Episodi
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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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This podcast is supported by an educational grant from Sirtex and Boston Scientific.
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Timestamps
00:00 - Introduction04:24 - Treatment Nonresponse Troubleshooting06:12 - Navigating Y90 Through Replaced Arteries09:09 - Mitigating Vasospasm in Embolization13:31 - What is ‘PREDATr’?21:12 - Dual Balloon Microcatheter System23:37 - Gelfoam Techniques and Application26:06 - Embolization Agents Preferences36:16 - Concerns with Cystic Artery Treatment and Biliary Stents42:15 - Prophylactic Antibiotics 44:29 - Utilizing High Lung Shunts49:28 - 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.
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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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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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This podcast is supported byTriSalus Life Scienceshttps://trinavinfusion.com/
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Timestamps00:00 - Introduction06:18 - Multidisciplinary Care of Fibroids15:45 - Treatment Decisions21:56 - Managing Asymptomatic Fibroids25:43 - Collaborative vs. Competitive Practices30:01 - UFE Procedure Approaches34:32 - Comparing Embolic Sizes and Amounts37:44 - Changes in Speed Using TriNav Catheters40:53 - Tactile Feedback at Stasis42:28 - Embolization Target Regions44:45 - Encountering and Troubleshooting Collaterals47:30 - Post-Op Pain Regiments57:28 - Wrap Up
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More about this episodeThe 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 -
Episodi mancanti?
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How is Y90 radioembolization rewriting the rules for managing large HCC tumors and creating new curative-intent therapeutic pathways where palliation was once deemed the only option? In this episode of the 2026 HCC Creator Weekend™, interventional radiologists Dr. Chris Malone (WashU), Dr. Tyler Sandow (Ochsner Health), and Dr. Beau Toskich (Mayo Clinic Florida) join host Dr. Zach Berman for a case-based discussion on advanced dosimetric strategies and embolization approaches for large and complex HCC lesions.
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This podcast is supported by an educational grant from Boston Scientific.
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Timestamps
00:00 - Introduction01:59 - Case 1: Ablative Dosing to Solitary Tumor04:38 - Post-Treatment Residual Arterial Enhancement07:35 - Case 2: Tumor with Multiple Feeding Arteries10:02 - Role of Combination with Immunotherapy13:01 - Case 3: Large Caudate Tumor16:03 - Approach to Extrahepatic Arterial Supply19:14 - Case 4: Tumor Adjacent to Viscera21:32 - Does Microsphere Count Matter?24:10 - Case 5: Radioembolization in HCC Downstaging28:18 - Dosing Paradigms for Large Tumors33:06 - Case 6: Pressure-Augmented Delivery35:16 - Case 7: Multifocal Disease and Satellite Lesions37:47 - Palliative Dosimetry vs. Radiation Lobectomy40:11 - Significance of Complete Pathonecrosis43:25 - Closing Remarks
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More about this episodeThe physicians discuss systematic approaches to patient selection, the nuances of MIRD single-compartment versus multi-compartment dosing, and the critical role of precise mapping and particle dynamics in optimizing treatment for heterogeneous tumors. The panel also examines how to navigate the risks and situational challenges of delivering high radiation doses to large central and multifocal tumors. They address practical concerns such as responding to post-treatment imaging changes, managing long-term risks like biliary strictures, and ensuring the safety of treating disease near mobile viscera. The specialists highlight the power of Y90 in successful downstaging, citing evidence of its superior potential to achieve complete pathological necrosis (CPN) at explant when compared with other modalities. Ultimately, they advocate for a bold, collaborative approach within the multidisciplinary tumor board, encouraging providers to employ combination therapies and advanced technologies to optimize patient outcomes and expand the boundaries of curable HCC.
