Podcasts about Percutaneous

In this episode of Behind the Knife, Dr. Patrick Georgoff sits down with Dr. Keri Seymour and Dr. Joey Lew to tackle the complex world of gastrostomy tubes. What may seem like a routine and straightforward procedure is anything but—full of nuanced patient considerations, timing dilemmas, technical challenges, and potential complications that can turn a “simple” consult into a 2 a.m. call you won't forget. From who truly needs a G tube and when to managing difficult post-op issues like dislodgement and buried bumper syndrome, this episode breaks down the practical, evidence-based approach every surgeon should know. Whether you're managing stroke patients, trauma cases, or navigating the tricky administrative obstacles around enteral access, this episode will equip you with the insights and strategies to confidently dominate your G tube consults. Hosts:  ·      Dr. Patrick Georgoff (Acute Care Surgeon, Duke University) ·      Dr. Keri Seymour (Minimally Invasive & Acute Care Surgeon, Duke Regional) ·      Dr. Joey Lew (Surgical Resident, BTK MIS Team) Learning Goals: By the end of this episode, listeners will be able to:  ·      Understand the nuanced indications for gastrostomy tube (G tube) placement. ·      Learn which patients truly benefit from G tubes, and when enteral access is not appropriate or indicated. ·      Appreciate the importance of goals of care discussions, assessment of comorbidities, and decision-makers—especially in neurocritical and elderly populations. ·      Know evidence-based timing for gastrostomy tube placement in stroke, TBI, and other complex scenarios. ·      Understand guideline recommendations and the clinical reasoning behind trial periods of nasogastric feeding versus early G tube placement. ·      Describe technical approaches to G tube placement and how to tailor the method to patient anatomy and clinical context. ·      Solidify knowledge of when to choose endoscopic, laparoscopic, open, or interventional radiology-guided placement. ·      Recognize, manage, and strive to prevent common and serious complications of G tubes, including early and late dislodgement, buried bumper syndrome, infection, bleeding, and gastrocutaneous fistula. ·      Discuss perioperative considerations, including anticoagulation, patient stability, and post-procedural care. ·      Understand why routine suturing of the G tube or bumper is not recommended, and how administrative and facility factors can drive clinical decisions. ·      Gain practical pearls and quick decision trees to dominate G tube consults and troubleshooting, day or night. References: ·      Braun R, Han K, Arata J, Gourab K, Hearn J, Gonzalez-Fernandez M. Establishing a clinical care pathway to expedite rehabilitation transitions for stroke patients with dysphagia and enteral feeding needs. Am J Phys Med Rehabil. 2024;103(5):390-394. doi:10.1097/PHM.0000000000002387 https://pubmed.ncbi.nlm.nih.gov/36867953/ ·      Burgermaster M, Slattery E, Islam N, Ippolito PR, Seres DS. Regional comparison of enteral nutrition-related admission policies in skilled nursing facilities. Nutr Clin Pract. 2016;31(3):342-348. doi:10.1177/0884533616629636 https://pubmed.ncbi.nlm.nih.gov/26993318/ ·      Chaudhry R, Kukreja N, Tse A, Pednekar G, Mouchli A, Young L, Didyuk O, Wegner RC, Grewal N, Williams GW. Trends and outcomes of early versus late percutaneous endoscopic gastrostomy placement in patients with traumatic brain injury: Nationwide population-based study. J Neurosurg Anesthesiol. 2018;30(3):251-257. doi:10.1097/ANA.0000000000000434 https://pubmed.ncbi.nlm.nih.gov/28459729/ ·      Cleverdon SA, Costantini TW, McGrew TM, Santorelli JE, Berndtson AE, Haines LN. Dysphagia in patients with traumatic brain injury, how often do they really need feeding access? Presented at: Academic Surgical Congress; February 2025; Washington, DC. Abstract 92.33. ·      Cmorej P, Mayuiers M, Sugawa C. Management of early PEG tube dislodgement: simultaneous endoscopic closure of gastric wall defect and PEG replacement. BMJ Case Rep. 2019;12(9):e230728. doi:10.1136/bcr-2019-230728 https://pubmed.ncbi.nlm.nih.gov/31488448/ ·      Galovic M, Stauber AJ, Leisi N, et al. Development and validation of a prognostic model of swallowing recovery and enteral tube feeding after ischemic stroke. JAMA Neurol. 