BackTable Vascular & Interventional

Latest Episodes:

Ep. 635 Methodical Approach to Adrenal Vein Sampling with Dr. Zoe Miller Apr 17, 2026

Show notes

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 - Introduction
02:26 - Preprocedural Workup Basics
06:21 - Planning CT Utility and Protocol
08:46 - Access Strategy
10:36 - Procedure Day Preparation
12:12 - Catheters and Side Holes
15:44 - Adrenal Vein Selection Techniques
18:50 - Troubleshooting Right Adrenal Vein Selection
24:34 - Sample Acquisition Coordination
27:38 - Aspiration Flow Optimization
29:34 - Preventing Reintervention and Vessel Damage
34:06 - Post-Procedure Follow-Up
35:46 - AVS in Cushing Syndrome
39:38 - Mentorship and Sourcing Knowledge
39:25 - 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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Ep. 634 Understanding Intravascular Lithotripsy in the OBL with Dr. Nicholas Petruzzi Apr 14, 2026

Show notes

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 Medical
https://shockwavemedical.com/

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Timestamps

00:00 - Introduction
02:35 - 2026 Coding Changes Overview
05:18 - Where IVL Codes Apply
06:35 - Iliac Reimbursement Impact
08:50 - IVL vs. Atherectomy
11:54 - BTK Reality and Future
14:44 - When IVL Is Not Ideal
16:05 - Catheters and Setup Basics
17:50 - Sizing and Technique Tips
23:01 - Javelin Forward Emitter
26:25 - 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 RCT
https://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

Ep. 633 Pelvic Venous Disease: Causes, Symptoms and Treatments with Dr. Deepak Sudheendra Apr 10, 2026

Show notes

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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Timestamps

00:00 - Introduction
01:43 - PVD Demand at Penn
06:42 - Approach & Algorithm
12:08 - Variation in Iliac Vein Compression
15:58 - Treatment Approaches
19:20 - Important Ultrasounds
22:15 - Intra-Procedural Workflow
31:14 - Iliac Vein Stenting and Avoiding Complications
36:31 - Gonadal Vein Embolization and Working with Patients
42:20 - 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

Ep. 631 Advancements in Carotid Stenting with Dr. Adnan Siddiqui Apr 07, 2026

Show notes

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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This podcast is supported by

Terumo
https://www.terumois.com/

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Timestamps

00:00 - Introduction
02:48 - From Aspirin to Endarterectomy
03:47 - Rise of Carotid Stenting
06:46 - CREST-2 and CMS Coverage
09:57 - Management of Severe Asymptomatic Carotid Stenosis
15:35 - New Stent Designs Explained
17:56 - Five Tips for New Operators
20:08 - Case Selection Algorithm
22:04 - Learning Curve and Mentorship
28:27 - What’s Next: IVL and Outpatient
31:24 - Managing Complications Safely
35:05 - 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 profile
https://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

Ep. 630 Trauma Embolization Techniques Using Vascular Plugs with Dr. Nima Kokabi, Dr. Brian Funaki, and Dr. Alex Villalobos Apr 03, 2026

Show notes

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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This podcast is supported by

Okami Medical
https://okamimedical.com/

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Timestamps

00:00 - Introduction
01:24 - Trauma Activation Workflow
06:42 - Empiric Arterial Embolization Indications
10:40 - Embolic Agent Preferences and Value Analysis
17:18 - Embolics on the Shelf
19:32 - LOBO Plug Use Cases
20:58 - Case 1: Abdominal Wall Hematoma
23:54 - LOBO Advantages, Cost, and Microcatheter Compatibility
26:33 - Alternative Access Approaches
30:31 - LOBO Sizing and Trackability
35:26 - Pusher Wire Features
38:20 - Delivery Catheter Requirements
43:41 - Case 2: Retroperitoneal Bleed
45:15 - LOBO Deployment Technique
49:41 - Case 3: Splenic Trauma
53:51 - Occlusion Time and Adjunct Embolics
57:07 - 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.

Ep. 629 Optimizing Prostate Treatment with Embolization Strategies with Dr. Art Rastinehad and Dr. Don Garbett Mar 31, 2026

Show notes

From consult to catheter, success in prostate artery embolization is shaped by a series of decisions that directly impact patient outcomes. In the third installment of our 2026 PAE University series, Dr. Chris Beck is joined again by Dr. Art Rastinehad and Dr. Don Garbett to discuss patient selection, procedural strategies, and practical case-based learnings in prostate artery embolization.

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This podcast is supported by an educational grant from Guerbet.

