BackTable Vascular & Interventional

The very first episode of BackTable was about bone marrow biopsies, and the procedure has come a long way since. Powered drivers, smarter planning, and a well placed periosteal block have made it faster and far more comfortable for patients. On this episode of the BackTable Podcast, Dr. Mohammad Samim, a musculoskeletal radiologist at NYU Langone Health, joins host Dr. Chris Beck to discuss best practices for image-guided bone marrow aspiration and biopsy. They discuss how more referrals are coming from hematology, what drives the need for imaging guidance, and why a careful periosteal block lets most patients avoid sedation.

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https://www.backtable.com/app

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This podcast is supported by

Varian OmniBone
https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone

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Timestamps

00:00 - Introduction
03:31 - Referral Trends and Procedure Volume
06:15 - Indications and Contraindications
12:28 - Sedation and the Periosteal Block
16:30 - Procedure Walkthrough
23:13 - Powered Access and Variable Speed
29:43 - Sclerotic Bone and Dry Taps
34:55 - Aspiration Pain and On-Site Pathology
37:35 - Sternal Bone Marrow Aspiration
39:07 - Efficiency With Powered Systems
43:37 - Ultrasound Guidance and Workflow
46:45 - Hemodilution and Repeat Biopsies
48:14 - Closing Remarks

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More about this episode

The conversation then walks through the procedure itself, from reviewing pelvic anatomy and planning a trajectory on the scout to choosing between a single needle and a coaxial system and aiming for a core close to 1.5 centimeters. Dr. Samim explains how variable speed powered drivers work for both soft and sclerotic bone, what to do when a needle gets stuck or a tap comes back dry, and why a slow, steady pull makes the aspirate less painful. The episode closes with workflow tips for efficiency, minimizing hemodilution, and getting a high-quality sample the first time.

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Resources

Increasing Volume of Bone Marrow Biopsies by Radiology Providers: Evaluation of Trends by Physician Specialty and Practice Setting. J Am Coll Radiol. 2020
https://doi.org/10.1016/j.jacr.2020.02.004

BackTable Episode 1, the very first BackTable episode, on bone marrow biopsy, with Dr. Chris Beck, Dr. Aaron Fritts, and Anish Parikh
https://www.backtable.com/shows/vi/podcasts/1/bm-bx-devices-jamshidi-vs-oncontrol

Dr. Mohammad Samim, NYU Langone Health
https://nyulangone.org/doctors/1487966693/mohammad-m-samim

Dr. Chris Beck, BackTable contributor page
https://www.backtable.com/shows/vi/contributors/dr-christopher-beck

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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

Which patients with bleeding hemorrhoids benefit from artery embolization, and who should go to surgery instead? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Kristen Rumer and Dr. Scott Thompson of Mayo Clinic to break down patient selection, technique, and follow-up for hemorrhoid artery embolization (HAE) at a major academic center. They explain why bleeding-predominant, Goligher grade II and III internal hemorrhoids are the best candidates, and how the technique has evolved from its origins in France to routine practice in the US.

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https://www.backtable.com/app

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This podcast is supported by

Terumo
https://www.terumois.com/haepodcast

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Timestamps

00:00 - Introduction
03:33 - Surgical Options and Recovery
07:31 - Ideal Candidates for Embolization
10:47 - HEMORR1 Trial Design and Embolics
15:37 - Arterial Anatomy and Coil Technique
19:53 - Collaboration with Colorectal Surgery
24:18 - Pelvic Pain and Patient Selection
28:48 - Scalability and Contraindications
32:02 - Recurrence and Collateral Supply
35:27 - Patient Goals and Expectations
37:37 - Closing Remarks

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More about this episode

The conversation covers advanced imaging, embolic selection, coil technique, and complication management. Dr. Thompson details the HEMORR1 trial protocol, including photon counting CTA, large spherical particles, and careful coil packing. Dr. Rumer discusses a bidirectional referral pathway and the unmet need for embolization options in anticoagulated and immunosuppressed patients. The episode closes with pearls for avoiding recurrence, managing chronic pelvic pain, and setting realistic expectations so patients understand what success means after HAE.

