BackTable Vascular & Interventional

Could replacing bulky coil packs with specialized liquid embolic agents be the key to faster, more cost-effective peripheral embolizations? In this kickoff episode of the BackTable 2026 Liquid Embolics Creator Weekend™, Dr. Kavi Krishnasamy (University of Alabama at Birmingham) and Dr. Gary Siskin (Albany Med) join Dr. Tyler Sandow to break down the foundational principles, deployment approaches, and expanding clinical applications of liquid embolics in non-neurological interventions. They discuss the transition toward a "liquid-first" procedural mindset, the technical nuances of adhesive and cohesive agents, and how targeted liquid cast creation might optimize procedure times and device expenditure compared to traditional coiling.

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This podcast is supported by an educational grant from Sirtex.

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Timestamps

00:00 - Introduction03:01 - Case 1: Rectus Sheath Bleed06:15 - Liquid Embolics: Advantages and Apprehension12:15 - Adhesive vs. Cohesive Mechanisms14:28 - LAVA Workflow and Deployment Considerations19:37 - Safe Post-Delivery Technique23:49 - Risks and Preventing Adverse Events27:06 - Case 2: Roadmap Mask for Embolic Visualization30:22 - Stuck Catheter Experiences34:01 - Glue Timing and Control37:13 - Rapid-Fire Practical Pearls41:40 - Closing Remarks

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More about this episode

The panel walks through procedural protocols, detailing microcatheter selection, dead-space calculations, and injection techniques designed to prevent arterial spasm and non-target reflux. Dr. Siskin and Dr. Krishnasamy detail troubleshooting strategies including catheter extraction maneuvers to prevent device entrapment, the use of road-map masking for better embolic visualization, and the application of pushable or detachable coils as distal backstops. They review approaches in high-yield clinical scenarios such as rectus sheath hematomas, gastroduodenal artery (GDA) obliteration, and type II endoleak interventions. The episode concludes with advice for early-career operators on gaining hands-on preclinical experience, mastering multi-embolic combinations, and identifying scenarios where liquid agents should be avoided.

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Resources

Treatment of Peripheral Arterial Hemorrhage with Lava LES (The LAVA Study)https://clinicaltrials.gov/study/NCT04649255

Onyx™ Liquid Embolic IDE Clinical Studyhttps://clinicaltrials.gov/study/NCT06742801

Fluidx’s GPX Embolic Device Meets Primary Endpoints in Pivotal Trialhttps://evtoday.com/news/fluidxs-gpx-embolic-device-meets-primary-endpoints-in-pivotal-trial

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

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

► https://www.backtable.com/app

What do you actually do when a Medicare audit letter lands in your inbox? On this episode of BackTable Podcast, Dr. Ally Baheti interviews healthcare attorney Jason Greis, partner at Benesch, to demystify the audit process and the rising scrutiny on interventional practices. They discuss why audits are accelerating, which procedures are under the microscope, and how enforcement economics and AI-driven review are reshaping the landscape for OBLs and ASCs.

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

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This podcast is supported by

RADPAD® Radiation Protectionhttps://www.radpad.com/

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Timestamps

00:00 - Introduction02:32 - Audit Hotspots in Endovascular Work05:00 - AI Oversight and Proactive Compliance13:35 - The Alphabet Soup of Audit Types19:16 - Responding to an Audit and the Appeals Ladder24:48 - Employment Status, Liability and AI Downcoding30:29 - Final Advice and Wrap Up

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More about this episode

The conversation covers the “alphabet soup” of audit types, the five-step appeals process, and strategies for proactive compliance and documentation. The discussion walks through personal liability, employment status, the risks of algorithmic downcoding by commercial payers, and why practices must balance when to fight and when to let an audit go. The episode closes with actionable advice on protecting your practice, the dangers of putting patient data into AI tools, and why trade organizations are the first line of defense.

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Resources

OIG: Utilization Trends and Medicare Part B Billing for Office-Based Peripheral Vascular Procedures Raise Questions About Program Integrity (OEI-01-24-00250)https://oig.hhs.gov/reports/all/2026/utilization-trends-and-medicare-part-b-billing-for-office-based-peripheral-vascular-procedures-raise-questions-about-program-integrity/

CMS Wasteful and Inappropriate Service Reduction (WISeR) Modelhttps://www.cms.gov/priorities/innovation/innovation-models/wiser

CMS Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH)https://www.cms.gov/fraud

CMS Medicare Fee-for-Service Appeals: The Five Levelshttps://www.cms.gov/medicare/appeals-grievances/fee-for-service

CMS Medicare Fee-for-Service Compliance Programs (TPE, RAC, SMRC, CERT)https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs

BackTable VI Ep. 478: ASC vs. OBL: Legal Insights Explainedhttps://www.backtable.com/shows/vi/podcasts/478/asc-vs-obl-legal-insights-explained

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

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

► https://www.backtable.com/app

As new guidelines redefine risk stratification for pulmonary embolism (PE), emerging technologies are also changing what it means to achieve procedural success. On this episode of the BackTable Podcast, interventional radiologist Dr. Julie Bulman (BIDMC) and interventional cardiologist Dr. Jay Giri (Penn Medicine) join host Dr. Chris Beck to discuss the evolving frameworks and technologies redefining standards for catheter-directed treatment of intermediate- and high-risk PE. They discuss the role of multidisciplinary PERT teams, patient selection, the impact of new thrombectomy devices, and why autologous blood return is a growing consideration for procedural success.