2019;76(5):561-570. doi:10.1001/jamaneurol.2018.4858 https://pubmed.ncbi.nlm.nih.gov/30742198/ ·      Gallo RJ, Wang JE, Madill ES. Things we do for no reason™. J Hosp Med. 2024;19(8):728-730. doi:10.1002/jhm.13263 https://pubmed.ncbi.nlm.nih.gov/38180160/ ·      George BP, Hwang DY, Albert GP, Kelly AG, Holloway RG. Timing of percutaneous endoscopic gastrostomy for acute ischemic stroke. Stroke. 2017;48(2):420-427. doi:10.1161/STROKEAHA.116.015119 https://pubmed.ncbi.nlm.nih.gov/27965430/ ·      Goldberg LS, Altman KW. The role of gastrostomy tube placement in advanced dementia with dysphagia: a critical review. Clin Interv Aging. 2014;9:1733-1739. doi:10.2147/CIA.S53153 https://pubmed.ncbi.nlm.nih.gov/25342891/ ·      Hartford A, Li W, Qureshi D, et al. Use of feeding tubes among hospitalized older adults with dementia. JAMA Netw Open. 2025;8(2):e2460780. doi:10.1001/jamanetworkopen.2024.60780 https://pubmed.ncbi.nlm.nih.gov/39976967/ ·      Hochu G, Soule S, Lenart E, Howley IW, Filiberto D, Byerly S. Synchronous tracheostomy and gastrostomy placement results in shorter length of stay in traumatic brain injury patients. Am J Surg. 2024;227:153-156. doi:10.1016/j.amjsurg.2023.10.012 https://pubmed.ncbi.nlm.nih.gov/37852846/ ·      Kobzeva-Herzog AJ, Nofal MR, Bodde J, et al. Implementation of a quality improvement initiative reduced adult inpatient gastrostomy tube dislodgements. Am J Surg. 2025;(article 116522). doi:10.1016/j.amjsurg.2025.116522 https://pubmed.ncbi.nlm.nih.gov/40782502/ ·      Kurt Boeykens, Ivo Duysburgh. Prevention and management of major complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol. 2021;8:e000628. https://pubmed.ncbi.nlm.nih.gov/33947711/ ·      Murphy LM, Lipman TO. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia. Arch Intern Med. 2003;163(11):1351-1353. doi:10.1001/archinte.163.11.1351 https://pubmed.ncbi.nlm.nih.gov/12796072/ ·      Papavramidis TS, Mantzoukis K, Michalopoulos N. Confronting gastrocutaneous fistulas. Ann Gastroenterol. 2011;24(1):16-19. https://pubmed.ncbi.nlm.nih.gov/24714282/ ·      Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg. 2022;14(4):286-303. doi:10.4240/wjgs.v14.i4.286 https://pubmed.ncbi.nlm.nih.gov/35664365/ ·      Reddy KM, Lee P, Gor PJ, Cheesman A, Al-Hammadi N, Westrich DJ, Taylor J. Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes. World J Gastrointest Pharmacol Ther. 2022;13(5):77-87. doi:10.4292/wjgpt.v13.i5.77 https://pubmed.ncbi.nlm.nih.gov/36157266/ ·      Singh D, Laya AS, Vaidya OU, Ahmed SA, Bonham AJ, Clarkston WK. Risk of bleeding after percutaneous endoscopic gastrostomy (PEG). Dig Dis Sci. 2012;57(4):973-980. doi:10.1007/s10620-011-1965-7 https://pubmed.ncbi.nlm.nih.gov/22138961/ ·      Thosani N, Rashtak S, Kannadath BS, et al. Bleeding risk and mortality associated with uninterrupted antithrombotic therapy during percutaneous endoscopic gastrostomy tube placement. Am J Gastroenterol. 2021;116(9):1868-1875. doi:10.14309/ajg.0000000000001348 https://pubmed.ncbi.nlm.nih.gov/34158462/ ·      Ward EC, Green K, Morton AL. Patterns and predictors of swallowing resolution following adult traumatic brain injury. J Head Trauma Rehabil. 2007;22(3):184-191. doi:10.1097/01.HTR.0000271119.96780.f5 https://pubmed.ncbi.nlm.nih.gov/17510594/ ·      Wick B. Timing of PEG tube placement in stroke patients with dysphagia: a multi-center retrospective cohort analysis using the TriNetX database. Am J Gastroenterol. 2024;119(10 Suppl):S1146-S1147. doi:10.14309/01.ajg.0001035684.98119.d5 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen BTK Fan Favorites:  General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In today's VETgirl online veterinary continuing education podcast, we interview Dr. Nick Jeffery, BVSc, PhD, MSc, DECVS, DECVN, Professor in Neurology and Neurosurgery from Texas A&M on a recent study by Freeman et al entitled “Percutaneous enzymatic chemonucleolysis of intervertebral disks appears safe and effective in treatment of acute-onset paraparesis and paraplegia in small dogs,” published in JAVMA in March 2025. Can the use of intradiscal chondroitinase ABC (often called "CHASE") injections under fluoroscopic-guidance work as a safe, minimally invasive option for small dogs with acute nonambulatory paraparesis or paraplegia, especially when deep pain perception is intact? If you're a general practitioner who sees a lot of down dogs—and especially if you practice in a Dachshund-heavy region—you'll definitely want to tune in.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Automated Real-Time Percutaneous Coronary Intervention Risk Model Leveraging Electronic Health Records.