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Timestamps

00:00 - Introduction
03:33 - Typical Referrals and Patient Workup
06:08 - Prostate Sizes and Bladder Necks
12:33 - Radial Versus Femoral Access
16:38 - Ipsilateral Crossing Techniques
17:02 - Preferred Microcatheters
20:32 - Troubleshooting Techniques with Microwires
22:35 - Intra-arterial Medications and Checkpoints
26:01 - Protecting Penile Collaterals
29:47 - Evolution of PAE Technique
32:20 - Liquid Embolics and Dilution Strategies
37:48 - Bead Sizing Considerations
39:59 - Managing Symptoms Post-PAE
48:33 - Repeat PAE Procedures
52:49 - Managing No-Flow After Injection
57:06 - Case Studies

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More about this episode

The discussion begins with consultation frameworks, focusing on imaging modalities and symptom scoring systems used to determine candidacy for PAE. Scenarios in which PAE may be less suitable, such as patients with high bladder neck anatomy, are also addressed alongside alternative management considerations. The conversation then transitions to procedural planning, including arterial access (radial versus femoral), workflow efficiencies to reduce operator fatigue, and preferred device selection such as microcatheters, microwires, and adjunctive vasodilators.
Technical challenges encountered during PAE are explored in detail, including management of collateral vessels and avoidance of non-target embolization through techniques such as coil protection and flow modulation. The role of liquid embolics is also discussed, with emphasis on dilution strategies that vary based on operator technique. Post-procedural care is then reviewed, including assessment of symptom response, expectations for clinical outcomes, and criteria for repeat embolization in select patients.

The episode concludes with three case studies highlighting procedural decision-making in complex scenarios, emphasizing recognition of anatomic variants and strategies to address intra-procedural challenges.

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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

Ep. 628 Techniques for Managing Biliary Drain Complications with Dr. Ahsun Riaz Mar 27, 2026

Show notes

Patients and IRs alike dread the persistent cycles of malfunction and repeated procedures that often accompany biliary drains. What can you do to keep patients off the doorstep of reintervention? In this episode of the BackTable Podcast, Dr. Ahsun Riaz of Northwestern Medicine joins host Dr. Michael Barraza to walk through strategies for preventing and managing complications of percutaneous biliary drain placement.

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Timestamps

00:00 - Introduction
01:51 - Complication Rates and Associated Factors
06:09 - PTC in Non-Dilated Biliary Systems
11:00 - Techniques for Access and Drain Placement
15:10 - Drain Flushing, Capping, and Ideal Positioning
17:48 - External versus Internal-External Biliary Drains
20:42 - Managing Pericatheter Leakage
23:01 - Life Expectancy and Stenting Malignant Strictures
26:32 - Tract Maturation and Minimizing Access Sites
28:56 - Addressing Unresolving Hyperbilirubinemia
34:52 - Managing Bloody Drain Output
38:12 - Approach to Dislodged Drains
39:40 - Drain-Associated Pain and Exchange Timing
42:49 - Strategy for Benign Biliary Strictures
45:18 - Final Thoughts and Closing Remarks

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More about this episode

The discussion begins with a look at the data on biliary drain-related adverse events, emphasizing the need to bring down the high rates of complications that may take a toll on patients' quality of life. Dr. Riaz stresses the importance of employing techniques at initial drain placement, such as placing left-sided drains where appropriate and minimizing biliary pressure buildup, to reduce the starting risk of malfunction. The physicians go on to share their algorithms for approaching various scenarios, from pericatheter leakage and drain dislodgement to unresolving hyperbilirubinemia, pointing out the factors and observations that should influence treatment approaches during planning and intraprocedurally. Finally, the physicians address the evolving landscape of long-term biliary management, assessing potential drainage strategies as survival rates improve in hepatobiliary malignancies, and underscore the critical importance of collaboration with gastroenterologists and surgeons to ensure cohesive, goals-of-care-centered management.

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Resources

Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis
https://doi.org/10.1016/j.jvir.2024.12.022

Ep. 627 Radial Access for Peripheral Interventions: Techniques & Considerations with Dr. Shailendra Singh Mar 24, 2026

Show notes

Radial roots, peripheral reach! Radial to peripheral (R2P) access is the focus of this week’s episode with interventional cardiologist Dr. Shailendra Singh (Pennsylvania’s Lehigh Valley Heart and Vascular Institute) and dual hosts Hady Lichaa and Sameh Sayfo. The conversation focuses on key techniques, pre-procedure planning and imaging, and ideal case selection for those new to the R2P approach.

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This podcast is supported by

Terumo

https://www.terumois.com/

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Timestamps

00:00 - Introduction
04:42 - Radial-to-Peripheral: Right vs Left Radial
10:18 - Ultrasound and Pedal Access Applications
17:10 - Ideal Cases When Starting Radial to Peripheral
25:59 - Impactful Radial Success Stories
29:38 - Managing Radial Spasm
35:22 - Left Radial Workflow
42:00 - Shelf Setup Essentials
48:43 - Renal Mesenteric Access
55:37 - Safe Sheath Removal
01:01:10 - Training and Courses
01:04:48 - Closing Thoughts

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More about this episode

Dr. Singh shares how he began incorporating radial-to-peripheral procedures into his practice after fellowship and how his experience with radial coronary access translated naturally to peripheral interventions. The group reviews access strategy, including right versus left radial selection, along with techniques for preventing and managing radial spasm. They also touch on staff workflow and training when introducing R2P into the lab. The episode closes with practical insights on case selection for operators new to the approach, the role of pedal access in selected CTO cases, and strategies for safe sheath removal and hemostasis.

