BackTable / VI / Podcast / Episode #179
Happiness is a Warm Coil: Treating GI Bleeds
with Dr. Donald Garbett
Interventional Radiologist Donald Garbett and our host Sabeen Dhand discuss their standard workups and procedural decision making for GI bleeds, including radial vs. femoral approach and preferred embolics.
BackTable, LLC (Producer). (2022, January 17). Ep. 179 – Happiness is a Warm Coil: Treating GI Bleeds [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Donald Garbett
Dr. Donald Garbett is a practicing Vascular and Interventional Radiologist at Minimally Invasive Specialists in Eugene, Oregon.
Dr. Sabeen Dhand
Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.
In this episode, interventional radiologist Dr. Donald Garbett and our host Dr. Sabeen Dhand discuss their standard workups and procedural decision making for GI bleeds.
The doctors start by describing the workup. Dr. Garbett says that the majority of his cases are referred from GI, either when GI cannot find the bleed or cannot access the bleed because of excessive bleeding into the GI lumen. Dr. Garbett often uses triple phase CT angiography. He emphasizes the importance of doing triple phase, in order to distinguish between arterial bleeds and varices, as this difference will guide further treatment decisions.
In non-emergency situations, Dr. Garbett prefers transradial access. He discusses his use of various embolic agents such as glue and combination of both detachable and pushable coils. Dr. Dhand mentions newer embolics such as Onyx. He adds that he sometimes administers a low dose of glucagon to inhibit bowel movements.
Finally, the doctors share various pearls of wisdom for GI embolization, such as the advantages of provocative angiogram, treatment decisions when a patient is crashing, and variceal indications for balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS).
Ep. 118 BRTO vs. PARTO in Gastric Variceal Bleeding:
YouTube Video: Embolization and Provocative Angiography in Lower GI Bleeds:
[Dr. Donald Garbett}:
I think probably two things. One thing is that the techs set up. So they've built, might be a little funny. They build a moat around the patient.
[Dr. Sabeen Dhand}:
Ah. You’re going to have to submit a picture of this at some point so we can put it on our website. What do you mean? I have a moat sometimes when we do like a PleurX catheter. Cause ascites or effusions are going to jump out at you. Is that what you mean? Like a little like towel? I don't know, wall?
[Dr. Donald Garbett}:
Kind of, yeah. They take the blankets all the way around the patient. But just below the butt and then up to the shoulders. And they build like a capture for the blood. Cause sometimes, you know if we get a crashing one, it is a huge mess.
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