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Resources

Mayo Clinic: Hemorrhoidal Embolization Trial (HEMORR1)
https://www.mayo.edu/research/clinical-trials/cls-20556753

Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease (Vidal technique)
https://pubmed.ncbi.nlm.nih.gov/35781988/

Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques (RadioGraphics)
https://pubs.rsna.org/doi/full/10.1148/rg.220014

Is the Goligher Classification a Valid Tool in Clinical Practice and Research for Hemorrhoidal Disease?
https://link.springer.com/article/10.1007/s10151-022-02591-3

Scott M. Thompson, M.D., Ph.D., Mayo Clinic
https://www.mayoclinic.org/biographies/thompson-scott-m-m-d-ph-d/bio-20535376

Kristy K. Rumer, M.D., Ph.D., Mayo Clinic
https://www.mayoclinic.org/biographies/rumer-kristy-k-m-d-ph-d/bio-20519891

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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

How do you devascularize a hypervascular tumor when the vessels feeding it are too small to catheterize? On this episode of BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Resmi Charalel and Dr. Milan Patel to walk through seven real-world cases where non-adhesive hydrogel liquid embolics made the difference. They break down patient selection, case planning, and how to deploy these agents for safe, efficient devascularization when traditional approaches fall short.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Instylla
https://instylla.com/embrace/

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Timestamps

00:00 - Introduction
02:23 - Liquid Embolic Use in Practice
04:46 - Case 1: Renal Mass
07:51 - Delivery Technique and Target Vessel Size
13:08 - Device Setup and Catheter Compatibility
21:57 - Case 2: Multifocal HCC
27:44 - Case 3: Large Renal Tumor
40:21 - Randomized Trial Outcomes
43:28 - Case 4: HCC Near the Gallbladder
49:39 - Case 5: Pelvic Tumor and Femoral Metastases
55:30 - Lessons from Early Use and Case Selection
1:01:37 - Case 6: Breast Cancer Liver Metastasis
1:05:23 - Closing Remarks

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More about this episode

The discussion reviews seven real-world cases, from renal and liver tumors to pelvic, bone, and breast metastases, sharing practical pearls on microcatheter selection, plug formation, controlled reflux, and navigating high-flow environments and multiple vessels. They dive into troubleshooting pitfalls like loose connections and procedural waste, the real learning curve for adopting liquid embolics, and the outcomes data that support broader adoption of these techniques. The episode closes with advice for early-career operators and a look at future directions for patients who are not candidates for other embolic therapies.

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Resources

Instylla HES Hypervascular Tumor Pivotal Study (NCT04523350)
https://clinicaltrials.gov/study/NCT04523350

Abi-Jaoudeh N, et al. Multicenter Randomized Trial Evaluating the Safety and Effectiveness of the Instylla Hydrogel Embolic System for Vascular Occlusion of Hypervascular Tumors. J Vasc Interv Radiol. 2026
https://doi.org/10.1016/j.jvir.2026.108946

Ganguli S, Lareau R, et al. A Water-Based Liquid Embolic: Evaluation of its Safety and Efficacy in a Rabbit Kidney Model. J Vasc Interv Radiol. 2021
https://doi.org/10.1016/j.jvir.2021.02.018

HALT: Embrace Hydrogel Embolic System Study of Embolization in Peripheral Arterial Bleeds (NCT05364502)
https://clinicaltrials.gov/study/NCT05364502

Kim GH, et al. Effectiveness and Safety of Transarterial Radioembolization Following Inferior Phrenic Artery Glue Embolization for Flow Redistribution in Hepatocellular Carcinoma. J Vasc Interv Radiol. 2026
https://doi.org/10.1016/j.jvir.2026.108784

Dr. Resmi Charalel, Montefiore Einstein
https://doctors.montefioreeinstein.org/providers/1558653980/resmi-charalel

Dr. Milan Patel, MD Anderson Cancer Center
https://faculty.mdanderson.org/profiles/milan_patel.html

Dr. Kavi Krishnasamy, BackTable contributor page
https://backtable.com/shows/vi/contributors/dr-venkatesh-krishnasamy

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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

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Endovascular Engineering (E2)
E2Helo.com

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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

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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.

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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

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by
Varian
https://www.siemens-healthineers.com/

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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

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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.

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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

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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

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by
Stryker Peripheral Vascular
https://www.stryker.com/us/en/peripheral-vascular.html

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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

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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.

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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

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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

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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90.

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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

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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.

