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BackTable / VI / Podcast / Episode #382

Iliofemoral Stenting: Decision-Making & Best Practices Explored

with Dr. Kush Desai and Dr. Steven Abramowitz

In this episode, host Dr. Chris Beck interviews interventional radiologist Dr. Kush Desai (Northwestern University Feinberg School of Medicine) and vascular surgeon Dr. Steve Abramowitz (MedStar Washington Health Center) about iliofemoral venous stenting.

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Iliofemoral Stenting: Decision-Making & Best Practices Explored with Dr. Kush Desai and Dr. Steven Abramowitz on the BackTable VI Podcast)
Ep 382 Iliofemoral Stenting: Decision-Making & Best Practices Explored with Dr. Kush Desai and Dr. Steven Abramowitz
00:00 / 01:04

BackTable, LLC (Producer). (2023, November 6). Ep. 382 – Iliofemoral Stenting: Decision-Making & Best Practices Explored [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Kush Desai discusses Iliofemoral Stenting: Decision-Making & Best Practices Explored on the BackTable 382 Podcast

Dr. Kush Desai

Dr. Kush Desai is an associate professor and the director of deep venous interventions at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Dr. Steven Abramowitz discusses Iliofemoral Stenting: Decision-Making & Best Practices Explored on the BackTable 382 Podcast

Dr. Steven Abramowitz

Dr. Steven Abramowitz is a practicing vascular surgeon at MedStar Georgetown University Hospital in Washington, D.C.

Dr. Christopher Beck discusses Iliofemoral Stenting: Decision-Making & Best Practices Explored on the BackTable 382 Podcast

Dr. Christopher Beck

Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.

Synopsis

We start this episode by reviewing the evolution of knowledge and treatment of venous disease over recent years. Dr. Desai and Dr. Abramowitz identify referral patterns that connect patients with vascular and interventional physicians, and they emphasize how most patients are diagnosed in primary care pathways rather than in the emergency room. The doctors also underscore the importance of educating referring physicians and patients on the impact of early intervention and how vascular and interventional physicians are well-equipped to provide specialized care and management of venous disease.

Dr. Desai and Dr. Abramowitz explain their work-up of patients with deep venous disease. The doctors cover necessary imaging studies and conservative treatments for clinic visits. They also explain their procedural approach, access sites, patient positioning preferences, and more.

The doctors share guiding anatomical landmarks and recommendations on tools for crossing, along with their decision-making process in treating post-thrombotic patients. They also discuss best practices in venous stenting and post-operative follow up algorithms. We conclude this episode with important advice on how to avoid dangerous life-threatening outcomes.

Resources

Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis (2023):
https://www.sciencedirect.com/science/article/pii/S1051044322013173

A review of the incidence, outcome, and management of venous stent migration:
https://www.sciencedirect.com/science/article/abs/pii/S2213333X2100411X

Transcript Preview

[Dr. Kush Desai]
There's a lot of different ways to do this. A lot of my vascular surgery colleagues are doing mid-thigh femoral access. Actually, my colleagues too, a lot of them do mid-thigh femoral access. I think the way I was "raised" and the way I've done procedures is if it's a post-thrombotic and there's an inflow lesion, particularly the common femoral vein, I do it under prone access, and I access typically small saphenous.

If it's not a posterior thigh extension of Giacomini vein, if there's a Saphenopopliteal junction. I like the small saphenous vein because primarily if we know that the active access is traumatic in of itself, particularly with some of the larger sheaths that some of these devices require, if I'm going to bag a vein, might as well bag the vein that people close for a living. Posterior tibial vein and then begrudgingly popliteal vein after that.

I will say that access management with closure and all that, that's probably where we need to come the furthest with venous. We have venous closure devices. I think those need to be studied in our interventions more and more, particularly with the level of anticoagulation that we're using because access-like complications not frequently talked about, but they do occur.

Sponsor Disclaimer: The content, information, opinions and viewpoints contained in this presentation are for educational purposes only. Some opinions expressed may represent those of the speaker and are based on their own clinical experience in their practice. This information is not meant or intended to serve as a substitute for a healthcare professional’s clinical training, experience or judgment. Guest speakers are paid consultants of Cook Medical. Always refer to the Instructions for Use for complete prescribing information including indications for use, warnings, precautions, adverse events and deployment/use instructions.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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