BackTable Vascular & Interventional

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.

► https://www.backtable.com/app

What do the 2026 coding changes mean for the financial viability of IVL in the OBL? In this episode of the BackTable Podcast, host Dr. Ally Baheti sits down with Dr. Nicholas Petruzzi to break down how intravascular lithotripsy fits into OBL workflows, and how upcoming lower-extremity revascularization coding updates may impact outpatient economics.

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This podcast is supported by

Shockwave Medicalhttps://shockwavemedical.com/

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Timestamps

00:00 - Introduction02:35 - 2026 Coding Changes Overview05:18 - Where IVL Codes Apply06:35 - Iliac Reimbursement Impact08:50 - IVL vs. Atherectomy11:54 - BTK Reality and Future14:44 - When IVL Is Not Ideal16:05 - Catheters and Setup Basics17:50 - Sizing and Technique Tips23:01 - Javelin Forward Emitter26:25 - Wrap Up

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More about this episode

The episode starts with a walkthrough of the key 2026 coding updates, including territory-based coding, new IVL add-on codes for aorto-iliac and fem-pop segments, the introduction of below-the-ankle codes, and the shift toward ‘simple’ versus ‘complex’ designations. From there, the conversation focuses on where IVL makes sense clinically and operationally, particularly as an alternative or complement to atherectomy, with discussion of low embolization risk seen in the DISRUPT PAD trial and the potential to avoid distal protection in select cases.

Dr. Petruzzi shares how he approaches IVL in the lab, including catheter selection, sizing, low-pressure technique, and repositioning strategies. They also touch on workflow considerations in the OBL and preview newer concepts like the forward-emitting Javelin device for heavily calcified lesions and situations where device exchange is limited.

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Resources

DISRUPT PAD III RCThttps://shockwavemedical.com/en-eu/clinical-evidence/pad-iii-rct/

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

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction01:43 - PVD Demand at Penn06:42 - Approach & Algorithm12:08 - Variation in Iliac Vein Compression15:58 - Treatment Approaches19:20 - Important Ultrasounds22:15 - Intra-Procedural Workflow31:14 - Iliac Vein Stenting and Avoiding Complications36:31 - Gonadal Vein Embolization and Working with Patients42:20 - Iliac Vein Embolization and Post-Op Care

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More about this episode

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

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

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Clean lumen club! This week, BackTable meets you at the carotid bifurcation to discuss all things carotid angioplasty and stenting. Interventional neuroradiologist and cerebrovascular surgeon Dr. Adnan Siddiqui, Vice Chairman of the University of Buffalo’s Department of Neurosurgery, joins host Dr. Sameh Sayfo to discuss the evolution and current state of carotid disease treatment.

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Get the BackTable app

https://www.backtable.com/app

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This podcast is supported by

Terumohttps://www.terumois.com/

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Timestamps

00:00 - Introduction02:48 - From Aspirin to Endarterectomy03:47 - Rise of Carotid Stenting06:46 - CREST-2 and CMS Coverage09:57 - Management of Severe Asymptomatic Carotid Stenosis 15:35 - New Stent Designs Explained17:56 - Five Tips for New Operators20:08 - Case Selection Algorithm22:04 - Learning Curve and Mentorship28:27 - What’s Next: IVL and Outpatient31:24 - Managing Complications Safely35:05 - Closing and Credits

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More about this episode

Dr. Siddiqui details the history of carotid stenosis treatment, charting its path and progression from medical therapy to endarterectomy and modern stenting approaches. He includes how recent trial data and updated CMS reimbursements have influenced practice and generated recent developments such as second generation stent technology. Dr. Siddiqui shares perspectives on patient selection, operator learning curve, complication preparedness, and the importance of structured training and proctoring as technology and techniques continue to improve. The physicians close by overviewing future directions for the carotid space such as IVL and how to approach management of procedural complications.

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Resources

Dr. Adnan Siddiqui provider profilehttps://www.ubns.com/physicians/dr-adnan-h-siddiqui/ Carotid Endarterectomy for Asymptomatic Carotid Stenosis: Asymptomatic

Carotid Surgery Trial (ACAS)https://www.ahajournals.org/doi/10.1161/01.str.0000141706.50170.a7

Asymptomatic Carotid Surgery Trial (ACST-2)https://www.acc.org/latest-in-cardiology/clinical-trials/2021/08/25/23/24/acst2

Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients (SAPPHIRE trial)https://www.nejm.org/doi/full/10.1056/NEJMoa040127

Medical Management and Revascularization for Asymptomatic Carotid Stenosis (CREST-2 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2508800

The North American Symptomatic Carotid Endarterectomy Trial (NASCET trial)https://www.ahajournals.org/doi/10.1161/01.str.30.9.1751

As interventional radiology cements its position as a primary clinical responder for acute arterial hemorrhage, what if you could achieve rapid and durable arterial occlusion with a single, highly deliverable device? In this episode of the BackTable Podcast, Dr. Alex Villalobos (UNC), Dr. Nima Kokabi (UNC), and Dr. Brian Funaki (UChicago) join host Dr. Kavi Krishnasamy to explore the shifting paradigms of arterial embolization in a case-based discussion highlighting modern vascular plug technologies.---

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https://www.backtable.com/app

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This podcast is supported by

Okami Medicalhttps://okamimedical.com/

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Timestamps

00:00 - Introduction01:24 - Trauma Activation Workflow06:42 - Empiric Arterial Embolization Indications10:40 - Embolic Agent Preferences and Value Analysis17:18 - Embolics on the Shelf19:32 - LOBO Plug Use Cases20:58 - Case 1: Abdominal Wall Hematoma23:54 - LOBO Advantages, Cost, and Microcatheter Compatibility26:33 - Alternative Access Approaches30:31 - LOBO Sizing and Trackability35:26 - Pusher Wire Features38:20 - Delivery Catheter Requirements43:41 - Case 2: Retroperitoneal Bleed45:15 - LOBO Deployment Technique49:41 - Case 3: Splenic Trauma53:51 - Occlusion Time and Adjunct Embolics57:07 - Closing Remarks

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More about this episode

The panel begins by discussing the range of embolic options and combinations at their disposal, sharing their preferences and treatment algorithms in various clinical scenarios. In particular, they emphasize the need for tools that provide immediate, predictable occlusion without the technical burden and cost of needing to deploy multiple embolic agents. The physicians go on to focus on Okami Medical’s LOBO vascular plug as a primary solution for rapid vessel occlusion, highlighting the micro-pore architecture and unique deliverability through microcatheters that make it advantageous for precise positioning and reliable embolization. Exploring its use in cases including rectus sheath hematomas, retroperitoneal bleeding, and splenic trauma, the physicians detail the technical nuances of sizing and positioning the LOBO as well as the long-term advantages of its artifact-free design. This episode ultimately underscores a growing preference for streamlined arterial embolization workflows that prioritize rapid stasis and clinical predictability while leveraging the strengths of a multimodal embolic toolkit.