV-to-LV ratio and 90-day functional gains seen with mechanical thrombectomy in STORM-PE and reduced clinical deterioration observed with ultrasound-assisted catheter-directed thrombolysis in HI-PEITHO. The conversation concludes with a call for collaborative, safety-first management that focuses on the patient’s clinical status and long-term post-PE functional recovery. --- Resources 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults https://doi.org/10.1161/CIR.0000000000001415 Composite Pulmonary Embolism Shock (CPES) Score https://doi.org/10.1161/CIRCINTERVENTIONS.124.014088 FOCUS study https://doi.org/10.1093/eurheartj/ehac206 STORM-PE trial https://doi.org/10.1161/CIRCULATIONAHA.125.077232 HI-PEITHO trial https://doi.org/10.1056/nejmoa2516567 PE-TRACT study https://petractstudy.org/homepage PEERLESS II study https://clinicaltrials.gov/study/NCT06055920 PERSEVERE trial https://clinicaltrials.gov/study/NCT06588634 --- 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

  • August 18 · 45 min

    Ep. 670 Understanding IR Attrition: Causes & Solutions with Dr. David R. Mittelstein

    Why do nearly half of IR residents consider leaving the specialty, and what can be done to change that? On this episode of the BackTable Podcast, Dr. Neil Jain interviews Dr. David Mittelstein, an integrated IR resident at UC San Diego and co-chair of the SIR RFS Recruitment Committee, about the findings of a national SIR survey on interventional radiology resident attrition. They discuss what drives uncertainty, from lifestyle and call burden to job market fears, and highlight the program features that encourage retention, such as structured training, high case volume, and a culture of camaraderie. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protection https://www.radpad.com/ --- Timestamps 00:00 - Introduction 04:31 - From Biomedical Engineering to IR 07:41 - Recruitment Committee Mission 12:37 - Match Trends Warning Sign 15:12 - Survey Design Demographics 20:21 - What Factors Matter 25:04 - Why Residents Consider Switching 30:23 - Recommendation 1 IR Curriculum 32:32 - Recommendation 2 More IR Rotation 34:10 - Recommendation 3 Build Camaraderie 38:30 - Advice for Residents Who Are Doubting 41:00 - What’s Next for RFS Recruitment 43:20 - Wrap Up --- More about this episode The conversation explores free-response themes from the survey, where 78 percent of residents cited lifestyle concerns, 31 percent pointed to job market uncertainty, and 22 percent mentioned call experience as reasons for questioning IR. Retention was linked to structured training (38 percent), high case volume and procedural experience (35 percent), and program camaraderie (18 percent). Dr. Mittelstein and Dr. Jain review three concrete recommendations to improve retention, examine early changes at programs like Georgetown, and offer practical advice to residents who may be quietly doubting their path in IR. --- Resources Episode # 554 Optimizing the IR/DR Curriculum & Experience https://www.backtable.com/shows/vi/podcasts/554/optimizing-the-ir-dr-curriculum-experience --- 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

  • August 11 · 41 min

    Ep. 669 Advancements in Pulmonary Embolism Algorithm & Management with Dr. David Dexter and Dr. Maya Serhal

    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 app https://www.backtable.com/app --- This podcast is supported by Imperative Care https://imperativecare.com/ --- Timestamps 00:00- Introduction 02:03- PE Response Workflow 05:32- Symphony Device 07:07- Sizing and Blood Loss 10:00- Multi-Port Hemodynamics 14:45- Procedure Endpoints 17:01- IVUS Guided Strategy 20:02- ProHelix and Lollipopping 25:48- Case Studies 34:12- 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 Embolism https://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 Trial https://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-PE https://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

  • August 4 · 1 hr 4 min

    Ep. 668 Entrepreneurship in Medicine: Bridging Healthcare and Business with Dr. Nneka Una

    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 app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:47 - From Employee to Owner 05:53 - Skills That Changed Everything 07:35 - The Wake Up Call 10:44 - Why Doctors Resist Business 15:06 - Profit as Patient Care 18:20 - Job vs. Business Entity 21:13 - CEO Hat and Team Systems 25:14 - Exit Value and Sellability 29:00 - More Profit: More Time Off 30:24 - Fear Before Breakthrough 35:32 - Choose Service Over Perfection 39:11 - Invest in Your Potential 46:26 - MEAT Week Priorities 48:40 - Three-Part Daily Rhythm 55:02 - Advice for Burned-Out Docs 59:29 - Wrap Up --- More about this episode Dr. 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. --- Resources EntreMD 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