FACT (fentanyl And Crushed Ticagrelor) PCI: A Randomized Control Trial of Patients Undergoing Percutaneous Coronary Intervention Who Receive Ticagrelor and Fentanyl

Displaced intraarticular calcaneal fractures (DIACFs) are associated with high rates of posttraumatic arthritis. Traditional management with open subtalar arthrodesis often results in high revision rates and complications. Acute open arthrodesis has shown success in Sanders III and IV calcaneus fractures, with favorable return-to-work and radiographic fusion outcomes. This study evaluates the radiographic results of calcaneus percutaneous reduction and posterior arthroscopic subtalar arthrodesis (C-PASTA) for acute Sanders III and IV fractures. In conclusion, C-PASTA demonstrates excellent fusion rates, significant restoration of calcaneal alignment, and minimal complications. These findings suggest that C-PASTA is a viable, minimally invasive technique for acute Sanders III and IV fractures. Click here to read the article.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Percutaneous Coronary Intervention Outcomes by 5 Major Race and Ethnic Subgroups.

What do you do when conventional gastric tubes are not an option? In this week's episode of BackTable, host Dr. Ally Baheti speaks with interventional radiologist Dr. Alex Wallace and physician assistant Lisa Rotellini-Colvet from the Mayo Clinic in Arizona about the percutaneous transesophageal gastrostomy (PTEG) procedure. The discussion explores how PTEG offers a transformative solution for patients who are not candidates for traditional transabdominal gastrostomy access. Suitable candidates for PTEG include individuals with malignancies, peritoneal carcinomatosis, prior gastrectomies, or ascites. --- This podcast is supported by: Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS Dr. Wallace and Lisa provide valuable insights on the benefits of early patient selection, thorough pre-procedural evaluation, step-by-step procedural guidance, and key considerations for post-procedural care. They also highlight the critical role of patient and staff education in achieving successful outcomes. The episode features real-world experiences, including a powerful story of a patient who benefited from her PTEG for over 560 days. Our guests advocate for increased awareness of PTEG and its early consideration in patients with advanced abdominal cancers, emphasizing its potential to greatly improve quality of life. --- TIMESTAMPS 00:00 - Introduction01:38 - History and Explanation of PTEG08:12 - Pre-Procedure Evaluation11:48 - Procedural Walkthrough20:46 - Post-Procedure Care and Suction Management24:45 - Exchange Process and Troubleshooting30:11 - Patient Education and Staff Training35:54 - Improved Quality of Life for Patients --- RESOURCES Percutaneous Transesophageal Gastrostomy: Procedural Technique and Outcomes (Rotellini-Coltvet, Wallace et al, 2023):https://pubmed.ncbi.nlm.nih.gov/37419279/

Impact of Intravascular Imaging Guidance on Percutaneous Coronary Intervention of Severely Calcified Lesions: The ECLIPSE Trial

Safety And Efficacy Of The Unilateral, Suture-based, Dry-closure Technique In Percutaneous Trans-axillary Aortic Valve Implantation

Clopidogrel Versus Aspirin for Long-term Maintenance Monotherapy in Patients with High Ischemic Risk After Percutaneous Coronary Intervention

With Jean-Claude Deharo, Hospital La Timone Adults, Marseille - France, Professor Fabien Praz, Inselspital Bern - Switzerland, Stefan Simovic, Faculty of Medical Sciences, University of Kragujevac, Kragujevac - Serbia and Vera Maslova, University Medical Center of Schleswig-Holstein, Kiel - Germany. This episode will tackle the EHRA Consensus document on management of patients with transvalvular leads undergoing percutaneous tricuspid clave interventions, focusing on assessment, procedural insights, post-procedure care, and expert perspectives.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Apixaban Dose in Patients With Atrial Fibrillation and Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention: Insights From AUGUSTUS.

Commentary by Dr. Jian'an Wang.

Commentary by Dr. Mayank Yadav.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Temporal Trends in Cardiovascular Events After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Safety and Efficacy of Different Stent Strategies in Percutaneous Coronary Intervention: A Network Meta-Analysis

Let's talk liver ablations. This week's episode of the BackTable Podcast provides a thorough review of modern microwave ablation methods, tools, and tech, featuring Dr. Asad Baig (interventional radiologist at Columbia University) and host Dr. Michael Barraza. --- This podcast is supported by an educational grant from Medtronic . --- SYNPOSIS Dr. Baig shares practical advice on how to become a key contributor at your tumor board and how to position your skillset as an interventional radiologist. He talks through his microwave ablation procedure technique, highlighting the role of ablation zone visualization software. The doctors go on to discuss a variety of ablation approaches, needle placement, intra- and post-operative imaging, and tips for dealing with challenging tumor locations. The episode concludes with Dr. Baig summarizing best practices for ensuring safe and effective ablations, and underscoring the importance of solid patient-physician communication throughout care. --- TIMESTAMPS 00:00 - Introduction 08:28 - Microwave Ablation Techniques 12:54 - Collaborative Approach in Tumor Boards 23:30 - Combined Ablation Cases and Techniques 36:12 - Challenging Liver Ablations 45:56 - Tips for Safe and Effective Ablations 50:07 - Balancing Biopsy and Ablation 01:00:34 - Conclusion --- RESOURCES The Emprint™ Ablation System with Thermosphere™ Technology: One of the Newer Next-Generation Microwave Ablation Technologies: https://pmc.ncbi.nlm.nih.gov/articles/PMC4640908/ Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria: https://pubmed.ncbi.nlm.nih.gov/24628534/ Percutaneous microwave ablation of hepatic lesions near the heart: https://pubmed.ncbi.nlm.nih.gov/34805581/ Microwave Ablation of Hepatic Tumors Abutting the Diaphragm Is Safe and Effective: https://ajronline.org/doi/10.2214/AJR.14.12879

