BackTable Vascular & Interventional

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. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Instyllahttps://instylla.com/embrace/ --- Timestamps 00:00 - Introduction02:23 - Liquid Embolic Use in Practice04:46 - Case 1: Renal Mass07:51 - Delivery Technique and Target Vessel Size13:08 - Device Setup and Catheter Compatibility21:57 - Case 2: Multifocal HCC27:44 - Case 3: Large Renal Tumor40:21 - Randomized Trial Outcomes43:28 - Case 4: HCC Near the Gallbladder49:39 - Case 5: Pelvic Tumor and Femoral Metastases55:30 - Lessons from Early Use and Case Selection1:01:37 - Case 6: Breast Cancer Liver Metastasis1:05:23 - Closing Remarks --- 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. --- 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. 2026https://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. 2021https://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. 2026https://doi.org/10.1016/j.jvir.2026.108784 Dr. Resmi Charalel, Montefiore Einsteinhttps://doctors.montefioreeinstein.org/providers/1558653980/resmi-charalel Dr. Milan Patel, MD Anderson Cancer Centerhttps://faculty.mdanderson.org/profiles/milan_patel.html Dr. Kavi Krishnasamy, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-venkatesh-krishnasamy --- 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. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Endovascular Engineering (E2)E2Helo.com --- Timestamps 00:00 - Introduction03:42 - Referral Patterns and PERT Scope05:25 - PE Workup Essentials07:26 - Targeted Assessment of Acuity11:36 - Reliability of the Walk Test14:35 - PE Treatment Pathways19:26 - Procedural Walkthrough24:15 - Catheter Sizing30:05 - Adjunct Aspiration Device Features35:09 - Blood Return Process and Safety40:03 - Helo Study Early Results45:09 - Determining Procedural Endpoints50:20 - Future Trials and Technologies53:48 - 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 Adultshttps://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 studyhttps://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. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byVarian https://www.siemens-healthineers.com/ --- Timestamps 00:00 - Introduction04:00 - GAE Workup and Patient Scoring05:28 - KL Score and MRI Debate10:15 - Patient Selection and Contraindications15:11 - Access Strategy and Closure Techniques19:54 - Catheters, Wires, and Embolic Choices28:19 - Cone Beam CT Workflow31:37 - Managing Collaterals34:26 - Follow-Up and Repeat GAE38:42 - Defining Success and Setting Expectations44:25 - Technique Nuances and Flow Modulation50:28 - Building Referral Networks56:56 - Keeping Referrers Engaged59:46 - Direct-to-Patient Marketing01:04:57 - Leveraging Social Media and Reviews01:12:42 - Tracking Leads and Insurance Coverage01:19:47 - 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 trialhttps://doi.org/10.1007/s00330-026-12505-8 Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Painhttps://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

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 apphttps://www.backtable.com/app --- This podcast is supported byStryker Peripheral Vascularhttps://www.stryker.com/us/en/peripheral-vascular.html --- Timestamps 00:00 - Introduction02:27 - Presentation, Referral Patterns, and Imaging06:07 - Acute Limb Ischemia: Treatment Algorithm 12:16 - Thrombectomy Device Selection16:09 - Thrombolysis and Applications Beyond Lower Extremity18:46 - Procedural Endpoints, Closure, and Case Selection24:43 - Deep Vein Arterialization: Patient Selection and Planning31:25 - DVA Technique: Imaging, Anesthesia, and Access34:58 - Step-by-Step DVA Approach 41:56 - Surveillance and Managing Expectations45:59 - Wound Care and Amputation Decisions49:40 - Future Directions in PAD52:43 - 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

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 apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90. --- Timestamps 00:00 - Introduction02:36 - Resection After Radioembolization06:07 - Personal Practices Between HCC and Liver Metases07:26 - Bridging Radiation Segmentectomy 11:22 - Understanding Portal Vein Tumor Thrombus14:21 - Preferences in Dosimetry Software17:57 - Liver Reserve Limits25:11 - Microsphere Activity and Density29:16 - Diving into PROACTIF33:32 - RCTs and Trial Challenges36:57 - Patient Diversity in PROACTIF41:42 - Extrahepatic Disease43:03 - Data Gaps and Takeaways45:32 - Defining Personalized Dosimetry and Bridging Software50:15 - Mixed Delivery Approaches and Dose Thresholds01:01:36 - Response and Local Control01:04:26 - Treating PVT Subgroups01:09:03 - Comparison Between Dosing and Survival01:15:03 - Differences in Patients Quality of Life After Transplantation01:26:34 - 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