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Resources
Yttrium-90 Radioembolization for the Treatment of Solitary, Unresectable HCC: The LEGACY Studyhttps://doi.org/10.1002/hep.31819
A US Study to Evaluate Transarterial Radioembolization (TARE) in Combination With Durvalumab and Bevacizumab Therapy in People With Unresectable Hepatocellular Carcinoma Amenable to TARE (EMERALD-Y90)https://clinicaltrials.gov/study/NCT06040099
TheraSphere With Durvalumab and Tremelimumab for HCC (ROWAN)https://clinicaltrials.gov/study/NCT05063565
Personalized versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trialhttps://doi.org/10.1016/S2468-1253(20)30290-9
Downstaging Outcomes for Hepatocellular Carcinoma: Results From the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) Consortiumhttps://doi.org/10.1053/j.gastro.2021.07.033
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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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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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This podcast is supported by
Stryker Peripheral Vascular, formerly Inari Medicalhttps://www.inarimedical.com/flowtriever-system
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Timestamps
00:00 - Introduction 01:24 - Building a PERT Team04:59 - 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 Associationhttps://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 Associationhttps://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 Associationhttps://pubmed.ncbi.nlm.nih.gov/31585051/
Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolismhttps://pubmed.ncbi.nlm.nih.gov/41910345/
PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolismhttps://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 embolismhttps://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 trialhttps://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 embolismhttps://pubmed.ncbi.nlm.nih.gov/40464677/
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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 can targeted liver radiation unlock surgical or transplant options for tough hepatocellular carcinoma (HCC) cases? In this episode of BackTable 2026 HCC Creator Weekend™ host Dr. Kavi Krishnasamy is joined by interventional radiologists Dr. Beau Toskich and Dr. Chris Malone to explore how downstaging and radiation lobectomy with Y-90 are creating new surgical and transplant opportunities for patients with limited future liver remnants. They discuss Y-90’s role as a “test of time” for tumor biology, strategies to prevent post-hepatectomy liver failure, and the ongoing challenge of recurrence even after R0 resection in cirrhotic livers.
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This podcast is supported by an educational grant from Sirtex and Boston Scientific.
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Timestamps
00:00 - Introduction01:31 - Rad Lobectomy Goals and Case Discussion06:09 - Selective vs Lobar Dosing07:51 - PVE Versus Y9009:35 - Downstaging to Transplant13:03 - Patient Selection Factors19:22 - Radseg vs. Lobar Strategy22:12 - Percent Liver Treated Debate26:38 - Particle Density and Catheter Bias28:04 - Downstaging Evidence MERIT LT36:20 - Operating After Y9041:25 - Hypertrophy Timing and Readiness43:03 - Wrap Up
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More about this episode
The discussion features a case of massive right-lobe HCC in a non-cirrhotic patient, with stepwise Y-90 dosing and selective retreatment leading to complete response and marked liver hypertrophy. The doctors compare radiation lobectomy with portal vein embolization (PVE), explore dosimetry advances from studies like DOSISPHERE and MERITS-LT, and stress the importance of careful mapping and patient selection. Additional topics include the pros and cons of different downstaging methods, functional imaging to assess risk, the impact of lab values and portal hypertension, and the practicalities of timing surgery after Y-90.
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Resources
Long-Term Overall Survival After Selective Internal Radiation Therapy for Locally Advanced Hepatocellular Carcinomas: Updated Analysis of DOSISPHERE-01 Trialhttps://jnm.snmjournals.org/content/early/2024/01/10/jnumed.123.266211
Downstaging hepatocellular carcinoma before liver transplantation: A multicenter analysis of the "all-comers" protocol in the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) consortiumhttps://pubmed.ncbi.nlm.nih.gov/37532179/
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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 -
When hemodialysis-dependent patients exhaust all conventional venous access options, how do IRs navigate complex central occlusions to provide a lifeline? In this episode of the BackTable Podcast, Dr. Gian Paolo Zamboni of Clínica Alemana in Santiago, Chile joins guest host Dr. Neil Jain to discuss workup protocols and advanced technical algorithms for complex central venous recanalization cases.