Mary Norine Walsh, MD, MACC, JACC: Case Reports Deputy Editor, is joined by author Dena Hayes, MD, discussing this study from Hayes et al presented at ACC.25 and published in JACC: Case Reports. The diagnosis of cardiac sarcoidosis (CS) is often challenging, particularly in atypical cases. The authors describe a case of a previously healthy 33-year-old woman who was found to have a biatrial mass and evidence of a diffuse inflammatory or neoplastic process on multimodality imaging. Percutaneous biopsy of the cardiac mass was performed and histopathology revealed granulomas consistent with CS. This case adds to the growing number of reports of CS presenting as an intracardiac mass.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning examines how to prevent adverse publicity by patients on social media. Chapters 00:00 Intro 02:01 Patient-Social Media Interaction 11:56 Lung Cancer Screening Recommendations 15:29 Perc vs Surg Revasc, SWEDEHEART Registry 18:06 Down Syndrome Patient Outcomes 19:20 Nighttime Cardiovascular Staffing Impact 23:42 Samurai Cannulation 28:30 Off-Pump AAD Via Upper Ministernotomy 30:35 Robotic Thoracic Truncal Vagotomy 31:59 Upcoming Events 33:02 Closing He explores the benefits and drawbacks of patient groups on social media, explains how social media impacted the Shanghai Pulmonary Hospital, and provides examples of online patient groups. He also discusses whether surgeons should encourage patients to post on social media, what roles surgeons should have in online patient groups, and discusses his own experience with online patient groups.   Joel also reviews recent JANS articles on lung cancer screening and USPSTF recommendations, percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease, outcomes in adult congenital heart disease patients with Down syndrome undergoing a cardiac surgical procedure, and the impact of nighttime cardiovascular intensive care unit staffing on failure to rescue and revenue.   In addition, Joel explores Samurai (the Direct True Lumen Technique) cannulation in acute type I aortic dissection, off-pump aortic arch debranching via upper ministernotomy, and robotic thoracic truncal vagotomy. Before closing, he highlights upcoming events in CT surgery.   JANS Items Mentioned  1.) Lung Cancer Screening and USPSTF Recommendations   2.) Percutaneous vs. Surgical Revascularization of Non-ST-Segment Elevation Myocardial Infarction With Multivessel Disease: The SWEDEHEART Registry  3.) Outcomes in Adult Congenital Heart Disease Patients With Down Syndrome Undergoing a Cardiac Surgical Procedure  4.) Impact of Nighttime Cardiovascular Intensive Care Unit Staffing on Failure to Rescue and Revenue  CTSNET Content Mentioned  1.) Samurai (the Direct True Lumen Technique) Cannulation in Acute Type I Aortic Dissection  2.) Off-Pump Aortic Arch Debranching Via Upper Ministernotomy  3.) Robotic Thoracic Truncal Vagotomy  Other Items Mentioned  1.) Career Center   2.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Is there a way to treat liver metastasis secondary to uveal melanoma without introducing systemic, treatment-related toxicity? Dr. Altan Ahmed (interventional radiologist at Moffitt Cancer Center) and Dr. Sid Padia (interventional radiologist at UCLA) join guest-host Dr. Kavi Krishnasamy to discuss HEPZATO, a novel device-based treatment for liver metastases from uveal melanoma. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Ahmed and Dr. Padia begin by exploring the design and setup of the HEPZATO clinical trials, while also speaking on patient selection criteria. The doctors then talk through the technical aspects of the intervention. After covering workflow and considerations related to procedure timing and coordination, the doctors go on to discuss drug dosing and optimizing treatment cycles. The episode concludes with current gaps in literature, current and future research aims, and potential future applications of the HEPZATO modality in treating other malignancies such as colorectal cancer. --- TIMESTAMPS 00:00 - Introduction 05:40 - Patient Selection Criteria 09:49 - Workflow 19:17 - Procedure Timing and Coordination 29:39 - Challenges and Considerations in Drug Dosing 32:39 - Optimizing Treatment Cycles and Patient Response 37:56 - Managing Post-Treatment and Adverse Effects 43:43 - Future Research and Gaps in Current Interventions 50:45 - Exploring New Applications for PHP Therapy 55:02 - Conclusion --- RESOURCES Hepzato: https://hepzatokit.com/ FOCUS Trial - Efficacy and Safety of the Melphalan/Hepatic Delivery System in Patients with Unresectable Metastatic Uveal Melanoma: Results from an Open-Label, Single-Arm, Multicenter Phase 3 Study: https://pubmed.ncbi.nlm.nih.gov/38704501/ FOCUS phase 3 trial results: Percutaneous hepatic perfusion (PHP) with melphalan for patients with ocular melanoma liver metastases (PHP-OCM-301/301A): https://ascopubs.org/doi/pdf/10.1200/JCO.2022.40.16_suppl.9510 Combining Melphalan Percutaneous Hepatic Perfusion with Ipilimumab Plus Nivolumab in Advanced Uveal Melanoma: First Safety and Efficacy Data from the Phase Ib Part of the Chopin Trial: https://pubmed.ncbi.nlm.nih.gov/36624292/ Troponin Elevation in Patients Undergoing Percutaneous Hepatic Perfusion for Metastatic Uveal Melanoma: https://pmc.ncbi.nlm.nih.gov/articles/PMC11010739/ Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Ocular Melanoma Metastases Confined to the Liver: A Prospective Phase II Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC7801354/ Southampton group - Quality of life after melphalan percutaneous hepatic perfusion for patients with metastatic uveal melanoma: https://pmc.ncbi.nlm.nih.gov/articles/PMC10906212/ Leiden group - Quality of Life Analysis of Patients Treated with Percutaneous Hepatic Perfusion for Uveal Melanoma Liver Metastases: https://pubmed.ncbi.nlm.nih.gov/38587534/

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Impact of Anthropometric Measures on Distal vs Conventional Radial Access for Percutaneous Coronary Procedures

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Time Trends in Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention: Meta-Analysis on Sex Differences

CLEAR-IE Outcomes of Percutaneous Mechanical Aspiration in Right-Sided Infective Endocarditis: A Multicenter Registry

It might be time to rethink your liver biopsy technique. Transfemoral transcaval core-needle liver biopsy has demonstrated key advantages over the transjugular approach and has become increasingly popular in recent years. Interventional radiologists Dr. Jacob Cynamon and Dr. Kapil Wattamwar join host Dr. Sabeen Dhand to discuss the inception and advantages of their novel approach. --- This podcast is supported by: Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS The doctors start with how they began using the transfemoral transcaval approach, along with the literature they published following adoption of this novel technique shortly thereafter. Dr. Cynamon and Dr. Wattamwar then go on to discuss the technique in detail, providing a thorough step-by-step and pausing to mention key considerations. The episode concludes with the doctors emphasizing the safety and efficacy of the transfemoral transcaval approach, citing specific findings and sharing exemplary cases. --- TIMESTAMPS 00:00 - Introduction 05:47 - Percutaneous vs. Transvenous Biopsies 08:56 - Evolution of Transfemoral Biopsies 12:41 - Comparing Transjugular and Transfemoral Approaches 24:52 - Pre-Procedural Imaging and Sheath Selection 29:23 - Complications and Case Studies 35:46 - Transcaval Biopsy Technique 45:00 - Conclusion --- RESOURCES Cynamon, 2016. Transfemoral Transcaval Core-Needle Liver Biopsy: An Alternative to Transjugular Liver Biopsy: https://pubmed.ncbi.nlm.nih.gov/26723528/ Wattamar, 2020. Transjugular versus Transfemoral Transcaval Liver Biopsy: A Single-Center Experience in 500 Cases: https://pubmed.ncbi.nlm.nih.gov/32798119/ Wattamar, 2022. The Use of the Transfemoral Transcaval Liver Biopsy Technique for Biopsies of Hepatic Masses: https://pubmed.ncbi.nlm.nih.gov/36182256/ Wattamar, 2022. Transcaval Creation of a Portal Vein Target for Transjugular Intrahepatic Portosystemic Shunt in a Patient with Portal Vein Thrombosis: https://pubmed.ncbi.nlm.nih.gov/34448032/

Commentary by Dr. Jian'an Wang.