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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

What do you do when Y-90 doesn’t deliver the results you expected? In this episode of the 2026 HCC Creator Weekend™, host Dr. Tyler Sandow is joined by Drs. Beau Toskich and Juan Gimenez to discuss the technical challenges and troubleshooting strategies that can make or break a Y-90 radioembolization case. Together, they explore innovative approaches like the PREDATr technique, share tips for reducing complications, and offer guidance on optimizing outcomes for patients with complex liver tumors.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by an educational grant from Sirtex and Boston Scientific.

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Timestamps

00:00 - Introduction
04:24 - Treatment Nonresponse Troubleshooting
06:12 - Navigating Y90 Through Replaced Arteries
09:09 - Mitigating Vasospasm in Embolization
13:31 - What is ‘PREDATr’?
21:12 - Dual Balloon Microcatheter System
23:37 - Gelfoam Techniques and Application
26:06 - Embolization Agents Preferences
36:16 - Concerns with Cystic Artery Treatment and Biliary Stents
42:15 - Prophylactic Antibiotics
44:29 - Utilizing High Lung Shunts
49:28 - Wrap Up and Credits

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More about this episode

The conversation begins with case-based examples of HCC radioembolization, focusing on how to assess treatment response and troubleshoot nonresponsive cases. They discuss how to interpret SPECT findings, identify missed tumor supply with cone-beam CT, and overcome obstacles such as vasospasm, extrahepatic feeders, and challenging arterial anatomy. They introduce the PREDATr technique (proximal radioembolization enabled by distal angiozone truncation) and explain how tools like gelfoam, balloons, and retrievable coils can preserve healthy liver tissue and improve microsphere delivery. The episode also addresses managing biliary stents, using antibiotic prophylaxis, and strategies for handling high lung shunts, making it a practical resource for anyone navigating the complexities of Y-90 treatment.

---

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

Are new technologies and teamwork the key to better fibroid treatment? In this episode of the BackTable Podcast, Drs. Francis Kang and Neil Resnick join host Dr. Chris Beck to share how multidisciplinary treatment planning is reshaping uterine fibroid management, from patient selection and referral patterns to procedural techniques that improve outcomes.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by
TriSalus Life Sciences
https://trinavinfusion.com/

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Timestamps
00:00 - Introduction
06:18 - Multidisciplinary Care of Fibroids
15:45 - Treatment Decisions
21:56 - Managing Asymptomatic Fibroids
25:43 - Collaborative vs. Competitive Practices
30:01 - UFE Procedure Approaches
34:32 - Comparing Embolic Sizes and Amounts
37:44 - Changes in Speed Using TriNav Catheters
40:53 - Tactile Feedback at Stasis
42:28 - Embolization Target Regions
44:45 - Encountering and Troubleshooting Collaterals
47:30 - Post-Op Pain Regiments
57:28 - Wrap Up

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More about this episode
The conversation begins with the importance of strong partnerships with OBGYN colleagues and how multidisciplinary planning leads to better outcomes for patients. They explore patient selection and education, especially for those considering surgical versus minimally invasive treatment options. Drs. Kang and Resnick compare procedural approaches, including when to use femoral versus transradial access, nerve blocks, and embolic particle selection. They also discuss strategies to achieve optimal embolization endpoints and practical tips for handling collateral vessels, avoiding non-target embolization, and managing post-procedural pain and recovery. The episode concludes with a look at newer technologies like the TriNav Catheter and its impact on embolization speed, operator confidence, and early imaging outcomes.
---

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

Will new PE guidelines redefine risk and therapy in pulmonary embolism (PE) care? In this episode of the BackTable podcast, host Dr. Michael Barraza is joined by interventional cardiologist Dr. Jay Giri and emergency physician Dr. Trevor Cummings to break down the latest changes in PE management. They discuss how multidisciplinary pulmonary embolism response teams (PERT) are implementing these guidelines at their institutions, the introduction of a more nuanced A-E risk stratification system, and the challenges of enrolling experienced centers into clinical trials as device innovation accelerates.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Stryker Peripheral Vascular, formerly Inari Medical
https://www.inarimedical.com/flowtriever-system

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Timestamps

00:00 - Introduction
01:24 - Building a PERT Team
04:59 - Trials Shaping PE Care
10:20 - Why New Guidelines Now
14:06 - New Risk Categories Explained
19:51 - Applying Guidelines Locally
23:34 - What Is C1 Risk
27:52 - New D Category Explained
30:33 - Evidence for Aggressive Therapy
33:31 - How PERT Teams Communicate
38:22 - Upcoming PE Trials Pipeline
43:42 - Program Growth and High Risk Trials
45:46 - Closing Remarks

