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  • Ep. 684 Understanding Hemorrhoid Artery Embolization Techniques with Dr. Kristen Rumer and Dr. Scott Thompson

    Ep. 684 Understanding Hemorrhoid Artery Embolization Techniques with Dr. Kristen Rumer and Dr. Scott Thompson
    Oct 16 2026
    Which patients with bleeding hemorrhoids benefit from artery embolization, and who should go to surgery instead? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Kristen Rumer and Dr. Scott Thompson of Mayo Clinic to break down patient selection, technique, and follow-up for hemorrhoid artery embolization (HAE) at a major academic center. They explain why bleeding-predominant, Goligher grade II and III internal hemorrhoids are the best candidates, and how the technique has evolved from its origins in France to routine practice in the US. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Terumohttps://www.terumois.com/haepodcast --- Timestamps 00:00 - Introduction03:33 - Surgical Options and Recovery07:31 - Ideal Candidates for Embolization10:47 - HEMORR1 Trial Design and Embolics15:37 - Arterial Anatomy and Coil Technique19:53 - Collaboration with Colorectal Surgery24:18 - Pelvic Pain and Patient Selection28:48 - Scalability and Contraindications32:02 - Recurrence and Collateral Supply35:27 - Patient Goals and Expectations37:37 - Closing Remarks --- More about this episode The conversation covers advanced imaging, embolic selection, coil technique, and complication management. Dr. Thompson details the HEMORR1 trial protocol, including photon counting CTA, large spherical particles, and careful coil packing. Dr. Rumer discusses a bidirectional referral pathway and the unmet need for embolization options in anticoagulated and immunosuppressed patients. The episode closes with pearls for avoiding recurrence, managing chronic pelvic pain, and setting realistic expectations so patients understand what success means after HAE. --- Resources Mayo Clinic: Hemorrhoidal Embolization Trial (HEMORR1)https://www.mayo.edu/research/clinical-trials/cls-20556753 Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease (Vidal technique)https://pubmed.ncbi.nlm.nih.gov/35781988/ Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques (RadioGraphics)https://pubs.rsna.org/doi/full/10.1148/rg.220014 Is the Goligher Classification a Valid Tool in Clinical Practice and Research for Hemorrhoidal Disease?https://link.springer.com/article/10.1007/s10151-022-02591-3 Scott M. Thompson, M.D., Ph.D., Mayo Clinichttps://www.mayoclinic.org/biographies/thompson-scott-m-m-d-ph-d/bio-20535376 Kristy K. Rumer, M.D., Ph.D., Mayo Clinichttps://www.mayoclinic.org/biographies/rumer-kristy-k-m-d-ph-d/bio-20519891 --- 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
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    40 Min.
  • Ep. 682 Liquid Embolization Techniques for Treating Hypervascular Tumors with Dr. Resmi Charalel and Dr. Milan Patel

    Ep. 682 Liquid Embolization Techniques for Treating Hypervascular Tumors with Dr. Resmi Charalel and Dr. Milan Patel
    Oct 9 2026
    How do you devascularize a hypervascular tumor when the vessels feeding it are too small to catheterize? On this episode of BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Resmi Charalel and Dr. Milan Patel to walk through seven real-world cases where non-adhesive hydrogel liquid embolics made the difference. They break down patient selection, case planning, and how to deploy these agents for safe, efficient devascularization when traditional approaches fall short. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Instyllahttps://instylla.com/embrace/ --- Timestamps 00:00 - Introduction02:23 - Liquid Embolic Use in Practice04:46 - Case 1: Renal Mass07:51 - Delivery Technique and Target Vessel Size13:08 - Device Setup and Catheter Compatibility21:57 - Case 2: Multifocal HCC27:44 - Case 3: Large Renal Tumor40:21 - Randomized Trial Outcomes43:28 - Case 4: HCC Near the Gallbladder49:39 - Case 5: Pelvic Tumor and Femoral Metastases55:30 - Lessons from Early Use and Case Selection1:01:37 - Case 6: Breast Cancer Liver Metastasis1:05:23 - Closing Remarks --- More about this episode The discussion reviews seven real-world cases, from renal and liver tumors to pelvic, bone, and breast metastases, sharing practical pearls on microcatheter selection, plug formation, controlled reflux, and navigating high-flow environments and multiple vessels. They dive into troubleshooting pitfalls like loose connections and procedural waste, the real learning curve for adopting liquid embolics, and the outcomes data that support broader adoption of these techniques. The episode closes with advice for early-career operators and a look at future directions for patients who are not candidates for other embolic therapies. --- Resources Instylla HES Hypervascular Tumor Pivotal Study (NCT04523350)https://clinicaltrials.gov/study/NCT04523350 Abi-Jaoudeh N, et al. Multicenter Randomized Trial Evaluating the Safety and Effectiveness of the Instylla Hydrogel Embolic System for Vascular Occlusion of Hypervascular Tumors. J Vasc Interv Radiol. 2026https://doi.org/10.1016/j.jvir.2026.108946 Ganguli S, Lareau R, et al. A Water-Based Liquid Embolic: Evaluation of its Safety and Efficacy in a Rabbit Kidney Model. J Vasc Interv Radiol. 2021https://doi.org/10.1016/j.jvir.2021.02.018 HALT: Embrace Hydrogel Embolic System Study of Embolization in Peripheral Arterial Bleeds (NCT05364502)https://clinicaltrials.gov/study/NCT05364502 Kim GH, et al. Effectiveness and Safety of Transarterial Radioembolization Following Inferior Phrenic Artery Glue Embolization for Flow Redistribution in Hepatocellular Carcinoma. J Vasc Interv Radiol. 2026https://doi.org/10.1016/j.jvir.2026.108784 Dr. Resmi Charalel, Montefiore Einsteinhttps://doctors.montefioreeinstein.org/providers/1558653980/resmi-charalel Dr. Milan Patel, MD Anderson Cancer Centerhttps://faculty.mdanderson.org/profiles/milan_patel.html Dr. Kavi Krishnasamy, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-venkatesh-krishnasamy --- 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
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    1 Std. und 9 Min.