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Vascular Surgery

Learn about Vascular Surgery on BackTable VI

Learn more on the BackTable VI Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on Vascular Surgery and how to build your practice by listening to the BackTable VI Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Ep 351 Discussing the Recent NYT Article with Dr. Frank Arko and Dr. Saher Sabri
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Vascular Surgery Podcasts

Listen to leading physicians discuss vascular surgery on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #420

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In this episode of the Backtable Podcast, host Dr. Chris Beck interviews guests Dr. Omar Chohan and Dr. Harris Chengazi about dialysis fistula declot procedures and their own experiences with various devices and strategies, including usage of pre-procedure ultrasound, heparinization, and closure techniques. Both Dr. Chohan and Dr. Chengazi are interventional radiologists at Great Lakes Medical Imaging in Buffalo, New York.

The doctors dive into treatment of anastomosis stenosis, stressing the importance of technique refinement, physical examination, and thoughtful pre-procedure planning. The discussion concludes with an invitation for listeners to share their experiences with the ‘bottle-cap’ hemostasis trick.

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Episode #419

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In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ilan Rzadkowolsky-Raoli about his experience of being diagnosed with a large saddle embolus and subsequently being treated by his best friend, Dr. Ripal Gandhi. Dr. Rzadkowolsky-Raoli is an interventional radiologist at Palmetto General Hospital in Miami, Florida.

Dr. Rzadkowolsky-Raoli discusses the impact of his diagnosis on his practice, how it has changed the way he approaches and speaks to his patients, and his advice for clinicians.

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Episode #418

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In this episode, host Dr. Sabeen Dhand interviews Dr. Charles Bailey about Limb Alert, a hospital protocol devised to expedite the diagnosis and treatment of patients presenting with acute limb ischemia. Dr. Bailey is a vascular surgeon and the Director of Peripheral Artery Disease (PAD) and Limb Salvage at the University of South Florida.

Dr. Bailey explains how the Limb Alert program standardizes the care pathway, rapidly alerts necessary personnel, initiates labs, and prepares the Penumbra Lightning Bolt 7 System for endovascular thrombectomy. The incorporated protocol significantly streamlines patient management, resulting in encouraging survival rates. Dr. Bailey further emphasizes the necessity for modern endovascular trials in acute limb ischemia and proposes a multicenter randomized trial to provide evidence for endovascular treatment.

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Episode #414

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In this episode, host Dr. Chris Beck interviews Dr. Jason Wagner about his experience withu the Hemodialysis Reliable Outflow (HeRO) graft and the Surfacer system for treating patients with end stage renal disease (ESRD) and limited vascular access options. Dr. Wagner is a practicing vascular surgeon in Sarasota, Florida.

Dr. Wagner explains the steps to implant a HeRO endovascular graft, how it provides a durable and reliable outflow for hemodialysis patients, and how it can be used and revised based on the patient’s needs. He also discusses the Surfacer system in obtaining central venous access, its advantages, and the necessity of preoperative imaging. Dr. Wagner emphasizes the critical role of continued learning in utilizing and optimizing these advanced dialysis solutions.

The suggestions and other information, which may include Merit products, are for the practitioner’s convenience and for general information purposes only. This information does not constitute medical or legal advice. Before using, refer to the Instructions for Use (IFU) for indications, contraindications, warnings, precautions, and directions for use.

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Episode #413

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This week on the BackTable Podcast, Dr. Darren Klass shares his experiences in the treatment of aortic dissections. Dr. Klass is an interventional radiologist at the University of British Columbia.

Dr. Klass underscores the criticality of intraoperative decision-making, the use of intravascular ultrasound (IVUS), and the importance of taking a multidisciplinary approach. The conversation further explores the nuances of treating acute complicated aortic dissections, stabilizing the intermedial flap, follow-up protocols, and the importance of raising awareness about this high risk disease.

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Episode #408

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In this episode, host Dr. Aaron Fritts is joined by interventional cardiologists Dr. Sameh Sayfo (Baylor Scott & White in Plano, TX) and Dr. Nicolas Shammas (Cardiovascular Medicine in Davenport, IA) for a discussion about critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment.