Commentary by Dr. Jian'an Wang.

Commentary by Dr. Yasushi Ueki.

Commentary by Dr. Samantha Saunders.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on 30 years' experience in percutaneous pulmonary artery interventions in transposition of the great arteries.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on apixaban and limiting aspirin for patients with atrial fibrillation, percutaneous coronary intervention, and multimorbidity.

In this episode, Dr. Valentin Fuster delves into the latest research surrounding the use of the mitral clip for patients with severe functional mitral regurgitation, comparing the results of three major trials: the French MITRA-FR trial, the American COAPT trial, and the Reshape HF 2 trial. While the COAPT and Reshape HF 2 trials show positive outcomes, especially in reducing hospitalizations and improving heart failure symptoms, the French trial saw no benefit, prompting debate over the influence of left ventricular volume and disease severity on treatment success, with expert opinions calling for further studies and individualized meta-analyses.

RESHAPE-HF2 – Percutaneous Repair of Moderate-to-Severe or Severe Functional Mitral Regurgitation in Patients with Symptomatic Heart Failure

I often get some questions from listeners I would never imagine.  I just got one of those questions from a runner who has a mallet toe.  Her doctor suggested surgery. The runner was worried because she been researching hammer toes and mallet toes. During that search she learned a lot about the plantar plate ligament as it relates to crooked toes.  She was worried that if she had the surgery, it might cause a plantar plate injury. Can a percutaneous tenotomy surgery cause a plantar plate injury?  Well, good question and that is what we're talking about today on the Doc On The Run Podcast. 

NOTION-3 – Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Implantation

INFINITY-SWEDEHEART – Percutaneous Coronary Intervention with a Bioadaptor Compared to a Contemporary Drug Eluting Stent- One Year Primary Outcomes

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Thanks to all of you for making this a Top 15 Podcast for 4 Years: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://blog.feedspot.com/medical_billing_and_coding_podcasts/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Sonal's 13th Season starts up and Episode 8 features a Newsworthy update on October's Breast Cancer Awareness Days. Sonal's Trusty Tip and compliance recommendations focus on percutaneous needle biopsies and procedure reports. Spark inspires us all to reflect on insight and wisdom based on the inspirational words of Socrates. Thanks to HCPro: Register for the Live Webinar on October 24th:⁠ ⁠www.hcpro.com/aiwebinar⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paint The Medical Picture Podcast now on: Spotify: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Apple Podcasts: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id153044217⁠7⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Amazon Music: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Find Paint The Medical Picture Podcast on YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Find Sonal on LinkedIn:⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/sonapate/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ And checkout the website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://paintthemedicalpicturepodcast.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠PaintTheMedicalPicturePodcast@gmail.com --- Support this podcast: https://podcasters.spotify.com/pod/show/sonal-patel5/support

Are you up-to-date on microwave ablation for hepatocellular carcinoma (HCC) treatment? Dr. Zachary Berman and host Dr. Michael Barraza discuss this treatment modality. They cover the spectrum of pre-procedure imaging and planning, procedure steps, and tips for navigating difficult cases. Dr. Berman is a hepatobiliary interventional oncologist and Associate Clinical Professor of Radiology at UC San Diego School of Medicine. --- This podcast is supported by an educational grant from: Variant https://www.varian.com/ --- SYNPOSIS Dr. Berman highlights the importance of a multidisciplinary approach, referral pathways, and the role of tumor boards in decision-making. The doctors also cover various ablation technologies, pre-procedure embolization, hydrodissection, biopsy considerations, and the incorporation of immunotherapy in ongoing research. Finally, Dr. Berman emphasizes the importance of ultrasound skills and presents some cases. --- TIMESTAMPS 00:00 - Introduction 10:09 - Techniques and Technologies 17:26 - Planning and Performing Ablations 21:35 - Tumor Size and Margins 25:09 - Navigational Software and Skills 30:47 - Hydrodissection Techniques 33:20 - Post-Ablation Imaging and Follow-Up 35:52 - Future of Ablation in IR and Cases --- RESOURCES Liver Imaging Reporting & Data System (LI-RADS®): https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS Liver Cancer Stages (BCLC): https://www.cancer.gov/types/liver/what-is-liver-cancer/stages Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795153/ Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698169/ Prospective double-blinded randomized controlled trial of Microwave versus RadioFrequency Ablation for hepatocellular carcinoma (McRFA trial): https://www.hpbonline.org/article/S1365-182X(20)30023-X/fulltext#:~:text=A%20total%20of%2093%20patients,RFA%20in%20treating%20small%20HCC. Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: a randomized controlled trial: https://jgo.amegroups.org/article/view/26929/html#:~:text=to%2080%20years.-,There%20were%20no%20statistically%20significant%20differences%20between%20both%20groups%20regarding,HCC%20ablation%20(Table%202). Surgical microwave ablation for the treatment of hepatocellular carcinoma in 791 operations: https://www.sciencedirect.com/science/article/abs/pii/S1365182X23020002 Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial: https://meetings.asco.org/abstracts-presentations/234189 One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach: https://pubmed.ncbi.nlm.nih.gov/23732261/

Moderator: William DeCarbo, DPM,FACFAS Panelists: Jason DeVries, DPM, FACFAS Brett Sachs, DPM, FACFAS Joshua Thun, DPM, FACFAS Run time: 36m