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Resources

Dr. Shailendra Singh’s Provider Profile
https://www.lvhn.org/doctors/shailendra-singh

Dr. Sameh Sayfo’s Provider Profile
https://www.bswhealth.com/physician/sameh-sayf

Dr. Hady Lichaa’s Provider Profile
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

Ep. 626 Single Stick Vascular Access: Techniques & Benefits Explained with Dr. Kevin Wong Mar 20, 2026

Show notes

With the single-stick technique proving to be an effective addition to the venous line placement toolkit, what is stopping IRs from venturing beyond the traditional dual-incision approach? In this episode of the BackTable Podcast, pediatric interventional radiologist Dr. Kevin Wong of USA Health joins host Dr. Ally Baheti to review the single-stick technique for central venous access, a method widely utilized in pediatric practice.

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Timestamps

00:00 - Introduction
01:35 - Origins of Single-Stick Access
03:10 - Setup and Bending the Needle
07:17 - Tunneling to the IJ
10:06 - Line Positioning and Measurement
14:45 - Wire Handling Considerations
18:55 - Clinical Advantages of Single-Stick Access
21:27 - Femoral Single-Stick Tips
23:41 - Common Mistakes and Pitfalls
27:39 - Needle-Free Lidocaine Administration
30:48 - Closing Remarks

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More about this episode

Delving into the origins, technical nuances, and clinical advantages, the physicians explore how the single-stick technique can reduce the risk of infection and minimize interference with other lines and tubing to improve patient care. The discussion provides a detailed technical breakdown of the procedure, offering a masterclass on navigating the curves up the neck as well as the equipment selection and sizing necessary to facilitate the process. With the aid of visual slides and demonstrations, Dr. Wong steps us through the specifics of bending the access needle, maneuvering tools to adapt to anatomical configurations, and handling ultrasound movement to confirm and maintain a safe trajectory throughout the procedure. The conversation emphasizes the tactile “feel” and attention to forces acting on the wire that are required to appropriately position the catheter.
Recognizing the logistical constraints that make it challenging for attendings to regularly adopt alternative procedural techniques, this episode serves as an accessible primer for clinicians looking to broaden their options for venous access with this effective, patient-centric technique.

Ep. 625 Managing Acute Arterial Thrombosis: Devices & Approaches with Dr. Shang Loh and Dr. Khanjan Nagarsheth Mar 17, 2026

Show notes

The advent of newer thrombectomy devices has turned what were once hours-long surgical cutdowns into endovascular cases that last under an hour. In this episode of BackTable, host Dr. Sabeen Dhand is joined by Dr. Shang Loh from the University of Pennsylvania and Dr. Khanjan Nagarsheth from the University of Maryland to discuss the evolution of arterial thrombectomy devices and modern techniques for acute arterial occlusions.

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This podcast is supported by:

Inari Medical
https://www.inarimedical.com/artix-system

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SYNPOSIS

The episode highlights major technological advancements over the past decade, including the development of mechanical and computer-assisted thrombectomy systems. The physicians review key features of newer devices, such as the ability to combine aspiration with stent retrievers, the use of PTFE baskets to reduce distal embolization, and the advantage of maintaining wire access throughout the case.

They share strategies for managing specific cases, including acute femoral-popliteal occlusions with distal reconstitution, intraoperative ischemic pain due to flow arrest, trauma-related thrombosis, and cases complicated by extensive calcification and chronic vascular disease. As vascular surgeons, they also discuss the ongoing role of open approaches, outlining when surgical cutdown is indicated and where they prefer endovascular first. The conversation further explores challenges such as acute limb ischemia, stent thrombosis, and visceral artery thrombosis, emphasizing the importance of staying current with rapidly evolving technologies to improve procedural efficiency and patient outcomes.

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TIMESTAMPS

00:00 - Introduction
02:04 - Evolution of Arterial Thrombosis Treatment
04:11 - New Devices and Techniques
10:42 - Case Studies and Practical Applications
24:26 - Techniques and Devices for Thrombectomy
25:33 - Managing Flow and Patient Safety
27:25 - Surgical vs. Endovascular Approaches
29:25 - Dealing with Complications and Failures
37:50 - Visceral Thrombosis and Advanced Techniques
41:09 - Future of Thrombectomy Devices
44:27 - Closing Remarks

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