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More about this episode

The conversation highlights the growth of catheter-directed lysis and mechanical thrombectomy, the rationale and practical impact of the new Category D for incipient cardiopulmonary failure (including normotensive shock), and the incorporation of PESI, sPESI, and Hestia for risk assessment. Additional topics include decision-making for low-risk patients, lactate and biomarkers for identifying higher-risk cases, communication strategies within PERT teams, AI-enabled risk stratification, and a preview of upcoming trials (PEITHO, PRAGUE-26, PEERLESS-2, PE-TRACT, and PERSEVERE) that are set to further transform PE care.

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Resources

Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement From the American Heart Association
https://pubmed.ncbi.nlm.nih.gov/21422387/

Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association
https://pubmed.ncbi.nlm.nih.gov/36688837/

Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association
https://pubmed.ncbi.nlm.nih.gov/31585051/

Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism
https://pubmed.ncbi.nlm.nih.gov/41910345/

PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism
https://pubmed.ncbi.nlm.nih.gov/39132600/

Rationale and design of the PE-TRACT trial: A multicenter randomized trial to evaluate catheter-directed therapy for the treatment of intermediate-risk pulmonary embolism
https://pubmed.ncbi.nlm.nih.gov/39638275/

Reduced-Dose Intravenous Thrombolysis for Acute Intermediate–High-risk Pulmonary Embolism: Rationale and Design of the Pulmonary Embolism International THrOmbolysis (PEITHO)-3 trial
https://pubmed.ncbi.nlm.nih.gov/34560806/

Design and rationale of the PERSEVERE study: a randomized controlled trial of large-bore mechanical thrombectomy versus the standard of care for high-risk pulmonary embolism
https://pubmed.ncbi.nlm.nih.gov/41453591/

Design and rationale of PRAGUE-26: a multicentre, randomised trial of catheter-directed thrombolysis for intermediate-high risk acute pulmonary embolism
https://pubmed.ncbi.nlm.nih.gov/40464677/

---

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

Pulmonary AVM may be rare, but missing them can lead to lifelong complications, especially in patients with hereditary hemorrhagic telangiectasia (HHT). How do you choose the right device and strategy to ensure long-term success with embolization? In this episode of the BackTable Podcast, host Dr. Kavi Krishnasamy is joined by Dr. Brian Funaki and Dr. Nima Kokabi to unpack the evolving treatment landscape for pulmonary arteriovenous malformations (PAVM). Through imaging breakdown, review of challenging real-world cases, and a discussion on advanced treatment strategies, the conversation tackles a key debate in pulmonary embolization: are plugs replacing coils as the new standard?

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Okami
https://okamimedical.com/

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Timestamps

00:00 - Introduction
01:43 - Defining HHT and PAVM
05:53 - Democratizing Interventions for HHT Patients
08:83 - Recommendations to Embolize PAVM
13:19 - Imaging Specificity and Procedural Preferences
23:29 - Persistence Rates with Plugs and Coils
25:59 - Lag in Utilization of Plugs
29:18 - Comparison of LOBO to Alternative Vascular Plugs
34:26 - Post Embolization Symptoms and Troubleshooting Methods
39:04 - PAVM Cases and Treatments
54:26 - Wrap Up and Credits

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The discussion begins by defining HHT and PAVM, highlighting the risks associated with untreated PAVM and the critical need for genetic screening and multi-organ evaluation. Drs. Funaki and Kokabi review current treatment recommendations, surveillance imaging, and follow-up protocols, with special considerations for pediatric and high-risk patients. They explore practical tips for optimizing embolization performance, focusing on device selection and the evolving role of vascular plugs. By comparing different plug designs, such as wire count and pore size, and sharing lessons from challenging cases, including persistent lesions, tortuous anatomy, and pseudoaneurysm management, they provide advanced troubleshooting and decision-making strategies to achieve more durable, successful PAVM treatments.

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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.

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How do you differentiate between iliac vein compression, gonadal vein reflux, and Nutcracker syndrome in patients with chronic pelvic pain? Dr. Deepak Sudheendra, director and interventional radiologist at 360 Vascular Institute, joins host Dr. Ally Baheti to share his approach to evaluating and managing pelvic venous disease (PVD).