Surgical arteriovenous fistula (AVF) creation has been a mainstay of dialysis care for multiple decades. What does it take to break into such an established space with a new endovascular medical device? In this episode of the BackTable Podcast, Dr. Jeffrey Hull discusses the challenging journey of developing the Ellipsys system for endovascular AVF creation. --- CHECK OUT OUR SPONSOR Medtronic ClosureFast https://www.medtronic.com/closurefast6f --- SYNPOSIS We trace Dr. Hull's path from the device's initial conception in 2006, through the first-in-human cases in 2013, to regulatory approval and acquisition by Medtronic in 2020. Dr. Hull highlights the roles of key business mentors, the importance of multidisciplinary collaboration with vascular surgery and nephrology, and the impact of investment. He also shares valuable insights on the benefits of having competitors and selecting a well-thought-out exit strategy. Additionally, we explore deep vein arterialization (DVA) as another application of endovascular AVF creation in the context of peripheral arterial disease. --- TIMESTAMPS 00:00 - Introduction 03:05 - The Birth of the Percutaneous AV Fistula Creation 15:04 - First-in-Human Cases 17:58 - Navigating the Startup Journey 21:52 - Identifying Mentors and Investors 27:33 - Competition and Criticism 36:43 - Regulatory Hurdles 44:45 - Acquisition by Medtronic 49:14 - Deep Vein Arterialization for Peripheral Arterial Disease 54:40 - Final Thoughts and Advice --- RESOURCES Avenu Medical: https://avenumedical.com/ Gracz KC et al. Proximal forearm fistula for maintenance hemodialysis (1977): https://pubmed.ncbi.nlm.nih.gov/839655/ Hull JE et al. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access (2018): https://pubmed.ncbi.nlm.nih.gov/29275056/ Endovascular Today- Update on Percutaneous AV Fistula Creation (2015): https://evtoday.com/articles/2015-june/update-on-percutaneous-av-fistula-creation Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art (2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353338/

Episode 2540 - On this Friday's show, Vinnie Tortorich welcomes Dr. Johnathan Edwards for part 2 of their discussion about improving VO2 max, addressing chronic pain, and more. https://vinnietortorich.com/2024/09/addressing-chronic-pain-dr-johnathan-edwards-episode-2540 PLEASE SUPPORT OUR SPONSORS YOU CAN WATCH ALL THE PODCAST EPISODES ON YOUTUBE - Increasing VO2 Max This is Part 2, a continuation of a conversation Vinnie and Johnathan shared. Johnathan has also been a competitive cyclist. (3:30) VO2 max is explained. (14:00). It's how your body uses oxygen to burn carbs and fats to create mechanical energy. How do you get a strong VO2 Max? (23:00) Your VO2 Max number helps determine longevity. (24:00) Motorcross is a huge challenge for your body as well as rowing. (27:00) Vinnie has helped a lot of people who have been morbidly obese, and once they lose weight they want to get moving. (33:00) What is VO2 max, what do the numbers mean, and how can it be increased? They give practical examples of how this can be accomplished. The goal of training this way is not to be an elite athlete but to increase VO2 Max, decrease injury, have fun, and work out efficiently. (42:55) The “RABIT” test takes speed, heart rate, and time and calculate it, which can give you an estimated VO2 max. Addressing Chronic Pain Disc dehydration (or desiccation) can be an issue. (53:00) What can be done? (58:00) Healing is energy in motion. Percutaneous hydrotomy is a treatment method that can help certain pain issues. You can find Dr. Johnathan Edwards here: He has written a book on pain management and percutaneous hydrotomy,  He also has another book on running He can be found online More News Don't forget to check out Serena Scott Thomas on Days Of Our Lives, on Peacock channel.  “Dirty Keto” is finally available on Amazon! You can purchase or rent it . Make sure you watch, rate, and review it! Eat Happy Italian, Anna's next cookbook, is available for pre-order!  You can go to: —upload your receipt and get bonus content.  You can preorder it from . Anna's recipes are in her cookbooks, website, and Substack–they will spice up your day! There's a new NSNG® Foods promo code you can use! The promo code ONLY works on the NSNG® Foods website, NOT on Amazon. https://nsngfoods.com/ [the_ad id="20253"] PURCHASE BEYOND IMPOSSIBLE (2022) The documentary launched on January 11! Order it TODAY! This is Vinnie's third documentary in just over three years. Get it now on Apple TV (iTunes) and/or Amazon Video! Link to the film on Apple TV (iTunes):  Then, Share this link with friends, too! It's also now available on Amazon (the USA only for now)!  Visit my new Documentaries HQ to find my films everywhere: REVIEWS: Please submit your REVIEW after you watch my films. Your positive REVIEW does matter! FAT: A DOCUMENTARY 2 (2021) Visit my new Documentaries HQ to find my films everywhere: Then, please share my fact-based, health-focused documentary series with your friends and family. The more views, the better it ranks, so please watch it again with a new friend! REVIEWS: Please submit your REVIEW after you watch my films. Your positive REVIEW does matter! FAT: A DOCUMENTARY (2019) Visit my new Documentaries HQ to find my films everywhere: Then, please share my fact-based, health-focused documentary series with your friends and family. The more views, the better it ranks, so please watch it again with a new friend! REVIEWS: Please submit your REVIEW after you watch my films. Your positive REVIEW does matter!  

Full article: Safety and Efficacy of Percutaneous Cryoablation for Recurrent or Metastatic Soft Tissue Sarcoma in Adult Patients Morgan McLuckey, MD, discusses an AJR article by Pal et al. exploring outcomes from percutaneous cryoablation performed for local control of treatment-refractory recurrent or metastatic soft-tissue sarcoma in adults.