To start, Dr. Shammas explains that infrapopliteal disease is difficult to treat due to the high rate of total occlusions and the high degree of medial calcinosis. Next, he gives an introduction to laser atherectomy for certain plaque locations and morphologies, and he describes previous studies that have shown its efficacy for calcified lesions. Intravascular ultrasound (IVUS) can also help guide vessel sizing, plaque morphology, and appropriate device selection. Dr. Shammas believes that the current atherectomy devices on the market are easy to learn to use and can be incorporated into any CLI program.

The doctors discuss the ongoing multicenter study on outcomes of the Auryon laser atherectomy system in CLI patients. Dr. Shammas reviews the study design, proposed endpoints, and current data on 30 day outcomes. We end the episode with advice on building a strong CLI program, which includes multidisciplinary collaboration, advocating for resources, a variety of different tools, and appropriate management of cardiovascular risk factors.

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Episode #407

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In this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews Dr. Eric Secemsky about the efficacy of drug eluting technologies in vascular interventions, with Dr. Secemsky offering insight into his own practice. Dr. Secemsky is an interventional cardiologist practicing at Beth Israel Deaconess Medical Center in Boston.

Dr. Secemsky believes that drug coated technology is a game-changer in the endovascular space since it improves patient outcomes by reducing the risk of needing additional procedures. Dr. Secemsky highlights the importance of various trials such as IMPERIAL and EMINENT, which compare the effectiveness of different stents. He also speaks about the significance of the Cook Medical prediction model to calculate intervention success rates and the role of disease site-specific interventions. Dr. Secemsky ends the podcast by sharing his thoughts about advancements in the near future, including the use of bioabsorbable stents and sirolimus drug-coated balloons.

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Episode #394

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In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. Dr. Levey is an interventional radiologist at the Memorial Hermann Health System in Houston, TX.

The doctors discuss how cryoneurolysis differs from radiofrequency (RF) ablation, highlighting the increased precision and gentleness to surrounding tissues. Dr. Levey describes the specifics of stellate ganglion procedures and cryoneurolysis techniques. They delve into the importance of research and collaboration in advancing the field, as well as the necessity of being patient-centered. They also address the need for financial discussions in medicine and the prospect for cryoneurolysis as a desmoid tumor treatment. To conclude, Dr. Levey shares her journey in building a career as a female in a male-dominated space and emphasizes the importance of physician availability to patients and colleagues.

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Episode #392

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In this episode of the BackTable Podcast, host Dr. Ally Baheti and Dr. Paramjit “Romi” Chopra discuss the processes involved in successful interventional radiology practice management. Dr. Chopra is an interventional radiologist practicing in Chicago, IL. He is the founder and CEO of Midwest Institute for Minimally Invasive Therapies.

Dr. Chopra advises young IRs against going solo, and he suggests finding people who’ve done it before, to avoid “reinventing the wheel.” Dr. Chopra emphasizes the importance of adopting a patient-centered approach, building systems, developing business sense, and understanding risk. He shares his own experiences of building systems using Salesforce and explains the concept of ‘omni-channel healthcare delivery’. He particularly discusses the importance of patient, provider, and payer relationships, and he offers solutions for dealing with inherent complications. The episode also covers identifying the right electronic health record and developing an effective inventory management system.

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Episode #390

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In this episode of the BackTable Podcast, host Dr. Chris Beck discusses atherectomy, laser technologies, and their use in vessel treatment with Dr. Tony Das, an interventional cardiologist practicing in Dallas, TX and one of the founding members of the VIVA Vascular Education Course in Las Vegas.

Dr. Das shares insights on the PATHFINDER registry, which is a prospective non-randomized, multicenter study to evaluate the performance and outcome of the Auryon laser atherectomy system. Their conversation explores the role of atherectomy in reducing stent usage, decreasing embolization likelihood, enhancing thrombus removal, and uncovering lesions. Dr. Das further provides recommendations for building a successful atherectomy program, utilizing laser technologies, and the importance of having ablative technology in outpatient labs. The doctors forecast future applications for artificial intelligence and remote monitoring.

