BackTable Vascular & Interventional

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.

► https://www.backtable.com/app

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.

► https://www.backtable.com/app

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.

► https://www.backtable.com/app

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.

► https://www.backtable.com/app