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This podcast is supported by
RADPAD® Radiation Protectionhttps://www.radpad.com/
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Timestamps
00:00 - Introduction03:06 - IR Practice and Referrals in Santiago07:19 - Pre-Procedure Workup15:06 - Standard Recanalization Techniques20:14 - Dual-Access Sharp Recanalization24:43 - Needle Maneuvers and Alternatives29:32 - Predilation, IVUS, and Stent Sizing37:42 - Transhepatic Technique and Indications45:45 - Tract Closure, Anticoagulation, and Follow-up50:03 - Advice and Closing Remarks
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More about this episode
The physicians review the critical role of pre-procedural planning, emphasizing the necessity of thorough workup with CT venography to accurately assess remaining vascular capital. Dr. Zamboni shares how his group addresses severe central venous occlusions, outlining a structured, stepwise approach that begins with standard maneuvers and progresses to sharp recanalization techniques before opting for dual-access approaches. He outlines critical safety measures, highlighting the importance of performing intraprocedural cardiac ultrasound, pre-dilating with caution, and keeping covered stents on the shelf to prevent fatal cardiac tamponade. For patients who lack viable conventional iliofemoral and IVC access, Dr. Zamboni shares an advanced jugular-to-transhepatic strategy, walking through the steps and nuances of creating a reliable working route, optimizing inflow, and managing post-procedure anticoagulation. Finally, Dr. Zamboni offers invaluable advice for IRs on mastering foundational techniques before tackling advanced cases and building strong, collaborative relationships with referring providers.
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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 does it really take to run a high-volume Y-90 program that is efficient, scalable, and patient-centered? In this episode of BackTable 2026 HCC Creator Weekend™, host Dr. Zach Berman is joined by Drs. Nima Kokabi and Kirema Garcia-Reyes to break down the systems, workflows, and strategies that drive successful radioembolization centers. The conversation focuses on overcoming referral and insurance delays, implementing multidisciplinary clinics, and using tools like single-session Y-90 and routine post-treatment dosimetry to reduce treatment times and improve outcomes.
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This podcast is supported by an educational grant from Sirtex and Boston Scientific.
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Timestamps
00:00 - Introduction04:46 - Multidisciplinary Model on Radioembolization08:39 - Referral Pathways and Embolization Preferences13:18 - Y-90 Follow Up and Imaging15:51 - Procedure Preparation and Involvement18:00 - Dosimetry Planning and Software ROI22:59 - Analyzing Outcomes and Quality Control26:47 - Various Ways to Expedite Treatments34:04 - Wrap Up and Credits
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More about this episode
The doctors discuss the importance of robust internal systems for patient selection, integration of dosimetry planning, and standardized follow-up protocols.They share insights on procedural workflows, including best practices for dosimetry ownership and equipment setup, and highlight the growing role of post-Y-90 dosimetry as both a quality control measure and a billable service. The episode also explores the order-map-treat paradigm, the impact of multidisciplinary tumor boards and clinics, and how single-session strategies are reshaping HCC care by cutting delays, reducing costs, and enhancing the patient experience.
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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 -
Routine doesn’t mean risk-free. What should be considered before, during, and after inferior vena cava (IVC) filter placement? In this episode of the BackTable Podcast, interventional radiologist Dr. Daniel O’Neal (Ohio State University) joins guest host Dr. Jessica Yoon to walk through the workup protocols, technical considerations, and multidisciplinary approaches required for placing and following up on IVC filters.