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Episode #384

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In this episode, host Dr. Aaron Fritts interviews vascular surgeon Dr. Syed Hussain and interventional radiologist Dr. Omar Saleh about new innovations in closure devices.

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Episode #382

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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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Episode #369

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In this episode, host Dr. Aaron Fritts interviews Dr. Maureen Kohi and Dr. Niten Singh on the VIVA Foundation’s multidisciplinary approach to advancing vascular medicine.

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Episode #351

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In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Saher Sabri and vascular surgeon Dr. Frank Arko about their perspectives on a July 2023 New York Times article about the ethics of peripheral arterial disease (PAD) treatment in outpatient based labs (OBLs) and ambulatory surgery centers (ASCs).

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Episode #326

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In this episode, host Dr. Ally Baheti interviews vascular surgeon Dr. Anahita Dua on the importance of political advocacy in healthcare, including why she created a PAC, the importance of healthcare workers in Congress, and how you can get involved.

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Episode #320

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In this episode, host Dr. Sabeen Dhand interviews interventional cardiologist Dr. Eric Secemsky about the role of intravascular ultrasound in lower extremity interventions, and how he published a consensus document to standardize its use across specialties and provide a framework for new users.

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Episode #312

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In this multidisciplinary episode, guest host and vascular surgeon Dr. Krishna Mannava interviews interventional cardiologist Dr. John Phillips about when and how he treats dissections after balloon angioplasty in peripheral vasculature.

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Episode #241

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In this episode, guest host Jill Sommerset interviews vascular surgeon Dr. Miguel Montero-Baker about his evolving use of ultrasound throughout his career in caring for critical limb-threatening ischemia (CLTI) patients.

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Episode #204

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We talk with interventional radiologist Dr. Stephen Wang about building an IVC filter retrieval program, the current guidelines on filter placement, and how to minimize the complications of filters.

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Episode #202

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Vascular Surgeon Krishna Mannava and Vive Vascular VP of Operations Kristin Longwell give advice on staffing the OBL/ASC based on their experiences over the last few years, including the essentials positions to start with, whether or not to use consulting firms, and sourcing your staff.

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Episode #197

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Vascular surgeon Dr. Martin Schroeder discusses the Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB) technique for treating aortoiliac disease, including patient workup, procedure steps, and pitfalls to avoid with stent placement.

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Episode #196

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We talk with Interventional Radiologist Dr. Carin Gonsalves about how her practice built a multidisciplinary Pulmonary Embolism (PE) Response team, including where to start, developing efficient workflows, and obtaining the equipment you need for success.

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Episode #193

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Vascular surgeon Krishna Mannava and Chas Sanders (founder of MARGIN) discuss their approach to choosing which disposables and devices to stock up on in the outpatient facility, and how to plan for supply chain issues.

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Episode #172

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CLI fighters Dr. Bryan Fisher and Dr. Sabeen Dhand discuss their approach to treating calcified arteries above the knee, including looking at newer technologies and choosing the appropriate device to effect real durable change to the calcified wall.

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Vascular Surgery Articles

Read our exclusive BackTable VI Articles for quick insights on vascular surgery, provided by physicians for physicians.

Tools & Techniques in Iliofemoral Stenting

Percutaneous iliofemoral venous stenting demands precise selection of tools and stents tailored to each clinical scenario. This article explores the strategic approaches for stent placement and sizing in both non-thrombotic and post-thrombotic conditions, aiming to enhance patient outcomes.

Periprocedural Pearls in Iliofemoral Stenting: Focus on Pre- & Post-Care

Iliofemoral vein stenting is explored in depth, focusing on critical aspects of procedural preparation and post-operative care. Learn more about medication strategies, patient discomfort management, imaging follow-ups, and the importance of regular surveillance for successful long-term outcomes.

Iliofemoral Venous Disease Diagnosis & Patient Management

Iliofemoral venous disease demands specialized diagnostic and management approaches. Learn about patient referral patterns, crucial diagnostic methods, and key strategies for effective treatment compliance.