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

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This podcast is supported by

Endovascular Engineering (E2)E2Helo.com

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Timestamps

00:00 - Introduction03:42 - Referral Patterns and PERT Scope05:25 - PE Workup Essentials07:26 - Targeted Assessment of Acuity11:36 - Reliability of the Walk Test14:35 - PE Treatment Pathways19:26 - Procedural Walkthrough24:15 - Catheter Sizing30:05 - Adjunct Aspiration Device Features35:09 - Blood Return Process and Safety40:03 - Helo Study Early Results45:09 - Determining Procedural Endpoints50:20 - Future Trials and Technologies53:48 - Final Thoughts and Closing Remarks

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More about this episode

The discussion highlights how PERT teams use updated guidelines and thorough clinical evaluation to guide patient classification and treatment pathway selection. Dr. Bulman and Dr. Giri outline their criteria for choosing anticoagulation, catheter-directed lysis, or mechanical clot removal, and compare the techniques and learning curves for medium- versus large-bore thrombectomy devices. They explore the significance of autologous blood return during aspiration thrombectomy, noting how new reinfusion systems can reduce blood loss and influence procedural decision-making. Dr. Bulman also presents early Helo Thrombectomy System study data demonstrating the benefits of mechanized aspiration with minimal complications. The episode closes with a critical look at defining true functional procedural endpoints beyond pulmonary arterial pressures and offers a preview of upcoming trial data, such as HI-PEITHO and PEERLESS II, that could further advance PE management.

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Resources

2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adultshttps://doi.org/10.1161/CIR.0000000000001415

Ultrasound-Facilitated, Catheter-Directed Thrombolysis in Intermediate-High Risk Pulmonary Embolism (HI-PEITHO)https://clinicaltrials.gov/study/NCT04790370

PEERLESS II studyhttps://clinicaltrials.gov/study/NCT06055920

Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism (PRAGUE-26)https://doi.org/10.1056/nejmoa2608012

Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3)https://clinicaltrials.gov/study/NCT04430569

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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 is it time to move from repeat drainage to a tunneled catheter for managing pleural effusions or ascites? On this episode of BackTable Podcast, Dr. Neil Jain interviews Dr. Marco Ertreo, interventional radiologist and IR residency program director at Strong Memorial Hospital, University of Rochester, about best practices for tunneled catheter management in both the chest and abdomen. They discuss the triggers for placing a tunneled catheter, patient selection, placement technique, home drainage protocols, complication management, and the unique considerations for malignant versus cirrhotic ascites.

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Timestamps

00:00 - Introduction06:39 - Indications and Pleural Catheter Placement Technique12:10 - Tunneling, Cuff Position and Exit Site Selection17:42 - Home Drainage, Volume Limits and Complications26:13 - Peritoneal Catheters, TIPS Candidacy and Catheter Choice35:16 - Avoiding Bowel and Varices43:42 - Key Takeaways and Closing Remarks

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More about this episode

Dr. Ertreo shares practical details about pocket selection, access points, catheter testing, and choosing Tenckhoff catheters for abdominal cases to avoid proprietary systems. The conversation covers volume limits, complication counseling, criteria for removal, and the psychological impact of living with a long-term drain. They discuss when to consider TIPS for cirrhotic patients, the importance of early conversations with patients and referring providers, and why multidisciplinary teamwork and family support are essential for long-term success.

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Resources

Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trialhttps://pubmed.ncbi.nlm.nih.gov/30037711/

Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guidelinehttps://www.atsjournals.org/doi/10.1164/rccm.201807-1415ST

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions, Part II: Recommendationshttps://pubmed.ncbi.nlm.nih.gov/31229333/

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases (AASLD)https://pubmed.ncbi.nlm.nih.gov/33942342/

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

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

► https://www.backtable.com/app

As interest in genicular artery embolization grows, what does it actually take to build a sustainable GAE practice? On this episode of the BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Anish Ghodadra and Dr. Amin Astani to share their blueprint for building a successful genicular artery embolization (GAE) practice. They discuss patient selection, imaging workup, scoring tools, and procedural techniques, including access strategies, device choice, and embolic selection. The conversation also covers follow-up protocols, defining treatment success, and how to set patient expectations.

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

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

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Timestamps

00:00 - Introduction04:00 - GAE Workup and Patient Scoring05:28 - KL Score and MRI Debate10:15 - Patient Selection and Contraindications15:11 - Access Strategy and Closure Techniques19:54 - Catheters, Wires, and Embolic Choices28:19 - Cone Beam CT Workflow31:37 - Managing Collaterals34:26 - Follow-Up and Repeat GAE38:42 - Defining Success and Setting Expectations44:25 - Technique Nuances and Flow Modulation50:28 - Building Referral Networks56:56 - Keeping Referrers Engaged59:46 - Direct-to-Patient Marketing01:04:57 - Leveraging Social Media and Reviews01:12:42 - Tracking Leads and Insurance Coverage01:19:47 - Final Thoughts and Next Steps

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More about this episode

Beyond technique, the discussion dives into practical strategies for growing a GAE practice: referral pathways, engaging physical therapists and orthopedic surgeons, direct-to-patient marketing, digital outreach, and tracking outcomes. The guests share experience-driven tips on handling insurance hurdles, building relationships with referring providers, and using data to demonstrate value. The episode wraps with reflections on negative trial results, the evolving landscape of GAE, and what it takes to keep a practice thriving in a competitive environment.

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Resources

Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trialhttps://doi.org/10.1007/s00330-026-12505-8

Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Painhttps://doi.org/10.1007/s00270-026-04410-w

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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