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This podcast is supported by
RADPAD® Radiation Protectionhttps://www.radpad.com/
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Timestamps
00:00 - Introduction02:10 - IVC Filter Basics07:37 - Workup and Contraindications12:18 - Pre-Procedural Imaging and Timing14:35 - Procedural Technique18:53 - Cavagram and Variant Anatomy23:18 - Filter Positioning and Deployment30:02 - IVC Filter Complications33:58 - Post-Placement Follow-Up39:14 - Final Thoughts and Closing Remarks
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More about this episode
The physicians review the key indications for the procedure, highlighting evidence-based patient selection and emphasizing the need for interventional radiologists to critically assess the clinical workup rather than function merely as technicians. They discuss how a comprehensive pre-procedural workup relies on cross-sectional imaging to identify access obstacles and to plan for adequate filter placement in cases of variant anatomy. Dr. O’Neal also shares technical tips from the suite, including deployment mechanics, positioning considerations, and strategies for preventing common complications. The conversation concludes with the IR’s ongoing responsibility to ensure a robust, multidisciplinary follow-up system with referring specialties, outlining potential strategies to ensure these devices are safely retrieved in a timely manner when no longer indicated.
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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 -
Can the right dosimetry approach turn palliative Y90 into a curative therapy? In this episode of the BackTable 2026 HCC Creator Weekend™, Interventional oncologists Dr. Riad Salem, Dr. Nima Kokabi, and Dr. Zach Berman examine modern Y90 dosimetry, from the decline of body-surface-area calculations to newer strategies that tailor treatment intensity to tumor burden, liver reserve, and clinical intent.
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This podcast is supported by an educational grant from Sirtex and Boston Scientific.
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Timestamps
00:00 - Introduction03:16 - MIRD and Dosing Considerations06:20 - BSA Is Dead09:26 - Early Stage Segmentectomy13:04 - Sphere Density Questions18:12 - CPN as the Goal18:41 - BCLC B Multifocal Strategy22:56 - Radiation Lobectomy Explained25:49 - Surgery and Adhesions28:59 - Advanced PVT Patients30:22 - Dosisphere and Biomarkers34:29 - Wrap Up
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More about this episode
The doctors discuss how to choose how much radiation treatment to give and why “activity” (what you order) is different from “dose” (what tissue receives). The episode goes on to compare one-area calculations with more nuanced methods that distinguish tumor from healthy tissue, and explains why advanced 3D planning is often simpler after treatment than before. The discussion also covers treatment goals for various clinical scenarios, such as when to aim for complete ablation versus palliation, managing radiation lobectomy, and tailoring therapy in cases with portal vein tumor thrombus. The episode concludes with insights on how imaging informs treatment intensity and how local and systemic therapies work together in the latest Y90 approaches.
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Resources
Combination treatment with transarterial chemoembolization, radiotherapy, and hyperthermia (CERT) for hepatocellular carcinoma with portal vein tumor thrombosis: Final results of a prospective phase II trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5581058/
A global evaluation of advanced dosimetry in transarterial radioembolization of hepatocellular carcinoma with Yttrium-90: the TARGET studyhttps://pubmed.ncbi.nlm.nih.gov/35394152/
Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinomahttps://pubmed.ncbi.nlm.nih.gov/27575820/
Long-Term Overall Survival After Selective Internal Radiation Therapy for Locally Advanced Hepatocellular Carcinomas: Updated Analysis of DOSISPHERE-01 Trialhttps://jnm.snmjournals.org/content/early/2024/01/10/jnumed.123.266211
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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 build a pipeline for passionate, well-prepared interventional radiologists from day one of med school? In this episode of the BackTable Podcast, Dr. Aaron Rohr, interventional radiologist and associate professor at the University of Kansas, joins guest host Dr. Jessica Yoon to discuss how IR is accessed, taught, and experienced by medical students throughout their early education.