Arterial Thrombectomy Device Selection & Clinical Decision-Making

There are a diversity of thrombectomy devices that are viable for arterial thrombectomy, including Boston Scientific AngioJet, Penumbra Indigo, AngioDynamics Auryon, and BD Rotarex. Each device has utility in different clinical scenarios. Learn more about effective arterial thrombectomy device selection.

Arterial Thrombectomy in Acute Limb Ischemia: A Practical Guide

Interventional radiologist Dr. Alexander Ushinksy details his procedural technique for arterial thrombectomy in acute limb ischemia, including patient preparation, imaging, heparinization, wire placement, and post-operative care.

Building an Acute Limb Ischemia Program: Focus on Referrals

IR Dr. Alexander Ushinsky shares expert advice on building a thriving peripheral vascular practice with a successful acute limb ischemia program.

Acute Limb Ischemia: Rutherford Classification, Imaging Techniques & Essential Labs

Dr. Alexander Ushinsky provides an in-depth look at his protocol for working up acute limb ischemia, covering physical examination, Rutherford classification, imaging, and labs. Learn more!

Arterial Dissection Treatment with Tacks

Arterial dissections can occur after lower extremity arterial angioplasty procedures. Common methods of arterial dissection treatment include stents or Tacks, with stents being the more prevalent option. Learn more!

Tacks vs Stents For Arterial Dissection Treatment

The Tack Endovascular System is a newer device that functions similarly to a stent, but with key differences that may make it more appropriate for treating arterial dissections in the superficial femoral artery (SFA) or the proximal popliteal artery.

Intravascular Ultrasound (IVUS) Imaging: Benefits & Drawbacks

Intravascular ultrasound (IVUS) imaging has shown benefits such as improved vessel assessment, enhanced procedural efficiency, reduced need for additional imaging and radiation exposure, and potential long-term durability of interventions. However, challenges in implementation, including cost, learning curve, and time constraints, need to be addressed to facilitate wider adoption of IVUS procedure.

Intravascular Ultrasound (IVUS) Consensus Guidelines

Interventional cardiologist Dr. Eric Secemsky explores key findings from IVUS consensus guidelines in coronary and peripheral interventions. Learn more!

Disclaimer: The Materials available on https://www.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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Podcasts

The Art & Science of Declotting the Dialysis Circuit with Dr. Omar Chohan and Dr. Harris Chengazi on the BackTable VI Podcast)
Experiencing a Pulmonary Embolism & Thrombectomy with Dr. Ilan Rzadkowolsky-Raoli on the BackTable VI Podcast)
Acute Limb Ischemia: Timing, Technology & Triage with Dr. Charles Bailey on the BackTable VI Podcast)
HeRO Grafts in Dialysis: Techniques, Challenges & Solutions with Dr. Jason Wagner on the BackTable VI Podcast)
TBAD Management: Best Practices in Aortic Dissection with Dr. Darren Klass on the BackTable VI Podcast)
Iliofemoral Stenting: Decision-Making & Best Practices Explored with Dr. Kush Desai and Dr. Steven Abramowitz on the BackTable VI Podcast)

Articles

Tools & Techniques in Iliofemoral Stenting

Tools & Techniques in Iliofemoral Stenting

Periprocedural Pearls in Iliofemoral Stenting: Focus on Pre- & Post-Care

Periprocedural Pearls in Iliofemoral Stenting: Focus on Pre- & Post-Care

Iliofemoral Venous Disease Diagnosis & Patient Management

Iliofemoral Venous Disease Diagnosis & Patient Management

Contributors

Dr. Theodosios Bisdas on the BackTable VI Podcast

Dr. Theodosios Bisdas

Dr. Syed Hussain on the BackTable VI Podcast

Dr. Syed Hussain

Dr. Maureen Kohi on the BackTable VI Podcast

Dr. Maureen Kohi

Kristin Longwell on the BackTable VI Podcast

Kristin Longwell

Dr. Krishna Mannava on the BackTable VI Podcast

Dr. Krishna Mannava

Chas Sanders on the BackTable VI Podcast

Chas Sanders

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