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Timestamps

00:00 - Introduction
01:43 - PVD Demand at Penn
06:42 - Approach & Algorithm
12:08 - Variation in Iliac Vein Compression
15:58 - Treatment Approaches
19:20 - Important Ultrasounds
22:15 - Intra-Procedural Workflow
31:14 - Iliac Vein Stenting and Avoiding Complications
36:31 - Gonadal Vein Embolization and Working with Patients
42:20 - Iliac Vein Embolization and Post-Op Care

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Dr. Sudheendra's clinical algorithm for diagnosing PVD emphasizes the importance of patient history and specific symptoms over isolated cross-sectional imaging findings. He shares his approach to the pre-procedural workup, highlighting the necessity of a standing venous reflux ultrasound to rule out superficial venous insufficiency. Beyond the technical steps, Dr. Sudheendra emphasizes the "soft skills" of managing a venous practice: counseling patients on conservative treatments like pelvic floor therapy, explicitly setting expectations about postoperative back pain, and avoiding unnecessary bilateral stents in young women.

Dr. Sudheendra details his intra-procedural workflow for diagnosing and treating PVD, providing a look into his unique preference for right internal jugular (IJ) vein access to perform venograms and place iliac vein stents. He explains how this approach allows him to consistently check inflow from the lower extremities, and shares his techniques for performing gonadal vein embolizations and accurately sizing iliac vein stents to prevent lifelong complications.

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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

Patients and IRs alike dread the persistent cycles of malfunction and repeated procedures that often accompany biliary drains. What can you do to keep patients off the doorstep of reintervention? In this episode of the BackTable Podcast, Dr. Ahsun Riaz of Northwestern Medicine joins host Dr. Michael Barraza to walk through strategies for preventing and managing complications of percutaneous biliary drain placement.

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Timestamps

00:00 - Introduction
01:51 - Complication Rates and Associated Factors
06:09 - PTC in Non-Dilated Biliary Systems
11:00 - Techniques for Access and Drain Placement
15:10 - Drain Flushing, Capping, and Ideal Positioning
17:48 - External versus Internal-External Biliary Drains
20:42 - Managing Pericatheter Leakage
23:01 - Life Expectancy and Stenting Malignant Strictures
26:32 - Tract Maturation and Minimizing Access Sites
28:56 - Addressing Unresolving Hyperbilirubinemia
34:52 - Managing Bloody Drain Output
38:12 - Approach to Dislodged Drains
39:40 - Drain-Associated Pain and Exchange Timing
42:49 - Strategy for Benign Biliary Strictures
45:18 - Final Thoughts and Closing Remarks

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More about this episode

The discussion begins with a look at the data on biliary drain-related adverse events, emphasizing the need to bring down the high rates of complications that may take a toll on patients' quality of life. Dr. Riaz stresses the importance of employing techniques at initial drain placement, such as placing left-sided drains where appropriate and minimizing biliary pressure buildup, to reduce the starting risk of malfunction. The physicians go on to share their algorithms for approaching various scenarios, from pericatheter leakage and drain dislodgement to unresolving hyperbilirubinemia, pointing out the factors and observations that should influence treatment approaches during planning and intraprocedurally. Finally, the physicians address the evolving landscape of long-term biliary management, assessing potential drainage strategies as survival rates improve in hepatobiliary malignancies, and underscore the critical importance of collaboration with gastroenterologists and surgeons to ensure cohesive, goals-of-care-centered management.

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Resources

Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis
https://doi.org/10.1016/j.jvir.2024.12.022

Are balloon occlusion microcatheters your new best friend for prostate artery embolization (PAE)? In this episode of BackTable, Dr. Raj Ayyagari, interventional radiologist at Boston Medical Center, joins Dr. Ally Baheti to tackle complex clinical and technical challenges in PAE.

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This podcast is supported by an educational grant from Guerbet.

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SYNPOSIS

Dr. Ayyagari shares his unique journey from urology to interventional radiology and his experience building successful PAE service lines at multiple institutions. He walks through a series of challenging cases involving intraprostatic penile arteries, perivesicular collaterals, and internal pudendal collaterals used to treat bilateral hemi-prostates. The discussion highlights the role of balloon occlusion microcatheters such as the Sniper, his transition from 100–300 micron particles to glue embolization, and scenarios where coil protection is essential to prevent nontarget embolization. He also covers post-procedural management, the importance of setting expectations around suprapubic tube removal, and why thorough patient and provider counseling is critical for optimal care.