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Timestamps
00:00 - Introduction02:49 - Finding IR: Then and Now06:54 - Challenges of Teaching IR in Core10:07 - How IR Thinks Through Problems14:40 - MAVIRIC Symposium20:09 - Engaging Teaching Models27:26 - Increasing Clinical Presence of IR30:17 - Leadership in Educational Initiatives35:57 - Reflections and Advice for Educators39:15 - Final Thoughts and Closing Remarks
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More about this episode
The physicians explore ways in which the transition from traditional fellowship models to integrated IR training pathways has increased the specialty’s visibility for early learners while also pointing out obstacles that continue to hinder greater integration of IR into the core medical curriculum. They discuss how IR’s involvement in diverse systems and disease processes offers valuable opportunities for comprehensive clinical learning, but simultaneously makes the specialty challenging for students with structured rotations to engage within a longitudinal fashion. Dr. Rohr goes on to highlight the Mid-America Vascular and Interventional Radiology Initiative Collegium (MAVIRIC), a student-led, faculty-supervised program hosted by KUMC that aims to introduce medical students to clinical, technical, and industry-related aspects of IR. He reflects on the effectiveness of hands-on interaction with devices and physicians’ demonstration of passion for their practice in piquing student interest. While acknowledging the burden of labor beyond work hours that such initiatives often demand of doctors and students alike, the physicians express their optimism for the growth of IR’s presence both in the hospital ecosystem and in the medical curriculum.
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Resources
MAVIRIChttps://www.maviric.org/
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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 -
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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This podcast is supported by
Okamihttps://okamimedical.com/
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Timestamps
00:00 - Introduction01:43 - Defining HHT and PAVM05:53 - Democratizing Interventions for HHT Patients08:83 - Recommendations to Embolize PAVM13:19 - Imaging Specificity and Procedural Preferences23:29 - Persistence Rates with Plugs and Coils25:59 - Lag in Utilization of Plugs29:18 - Comparison of LOBO to Alternative Vascular Plugs34:26 - Post Embolization Symptoms and Troubleshooting Methods39:04 - PAVM Cases and Treatments54:26 - Wrap Up and Credits
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More about this episode
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.
► https://www.backtable.com/app -
Why are some GJ tubes more prone to failure, and what can you actually do about it? In this episode of the BackTable Podcast, Dr. Chris Beck hosts Dr. Kevin Wong, a pediatric interventional radiologist at the University of South Alabama, to discuss the complexities of gastrojejunostomy (GJ) tube management in hospital-based IR, especially in pediatric patients. The discussion offers clinically relevant guidance on troubleshooting, device selection, and multidisciplinary approaches to enhance GJ tube care and improve patient outcomes.
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Timestamps
00:00 - Introduction05:40 - Etiologies of GJ Tube Dislodgement and Placement Considerations 12:17 - Spiral Upsizing Solutions14:30 - Parent Education Playbook19:34 - Indications for GJ Conversion21:55 - Criteria for GJ Removal24:12 - Preferred Low-Profile Tube Designs27:15 - Addressing Suboptimal Angles and Guidewire Selection31:26 - Strategies to Prevent Tube Occlusion33:34 - Wish List for Industry 36:12 - Balloon Assisted Placement Techniques37:58 - Wrap Up and Credits
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More about this episode
The doctors explore why GJ tubes fail and how to manage common complications, such as balloon failures, vomiting-induced dislodgement, stoma enlargement, and recurrent malfunction due to poor gastrostomy angle or architecture, often seen with surgically placed G-tubes. Dr. Wong shares prevention strategies, including parent education on balloon-volume checks and refills, sending patients home with a backup G-tube, minimizing upsizing, and addressing traction and granulation tissue (including the use of silver nitrate). He also covers approaches to clog management such as warm water, Coke, aggressive flushing, and avoiding routing medications through the G port. The episode wraps up with a discussion on device preferences (AMT G-JET versus MIC-KEY), tips for wire and catheter exchanges, and the need for industry improvements in materials and lumen design.
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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 -
A high-functioning HCC tumor board can turn complex transplant decisions into coordinated treatment plans that account for liver reserve, tumor biology, and evolving biomarkers. In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, abdominal transplant surgeon Dr. Ari Cohen (Ochsner Health) and transplant hepatologist Dr. Neil Mehta (UCSF) join host Dr. Kavi Krishnasamy to map out strategies for effective multidisciplinary treatment and transplantation planning in HCC.