  • July 31 · 25 min

    Ep. 667 Aortoiliac Arterial Disease Treatment with Dr. Eric Secemsky

    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 app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:56 - Patient History 05:42 - CTA and Angio Findings 09:30 - Strategy Access and IVUS 13:17 - IVUS Sizing and Lesion Review 16:38 - IVL Angioplasty Technique 18:28 - Stenting and Final Result 22:50 - Post-procedure Meds and Outcome 24:34 - 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

  • July 28 · 1 hr 17 min

    Ep. 666 Dear IR Residency - Residency Reflection with Dr. Gregg Khodorov and Dr. Aesha Patel

    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 app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:34 - Rapid Fire Reflections 07:20 - Complications and Confidence 12:01 - Applicant Misconceptions 16:54 - Defining a Great Program 26:38 - Lessons Learned Over Time 29:12 - Pearls and Hard-Won Lessons 33:09 - Valuing Bread-and-Butter Cases 35:24 - Complications and Empathy 41:03 - Memorable Attending Phrases 43:06 - Habits for the Future 47:34 - Mentorship and Craftsmanship 52:42 - IR Culture and Professional Pride 57:44 - The Future of IR Training 01:08:34 - 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 Program https://www.sciencedirect.com/science/article/pii/S1076633221000568 Diversity in Interventional Radiology Residency Programs https://www.sciencedirect.com/science/article/abs/pii/S1546144025002765 Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residency https://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

  • July 21 · 43 min

    Ep. 665 Advanced Strategies for Targeted Bone Biopsies with Dr. Peter C. Thurlow

    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 app https://www.backtable.com/app --- This podcast is supported by Varian https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction 04:17 - Approaching Focal Bone Lesions 06:17 - Differentiating Lesions and Pain Management 13:13 - Settling on Bone Biopsy Imaging 16:55 - Understanding Pre-Op Imaging from Lesion Characteristics 21:50 - Maintaining Communication Across Specialties 24:21 - Which Devices To Select and Navigating Challenges 32:28 - Trajectory Paths and Surgical Considerations 35:30 - How to Avoid and Mitigate Biopsy Complications 41:30 - 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

  • July 17 · 1 hr 42 min

    Ep. 664 Understanding Genicular Artery Embolization for Knee Osteoarthritis with Dr. Peter Minko

    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 app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:13 - The Embolization Landscape in Germany 07:25 - The Basics of GAE Patient Workup 13:49 - The Unideal Patient Candidate for GAE 16:55 - Measuring Outcomes Beyond Clinical Scores 23:14 - Procedure Specifics: Minko’s Choice 36:28 - Discussing the Future of Temporary vs. Permanent Embolics 43:47 - Collateral Flow Strategy and Procedure Wrap-Up 49:05 - Post-Procedure Rehab Guidelines 52:00 - Repeat GAE Treatment Algorithm 58:00 - Safety and Outcomes in Post-TKA Patients 01:04:11 - GAE and Associations with the Hospital Anxiety and Depression Scale (HADS) 01:09:40 - Call for Better Trials and Evidence in GAE 01:14:11 - Case Presentation: GAE Transpedal Access Case 01:21:05 - 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 Embolization 01:40:55 - Wrap Up --- More about this episode The 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. --- Resources Dr. Peter Minko https://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

  • July 14 · 54 min

    Ep. 663 Advancements in Tibial Artery Stenting & Scaffolding with Dr. Sahil Parikh

    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 app https://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 - Introduction 04:00 - Bioengineering Origins 08:29 - 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

  • July 10 · 39 min

    Ep. 662 Pathways to Interventional Radiology: ESIR vs. Integrated Dr. John Cieslak

    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 app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:47 - 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

  • July 7 · 44 min

    Ep. 661 Practical Strategies for Advanced Embolization Techniques with Dr. Harris Chengazi

    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 app https://www.backtable.com/app --- This podcast is supported by Okami Medical https://okamimedical.com/ --- Timestamps 00:00 - Introduction 02:22 - Multidisciplinary Vascular Practice Model 05:51 - Understanding Plugs in Embolization 08:34 - Comparing Plugs, Coils, and Liquid Embolics 13:48 - LOBO Occlusive Device 16:12 - Plug Sizing and Vessel Measurement 20:45 - Deliverability and Catheter Selection 24:28 - Limitations of Point Embolization 29:03 - PARTO Access and Technique 32:46 - Other LOBO Use Cases 34:33 - LOBO Deployment Mechanism 36:23 - Cost Effectiveness of Embolics 41:08 - 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

  • July 3 · 59 min

    Ep. 660 Techniques & Outcomes of Portal Vein Embolization with Dr. David C. Madoff