Percutaneous Versus Surgical Treatment for Patients with Aortic Stenosis and Coronary Disease

N Engl J Med 1992;326:10-16Background: Revascularization with coronary artery bypass surgery improves symptoms in patients with chronic stable angina as seen in the European Coronary Surgery Study. Percutaneous transluminal coronary angioplasty (PTCA) is less invasive compared to surgery and is associated with less mortality and morbidity. Consequently, its use increased significantly in the late 1980s and early 1990s, driven by its perceived benefits over medical therapy alone due to the ability of PTCA to reduce coronary artery luminal stenosis.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The Angioplasty Compared to Medicine (ACME) study sought to test the hypothesis that PTCA improves symptoms in patients with single vessel sable coronary artery disease.Patients: Eligible patients were recruited from Veterans Affairs centers. Patients had to have 70 – 99% stenosis in the proximal two thirds of one major epicardial coronary artery plus one of the following: stable angina pectoris, very positive exercise-tolerance test (ST-segment depression ≥3 mm) or a myocardial infarction within the past 3 months.Baseline characteristics: The study screened 9,573 patients and among them only 212 (2.2%) were enrolled – 107 randomized to medical therapy and 105 to PTCA. The reasons for patients' exclusion were provided in table 1 of the manuscript. Some key exclusion criteria were previous CABG, unstable angina, prior PTCA, 3-vessel disease or lesions not suitable for PTCA.The average age of enrolled patients was 63 years. Approximately 30% had prior myocardial infarction, 53% had hypertension, 18% had diabetes, 1% had congestive heart failure, and 31% were current smokers. There were more employed participants in the PTCA arm 42% vs 29%. The average systolic blood pressure was 136 mm Hg. The average total cholesterol was 230 mg/dl.The average duration participants did on the treadmill was 8.8 minutes. Approximately 38% had LAD disease, 25% had LCx disease, and 37% had RCA disease.Procedures: All patients were admitted to the hospital. Anti-anginal medications were stopped for at least 24 hours and exercise stress test that included thallium Scintigraphy was performed. The test was considered positive if there was horizontal or down-sloping ST-segment depression ≥ 1.0 mm in one or more leads measured 80 msec after the J point that occurred during or after treadmill exercise testing. Patients who had angina during the test but did not meet the above criteria could be included if there was evidence on thallium scanning of a reversible defect in the area corresponding to the index lesion. If the test showed ischemia, patients were then assigned to PTCA or medical therapy.All patients received aspirin 325 mg/day. Patients in the medical arm received one or combination of the following: nitrates, beta-blockers or calcium channel blockers. Patients in the PTCA arm received calcium channel blockers before and for one month after the procedure, and nitroglycerin during and for 12 hours after the procedure.Patients were followed monthly. Patients were admitted to the hospital 6 months after randomization, for repeat exercise testing and coronary angiogram. For patients in the medical arm, this exercise testing was performed while they continued their anti-anginal medications. In contrast, patients in the PTCA arm stopped their anti-anginal medications for at least 24 hours before the test.Endpoints: The primary end points were changes in exercise tolerance, angina attacks and the use of nitroglycerin. Change in the degree of stenosis in the index lesion was measured as a secondary endpoint.Analysis was performed based on the intention-to-treat principle. The sample size to achieve 95% power at an alpha level of 0.05 was 192. This was based on the assumption that PTCA would increase exercise duration by 1-minute compared to medical therapy. To account for potential loss to follow-up, the recruitment goal was set at 200 patients.Results: Among the 105 patients assigned to PTCA, 95% underwent the procedure, and among them, the procedure was considered successful in 82%. Successful PTCA was defined >20% decrease in percent stenosis of all lesions in which dilation was attempted. Among the 107 patients assigned to medical therapy, 10% underwent PTCA.The mean duration from randomization to follow-up exercise testing was approximately 7 months. PTCA led to greater increase in exercise time compared to medical therapy alone (2.1 minutes vs 0.5 minutes; p< 0.0001) as well as time to onset of angina (2.6 minutes vs 0.8 minutes; p

It's called "percutaneous hydrotomy" and it's billed as a revolutionary pain treatment. Dr. Jonathan Edwards, anesthesiologist and polymath, shares groundbreaking insights on alternative pain treatments and metabolic health.In this episode of Stay Off My Operating Table, we dive deep into cutting-edge medical approaches with Dr. Jonathan Edwards. Learn about percutaneous hydrotomy, a French technique for treating musculoskeletal pain, and its potential benefits for athletes and chronic pain sufferers.Dr. Edwards also discusses his work with ketamine in treating depression and suicidal ideation, offering hope for those struggling with mental health issues. The conversation touches on the fascinating lean mass hyper responder phenomenon, challenging conventional wisdom about cholesterol and heart health.Key topics covered:00:00 Introduction05:30 Percutaneous hydrotomy explained15:45 Ketamine for depression and suicide prevention25:20 Lean mass hyper responders and cholesterol35:10 Alternative approaches to metabolic health45:00 Controversy in alternative medicineConnect with Dr. Jonathan Edwards:Website: https://jonathanedwardsmd.comTwitter: @johnedwardsmdSubstack: johnathanedwardsmd.substack.comSend us a Text Message. Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier. So take action right now. Book a call with Dr. Ovadia's team. One small step in the right direction is all it takes to get started. How to connect with Stay Off My Operating Table:Twitter: Dr. Ovadia: @iFixHearts Jack Heald: @JackHeald5 Learn more: Learn more about Dr. Ovadia's personalized health coaching Get Dr. Ovadia's book Stay Off My Operating Table on Amazon. Take Dr. Ovadia's metabolic health quiz: iFixHearts visit Dr. Ovadia's website: Ovadia Heart Health visit Jack Heald's website: CultYourBrand.com Theme Song : Rage AgainstWritten & Performed by Logan Gritton & Colin Gailey(c) 2016 Mercury Retro RecordingsAny use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