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This podcast is supported by an educational grant from Sirtex and Boston Scientific.
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Timestamps
00:00 - Introduction00:51 - Starting a Tumor Board06:39 - Building Referral Streams09:03 - Academic and Community Practice Integration14:31 - Treatment Selection Criteria20:38 - Modern HCC Biomarkers25:24 - Role of ctDNA and Biopsy29:37 - Bridging Therapy on Transplant Waitlist32:34 - Downstaging Strategy and Risks39:25 - Final Thoughts and Closing Remarks
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More about this episode
The physicians discuss what it takes to build a robust tumor board, from fostering hospital buy-in to engaging leaders across specialties and utilizing virtual formats for consistent participation. The conversation explores clinical decision-making, emphasizing the integration of AFP-L3 and DCP biomarkers alongside AFP to better understand tumor biology and predict post-transplant recurrence. Dr. Mehta and Dr. Cohen also share their patient selection criteria, discussing how bilirubin, liver disease etiology, and INR influence decisions. While radiographic guidance remains central to HCC management, they highlight the growing potential of reliable ctDNA analysis and other biomarkers. The specialists conclude by emphasizing that an integrated, communicative tumor board is the most effective way to navigate the nuances of liver reserve and HCC biology to achieve the best possible patient outcomes.
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Resources
Sustained AFP-L3 or DCP expression is associated with progression risk and inferior outcomes in unresectable hepatocellular carcinoma.https://doi.org/10.1007/s10238-025-01877-8
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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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Can arterial closure devices transform your OBL workflow and get patients moving sooner? In this episode of the BackTable Podcast, Dr. Mike Barraza sits down with Interventional Radiologist Dr. Dave Johnson to discuss the ins and outs of launching and running an office-based lab (OBL) in Florida. While covering startup logistics, staffing, regulatory requirements, and cost-saving strategies, the conversation centers on how the use of arterial closure devices can streamline workflow, speed post-procedure recovery, and enhance both efficiency and patient care in the OBL setting.
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Terumohttps://www.terumo.com/
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Timestamps
00:00 - Introduction01:31- Launching The OBL04:41- Logistics And Staffing07:14 - Standardizing Supplies11:57 - OBL vs. Hospital Cases15:30 - Patient Experience Benefits17:41 - Efficiency And Throughput20:49 - Closure Devices For Flow23:28 - Early Ambulation With AngioSeal26:14 - Anticoagulation Decisions28:31 - AngioSeal Access Technique30:20 - Avoiding Hostile CFA Access32:19 - Choosing SFA or Radial34:04 - Do You Need Groin Runs36:14 - Closure Device Fundamentals38:53 - Ultrasound Guided AngioSeal45:11 - Post Op Monitoring Checklist
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More about this episode
Dr. Johnson explains that some procedures, such as Prostate Artery Embolization (PAE), may still require a hospital setting due to insurance coverage, patient preference, or unique clinical needs. He compares patient experiences in OBLs versus hospitals, emphasizing the advantages of privacy, convenience, and personalized communication in the OBL environment. A major challenge discussed is managing post-procedure recovery and patient throughput with limited holding beds, where femoral arterial closure devices like Angio-Seal are essential for early ambulation and efficient turnover. The discussion highlights best practices for access site selection, ultrasound guidance, and post-closure assessment, providing actionable insights for IR physicians aiming to optimize office-based procedures.
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Resources
Cost Comparison of Prostatic Artery Embolization Between In-Hospital and Outpatient-Based Lab Settingshttps://pubmed.ncbi.nlm.nih.gov/39310461/
Prostate Artery Embolization: Indication, Technique and Clinical Resultshttps://pubmed.ncbi.nlm.nih.gov/29975976/
Ultrasound-guided angio-seal deploymenthttps://pubmed.ncbi.nlm.nih.gov/25735527/
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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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With recent updates to the Barcelona Clinic Liver Classification (BCLC), how should multidisciplinary teams adapt their treatment strategies to accommodate the newest evidence? In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, Dr. Neil Mehta of UCSF and Dr. Riad Salem of Northwestern Medicine join host Dr. Tyler Sandow to explore the complexities of hepatocellular carcinoma (HCC) therapies and the practical application of the latest global algorithms in balancing standardized therapeutic algorithms with individual patient factors.