    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 app https://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protection https://www.radpad.com/ --- Timestamps 00:00 - Introduction 02:14 - IO Practice and Research 07:25 - PVE Indications and Adequate FLR 12:55 - Referrals and Patient Selection 17:27 - PVE vs. Y90 Radiation Lobectomy 22:12 - Liver Venous Deprivation 25:31 - Measuring FLR Function 30:11 - Procedural Planning and Technique 36:36 - Preferred Embolic Agents and Challenges 46:58 - Ipsilateral vs. Contralateral Access 50:52 - Complications, Medications, and Follow-Up 55:45 - 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 Trial https://www.dragontrial.com/ Three hundred and one consecutive extended right hepatectomies: Evaluation of outcome based on systematic liver volumetry https://doi.org/10.1097/SLA.0b013e3181b674df Portal vein embolization with N-butyl-cyanoacrylate improves liver hypertrophy compared to microparticles – A Swedish multicenter cohort study https://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

  • June 30 · 44 min

    Ep. 659 Combination Therapy for Hepatocellular Carcinoma with Dr. Beau Toskich and Dr. Lingling Du

    How do you safely combine locoregional and systemic therapies to treat hepatocellular carcinoma (HCC) when traditional guidelines suggest your hands are tied? In this episode of the 2026 HCC Creator Weekend™, medical oncologist Dr. Lingling Du (Ochsner Health) and interventional radiologist Dr. Beau Toskich (Mayo Clinic Florida) join Dr. Tyler Sandow to break down patient selection, timing strategies, and the practical application of clinical trial outcomes when integrating Y90 radioembolization and immunotherapy in HCC management. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction 01:48 - Two HCC Cases 03:31 - Disease Progression on Combination Therapy 07:05 - Alternatives After Immunotherapy Failure 09:09 - Salvage with Ablative Y90 13:41 - Mechanism of Immunotherapy 15:43 - EMERALD-1 and LEAP-012 20:52 - Adverse Events with Combination Therapy 27:21 - Treatment Timing and Sequencing 28:48 - Case: Borderline BCLC B 33:48 - Case: BCLC C with Portal Vein Thrombus 37:06 - Raising the Survival Tail 40:11 - Final Thoughts and Closing Remarks --- More about this episode The physicians highlight how selective local treatment can achieve complete responses and salvage cases with aggressive disease. They emphasize that treatment based on anatomical and biological phenotype may yield better results than strictly adhering to rigid staging categories, while acknowledging the challenges of managing microscopic disease and unpredictable long-term tumor behavior. Dr. Du and Dr. Toskich also note that selecting the right combination regimens requires balancing aggressive tumor kinetics against the patient’s baseline liver function, pointing out that well-tolerated regimens like STRIDE are often easier to pair with Y90 than checkpoint or VEGFR inhibitors that alter tumor blood flow. While recent TACE-immunotherapy trials (EMERALD-1 and LEAP-012) may be confounded by patient heterogeneity, the physicians observe that a distinct subset of patients achieves durable, long-term remission, effectively raising the survival tail for an otherwise incurable population. Ultimately, they conclude that cross-specialty education and leaning into the expert intuition of a multidisciplinary team are essential for securing the best outcomes for patients with intermediate and advanced HCC. --- Resources Study of Durvalumab and Tremelimumab as First-line Treatment in Patients With Advanced Hepatocellular Carcinoma (HIMALAYA) https://clinicaltrials.gov/study/NCT03298451 A Study of Atezolizumab in Combination With Bevacizumab Compared With Sorafenib in Patients With Untreated Locally Advanced or Metastatic Hepatocellular Carcinoma (IMbrave150) https://clinicaltrials.gov/study/NCT03434379 Nivolumab plus ipilimumab versus lenvatinib or sorafenib as first-line treatment for unresectable hepatocellular carcinoma (CheckMate 9DW): an open-label, randomised, phase 3 trial https://doi.org/10.1016/S0140-6736(25)00403-9 Durvalumab with or without bevacizumab with transarterial chemoembolisation in hepatocellular carcinoma (EMERALD-1): a multiregional, randomised, double-blind, placebo-controlled, phase 3 study https://doi.org/10.1016/S0140-6736(24)02551-0 Transarterial chemoembolisation combined with lenvatinib plus pembrolizumab versus dual placebo for unresectable, non-metastatic hepatocellular carcinoma (LEAP-012): a multicentre, randomised, double-blind, phase 3 study https://doi.org/10.1016/S0140-6736(24)02575-3 --- 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

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