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TIMESTAMPS

00:00 - Introduction
02:14 - Building a Practice in Prostate Artery Embolization
08:19 - Case Studies and Techniques in Prostate Artery Embolization
23:16 - Challenges in Embolization Techniques
23:47 - Step-by-Step Guide to Embolizing a Hemi Prostate
25:24 - Choosing the Right Beads for Embolization
29:10 - Transitioning to Liquid Embolics
35:38 - Setting Patient Expectations and Pre-Procedure Evaluation
40:17 - Post-Procedure Care and Medications
44:06 - Conclusion and Final Thoughts

A negative angiogram in a patient with recurrent lower GI bleeding often calls for provocative angiography. In this episode of the BackTable Podcast, IR hosts Mike Barraza and Sabeen Dhand team up to talk tools, techniques, and tPA dosing for safe and effective treatment of lower GI bleeds with provocative mesenteric angiography.
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This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/
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SYNPOSIS
Dr. Dhand describes the utility of provocative angiography in recurrent lower GI bleed patients with negative CTA and angiography, addressing common myths and concerns that may contribute to its underutilization. The conversation covers detailed procedure steps for both targeted and untargeted angiography, including access sites, dosing of tPA, and angiographic technique. Dr. Dhand emphasizes the importance of gradual increases in tPA dosage in 2 mg increments, and clear communication with care teams and the patient about the nature of the procedure. He also emphasizes the effectiveness and safety of this procedure by sharing real-world cases.
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TIMESTAMPS
00:00 - Introduction
02:04 - Provocative Angiography for Lower GI Bleeds
04:09 - Detailed Protocol for Provocative Angiography
11:13 - Technical Details and Best Practices
20:07 - Challenges in GI Bleeding Studies
22:40 - Selective Embolization Techniques
27:44 - Handling Negative Angiograms
32:56 - Real-World Case Studies
35:15 - Final Thoughts
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RESOURCES
Thiry et al. Provocative Mesenteric Angiography: Outcomes and Standardized Protocol for Management of Recurrent Lower Gastrointestinal Hemorrhage
https://pubmed.ncbi.nlm.nih.gov/34506023/

Are you up to date with the latest guidelines on deep venous thrombosis (DVT) management? Dr. Steven Abramowitz, vascular surgeon at MedStar Health, joins host Dr. Chris Beck for a deep dive into emerging clinical data in DVT management, where they review the evolving indications for mechanical thrombectomy and the implications of studies like the ATTRACT trial, the CLOUT registry, and the ongoing DEFIANCE trial.

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This podcast is supported by:

Inari Medical
https://www.inarimedical.com/

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SYNPOSIS

Dr. Abramowitz reviews recent data comparing outcomes of mechanical intervention versus lytic-based therapy, outlining how each approach fits into current practice. He underscores the critical role of IVUS in determining treatment endpoints, while noting the ongoing challenge of an absent standardized definition. The conversation also offers practical insights on procedural techniques and the evolving role of anticoagulation, emphasizing the importance of close collaboration and open communication with referring physicians.

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TIMESTAMPS

00:00 - Introduction
00:45 - Overview of DVT Management
02:50 - New Guidelines for DVT Treatment
07:30 - Technical Endpoints in DVT Treatment
13:26 - Clout Registry and Its Findings
17:57 - Anticoagulation and DVT
23:05 - Defining Acute DVT Management
27:00 - Evolving Approaches to Acute DVT
28:19 - Patient Experience and Quality of Life
31:08 - Referring Providers and Data Impact
37:01 - Single Session Treatments and Stenting
41:07 - Chronic Venous Disease Management

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RESOURCES

(ATTRACT) Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019;24(5):442-451. doi:10.1177/1358863X19862043
https://pubmed.ncbi.nlm.nih.gov/31354089/

(CLOUT) Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol. 2023;46(11):1571-1580. doi:10.1007/s00270-023-03509-8
https://pubmed.ncbi.nlm.nih.gov/37580422/

(DEFIANCE) Abramowitz SD, Marko X, D'Souza D, et al. Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis. Am Heart J. 2025;281:92-102. doi:10.1016/j.ahj.2024.10.016
https://pubmed.ncbi.nlm.nih.gov/39491572/