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Timestamps
00:00 - Introduction01:54 - HCC Case Discussion08:05 - Guest Introductions10:37 - BCLC Committee and 2025 Update15:54 - CUSE and Tumor Board Goals17:46 - Bridging vs Curative Y9022:37 - Patient Factors in Treatment Algorithms26:41 - Liver Function and Hyperbilirubinemia Trends30:25 - HCC Treatment Decision Ownership34:36 - Radiation Segmentectomy vs Surgical Resection37:35 - BCLC B Heterogeneity41:51 - Improving HCC Risk Stratification43:48 - Final Thoughts and Closing Remarks
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More about this episode
The discussion begins with an inside look at the consensus process behind the 2025 BCLC updates, highlighting the official inclusion of Y90 radioembolization as a recognized therapeutic option. The experts introduce the "CUSE" (Complexity, Uncertainty, Subjectivity, and Emotion) framework to provide a structured approach to the subjective considerations that modulate purely data-based algorithms in multidisciplinary decision-making. Dr. Salem and Dr. Mehta speak on the nuances of surgical resection versus radiation segmentectomy in a case-based discussion, highlighting how factors such as portal hypertension, patient age, and etiology of cirrhosis should influence treatment pathways. Finally, they underscore the paradigm shift toward pursuing complete pathonecrosis (CPN) as a primary curative goal, regardless of bridging status, and reiterate that success in HCC care is driven by continuous communication and collaboration between physicians and patients.
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Resources
BCLC 2026 Updatehttps://doi.org/10.1016/j.jhep.2025.10.020
---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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When a liver tumor is hard to see, the limits of conventional image guidance can become the limits of treatment. In this episode of the BackTable Podcast, Netherlands interventional oncologist Dr. Maarten (M.L.J.) Smits shares a step-by-step walkthrough of the new hepatic arteriography and C-arm CT–guided ablation (HepACAGA) technique, punctuated with a real-world case series at the end. Find out how intra-arterial contrast, cone-beam CT, and 3D needle guidance can improve tumor conspicuity, targeting accuracy, and ablation margin assessment within a single angiography suite.
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Timestamps
00:00 - Introduction02:55 - Netherlands Tech Access04:31 - Origin of HepACAGA07:14 - Why Use a Catheter?11:24 - Tools and Setup13:13 - Catheters and Devices17:06 - Contrast Protocol Basics22:51 - Targeting and Needle Guidance31:09 - Patient Selection35:56 - Extra Benefits and Multimodal39:58 - Workflow and Outcomes46:14 - Evidence and Early Studies51:41 - Rethinking Size Cutoffs57:54 - HCC Case Walkthrough01:02:27 - Hard-to-See Metastasis01:06:22 - Margin Driven Reablation01:11:04 - Bleeding and Embolization01:16:05 - Renal ACAGA Expansion01:23:31 - Adoption and Next Steps
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More about this episode
Dr. Smits explains the origins of HepACAGA and why catheter-based contrast delivery can meaningfully change ablation planning, particularly for small lesions, poorly visualized tumors, and cases where ultrasound or conventional CT guidance may be insufficient. He walks through the practical setup, including catheter positioning, contrast dilution, timing protocols, needle navigation, apnea/end-expiration technique, and built-in fusion for immediate ablation verification. He also describes how the angio suite environment supports multimodal treatment, including intraprocedural embolization when bleeding occurs or when additional transarterial therapy is needed.
The episode also examines early outcomes from Dr. Smits’ group, including a reported reduction in local recurrence from approximately 25% to 5%, with a modest increase in procedure time. Case examples include HCC, small colorectal liver metastases, margin-driven re-ablation, hemorrhage management, and extension of the ACAGA concept to renal tumors (RenACAGA).