Venous closure devices, GLP1-s linked to blindness and cancer, resisting the urge to do an ECG, and transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation are the topics discussed this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study https://doi.org/10.1093/europace/euae105 II GLP1-s and Blindness Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255 Locke Twitter  https://x.com/doc_BLocke/status/1808972226655629610 When to Start a Statin Is a Preference-Sensitive Decision https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808 III GLP1-s and Cancer Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820833 IV Screening ECG Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721 Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP)  https://doi.org/10.1016/S0140-6736(21)01637-8 Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study) https://doi.org/10.1016/S0140-6736(21)01698-6 IV TEER for Secondary Mitral Regurgitation Randomized investigation of the MitraClip device in heart failure: Design and rationale of the RESHAPE-HF2 trial design https://doi.org/10.1002/ejhf.3247 Percutaneous repair of moderate-to-severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE-HF2 trial and comparison to COAPT and MITRA-FR trials https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3286 Jun 21, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001237 Stats Blog https://www.r-bloggers.com/2023/07/the-benjamini-hochberg-procedure-fdr-and-p-value-adjusted-explained/ You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI. We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations. --- TIMESTAMPS 00:00 - Introduction 03:01 - Sacral Fractures and Sacroplasty 15:17 - Treatment Options for Sacral Fractures 17:34 - Consequences of Untreated Sacral Fractures 28:32 - Sacroplasty Registry and Current Research 38:08 - Imaging Modalities: CT vs. Fluoroscopy 40:49 - Complications of Sacroplasty: Extravasation 43:21 - Bone Quality and Fracture Healing 45:42 - Growing Awareness of Sacral Fractures and Treatment Options --- RESOURCES Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982): https://pubmed.ncbi.nlm.nih.gov/7097924/ Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000): https://pubmed.ncbi.nlm.nih.gov/11094996/ Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019): https://pubmed.ncbi.nlm.nih.gov/31587952/ Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008): https://pubmed.ncbi.nlm.nih.gov/17981097/ Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017): https://pubmed.ncbi.nlm.nih.gov/29149151/ Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020): https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023): https://pubmed.ncbi.nlm.nih.gov/37207812/ Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019): ​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx

In this episode, interventional cardiologist Dr. Peter Soukas joins us to discuss percutaneous transmural arterial bypass (PTAB) using the DETOUR system, a novel percutaneous treatment for extensive and complex blockages in the superficial femoral artery (SFA). --- CHECK OUT OUR SPONSOR Endologix https://endologix.com/ --- SYNPOSIS Dr. Soukas shares his extensive experience and insights into PTAB development, benefits, patient selection, and procedural details. The idea behind PTAB is to create an SFA-to-popliteal artery bypass through endovascular means, using a system of overlapping stent grafts within the femoral vein as a conduit. When planning the procedure, it is important to consider the location of reentry into the popliteal artery, avoid calcified zones, and meet femoral vein size criteria. Additionally, we explore the advantages of PTAB over other endovascular options and traditional open surgical bypass, which carry a higher likelihood of restenosis and longer recovery times, respectively. We also discuss the types of training and support available for physicians interested in adopting this technique, cost and reimbursement aspects, and the future direction of PTAB, including ongoing post-market studies. --- TIMESTAMPS 00:00 Introduction 02:38 Dr. Soukas' Career in Vascular Medicine 05:19 Introduction to PTAB 13:00 Landing Zones 19:37 Stent Graft Sizing 23:14 Patient Selection and Adjunctive Medical Therapy 28:04 Procedural Risks 29:18 Navigating PTAB Implementation 32:20 Opportunities for Learning PTAB --- RESOURCES PTAB with the DETOUR System: https://endologix.com/ptab/detour/ Brown Vascular and Endovascular Fellowship: https://brownmedicine.org/3/cardiology-vascular-endovascular-fellowship/ COMPASS Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118 VOYAGER Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2000052 DETOUR 2 Trial: https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext

In this episode, Dr. Marta Lobato explores advanced endovascular techniques in below the knee (BTK) and below the ankle (BTA) interventions for critical limb ischemia (CLI). She introduces various skills that were developed and used by her team, such as the telescopic needle, buddy needle, balloon-assisted puncture, and vasodilation to prevent artery spasm. Dr. Lobato is a vascular surgeon at Hospital de Cruces in Barakaldo, Spain. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS The discussion covers the importance of visualizing the fifth metatarsal for effective lateral views in X-rays, the intricacies of accessing the lateral and medial plantar arteries, and the significance of starting with easier procedures before attempting more complex interventions. Additionally, Dr. Lobato highlights the role of social media in learning about innovative medical practices. --- TIMESTAMPS 00:00 - Introduction 05:54 - Below the Knee and Ankle Interventions 15:35 - Complexities of Zone 2 and 3 Access 23:12 - Buddy Needle Technique for Calcified Arteries 30:12 - Advanced Techniques for Supporting the Wire 34:13 - Vasodilator Use 37:12 - Balloon-Assisted Techniques 41:02 - Advancing Your Endovascular Skills --- RESOURCES Tips and Tricks for Simple and Complex Below-the-Ankle Punctures: https://pubmed.ncbi.nlm.nih.gov/38441118/ Buddy Needle Technique to Facilitate Retrograde Puncture of Heavily Calcified Tibial Vessels: https://pubmed.ncbi.nlm.nih.gov/28587566/ Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach: https://pubmed.ncbi.nlm.nih.gov/34989276/ Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures: https://pubmed.ncbi.nlm.nih.gov/36415934/ The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia: https://pubmed.ncbi.nlm.nih.gov/38523459/ New antioxidant therapy for hard-to-heal neuroischaemic diabetic foot ulcers with deep exposure: https://pubmed.ncbi.nlm.nih.gov/37029973/ Percutaneous endovascular arteriovenous fistula creation for hemodialysis access using "off-the-shelf" conventional devices: https://pubmed.ncbi.nlm.nih.gov/33251393/