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Resources
Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablationhttps://pubmed.ncbi.nlm.nih.gov/37704863/
Renal Arteriography and C-arm CT-Guided Ablation (RenACAGA) for Thermal Ablation of Challenging Renal Tumorshttps://pubmed.ncbi.nlm.nih.gov/40295401/
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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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Vascular trauma care looks a lot different when the OR is improvised, supplies are limited, and limb salvage decisions cannot wait. On this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Ahmad Hussain, a Southern California private-practice “hired gun” who volunteered on a WHO/UN-coordinated humanitarian mission to Gaza after an orthopedic colleague requested vascular surgeons due to widespread limb loss.
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Timestamps
00:00 - Introduction04:02 - Why Volunteer In Gaza?07:41 - Logistics and Crossing Into Gaza10:45 - Hospital as Refugee Camp13:34 - First Vascular Trauma Case18:24 - Mass Casualty Triage23:20 - Kids Guiding Doctors27:09 - Evacuation Uncertainty32:03 - Would You Go Back?37:55 - How to Volunteer39:30 - Show Wrap Up and Credits
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More about this episode
Dr. Hussain describes entering through the Rafah border with suitcases of medical supplies, working in a hospital functioning as a refugee camp for tens of thousands, and treating shrapnel-related vascular trauma with limited imaging (mainly ultrasound and X-ray), scarce anesthesia, and minimal surgical resources, relying heavily on skilled local medical students and residents. He recounts mass-casualty triage, the emotional impact of caring for injured children, bonding with the children who assisted the volunteers, and the dangerous, militarized evacuation via Israel with U.S. embassy assistance. He says he wants to return, but notes tightened restrictions and dwindling aid, and he recommends other organizations, noting any specialty of medical professionals should consider volunteering.
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Resources
Gift of Disability Alleviation (GODA)https://indushospital.ca/appeal/gift-of-disability-alleviation-goda/
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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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For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization.
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Timestamps
00:00 - Introduction 01:42 - Dr. Yan Epelboym’s Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts
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More about this episode
The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization.
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Resources
Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/
Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050
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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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Your guide to better planning, access, and sampling. In this episode of the BackTable Podcast, we revisit every IR’s favorite procedure with Dr. Zoe Miller, Assistant Professor of Clinical Interventional Radiology and Associate Program Director at the University of Miami. Together with host Dr. Ally Baheti, Dr. Miller walks through a methodical approach to adrenal vein sampling to help you overcome common procedural challenges and reliably point your patients towards the proper therapies.
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Timestamps
00:00 - Introduction02:26 - Preprocedural Workup Basics06:21 - Planning CT Utility and Protocol08:46 - Access Strategy10:36 - Procedure Day Preparation12:12 - Catheters and Side Holes15:44 - Adrenal Vein Selection Techniques18:50 - Troubleshooting Right Adrenal Vein Selection24:34 - Sample Acquisition Coordination27:38 - Aspiration Flow Optimization29:34 - Preventing Reintervention and Vessel Damage34:06 - Post-Procedure Follow-Up35:46 - AVS in Cushing Syndrome39:38 - Mentorship and Sourcing Knowledge39:25 - Closing Remarks
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More about this episode
The physicians outline the key aspects of the pre-procedural workup, from setting expectations with patients to the utility of CT in operative planning. Dr. Miller provides a detailed exploration of strategies and tools for achieving safe access of the adrenal veins, particularly on the right side, and obtaining adequate samples. She emphasizes the importance of collaboration, both within the IR team and with other specialists, to ensure maximal procedural yield and to ultimately provide patients with valuable guidance in their treatment. The episode concludes with a discussion of the challenges presented by co-secreting tumors in hormone level assessment as well as the value of seeking out data and the experiences of mentors in developing your own best practices as an IR.
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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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