Not every patient benefits from every intervention. And knowing when to say no is just as important as knowing how to proceed. Most of us have been in that position - weighing technical feasibility against everything that doesn’t show up on imaging or in guidelines. We get into this in this week’s episode. Listen to the full conversation in collaboration with The BackTable Podcast and Dr. Sabeen Dhand. Check out our channel now!

This week's collaborative episode features a conversation between BackTable and us, exploring how no-option limb-threatening ischemia has pushed clinicians to rethink clinical decision-making and how they learn from one another in practice. We join Dr. Sabeen Dhand to discuss the origins of BackTable, the loss of physician voice within institutional medicine, and why peer-driven platforms have become essential for advancing complex peripheral and limb salvage care. The conversation then moves into a detailed, experience-driven discussion of deep venous arterialization, including how early failures, unintended outcomes, repetition, and long-term follow-up shaped modern DVA techniques. Throughout the episode, the focus remains on responsibility to no-option patients, international collaboration, and how practical advances in limb salvage have emerged through shared clinical experience. 04:20 Losing professional voice inside institutional medicine 09:43 How BackTable and Life of Flow were built around peer learning 13:05 Why deep venous arterialization became necessary 14:12 Hitting the limits of conventional revascularization 18:32 The unintended anastomosis that changed everything 20:11 Long-term patient outcomes that reshaped clinical direction 25:06 Community-driven innovation and shared problem solving 33:00 How repetition and follow-up refined technique and outcomes 51:36 Defining poor candidates and the limits of DVA Who Should Listen This episode is relevant for vascular surgeons, interventional radiologists, and clinicians managing advanced limb-threatening ischemia, as well as physicians interested in how peer-led platforms, informal collaboration, and real-world iteration influence modern procedural innovation. About Dr. Sabeen Dhand .Dr. Sabeen Dhand is an interventional radiologist who completed his fellowship at Northwestern and currently practices at PIH Health in Los Angeles. His clinical work focuses on limb salvage, aortic aneurysms, and neurovascular disease, including stroke. In this episode, Dr. Dhand shares why he built BackTable, the challenges of maintaining professional autonomy within institutions, and how physician-led platforms support practical learning and collaboration across specialties. Connect with Sabeen 📲 Instagram: @thebeenx About BackTable BackTable is a physician-led podcast platform created to help practicing clinicians stay current as the medical repertoire continues to expand. The platform focuses on sharing practical insight on conditions, procedures, and practice-building topics through peer-to-peer discussion rather than institutional filters. BackTable provides a space where physicians learn directly from colleagues and experts actively working in the field, reflecting how clinical knowledge is often exchanged in real practice. Explore BackTable 🌐 Website: backtable.com 📲 Instagram: @backtableind 🐦 X: @backtable ▶️ YouTube: @_backtable Follow Life of Flow 📲 Instagram: @LifeofFlowPodcast 👍 Facebook: Life of Flow Podcast 💼 LinkedIn: Life of Flow Podcast 🐦 X: @VascularPodcast If this episode helped clarify how no-option patients are reshaping limb salvage and procedural innovation, consider sharing it with a colleague. A review also helps others find conversations grounded in real-world clinical practice.

This week’s episode features Dr. John H. Rundback, Director of the Interventional Institute at Holy Name Medical Center and one of the most experienced voices in complex peripheral work. Dr. Rundback joins Miguel and Lucas for a grounded conversation on how below-the-knee disease has changed, why operators rely on different tools and access strategies today, and what the AMBITION BTK clinical trial aims to clarify about treating BTK patients. Along the way, he shares insights shaped by decades of clinical practice, research leadership, and his role in major multicenter studies. This episode follows Dr. John Rundback’s perspective on BTK disease and how new tools and techniques shape everyday decision-making. 03:09 How BTK and below-the-ankle disease differ from proximal disease 05:28 What pushed operators toward atherectomy in BTK care 06:56 Introducing AngioDynamics and the AMBITION BTK trial 10:49 How the Auryon laser works and what makes it different 14:44 Why early results led to launching the AMBITION BTK study 20:06 How high-volume operators identify meaningful patterns early 23:28 Tips and workflow for using the Auryon laser below the knee 29:12 Why Miguel now uses primary pedal access in many BTK cases 37:30 How the AMBITION BTK trial uses a hierarchical win-ratio endpoint Who Should Listen This episode is relevant for clinicians who treat below-the-knee disease, early-career physicians interested in real-world atherectomy decision making, and professionals involved in device evaluation, trial design, and BTK care pathways. About John H. Rundback, MD John H. Rundback, MD, is a renowned interventional radiologist in practice since 1993 and is the Director of the Interventional Institute at Holy Name Medical Center. He is board-certified in radiology and holds a Certificate of Added Qualification in Angiography and Interventional Radiology. He has been named as a Top Doctor by Castle Connolly. Dr. Rundback's research interests include peripheral arterial, carotid, and aortic aneurysmal disease, deep venous thrombosis and varicose veins, as well as state-of-the-art minimally invasive cancer therapies, and he is the principal investigator on a number of multi-center trials. He has presented at more than 200 conferences and is the program chairman for his own peripheral arterial disease symposium. He has served as an editor and reviewer for peer-reviewed medical journals and has published over 100 articles. Dr. Rundback is a past member of the Board of Directors of the Society of Interventional Radiology Foundation and Founding Chair for the Foundation's Cooperative Alliance for Interventional Research Clinical Trials Network. At Holy Name, he serves on the Patient Safety Committee, the Cancer Committee and the Credentialing Committee. Dr. Rundback earned his medical degree from SUNY Downstate Medical Center, after which he completed his internship at St. Vincent's Hospital and Medical Center, New York, N.Y. He completed his diagnostic radiology residency at Beth Israel Medical Center, New York, N.Y., where he also served as chief resident, and completed his fellowship in interventional radiology at Washington Hospital Center, Washington, D.C. Connect with John 💼 LinkedIn: John H. Rundback, MD About AngioDynamics Established in 1988, as a division of E-Z-EM, AngioDynamics is a company with a rich history that’s defined by its innovation and growth as a committed medical community partner with a focus on developing high-quality medical devices that improve patient outcomes. The company’s commitment to advancing medical solutions has established a strong presence in key healthcare markets worldwide. Through strategic partnerships, distribution networks, and a diverse product portfolio, AngioDynamics continues to contribute to the improvement of patient outcomes on a global scale. AngioDynamics has a notable global presence, with worldwide operations. Learn more about Angiodynamics and the Auryon System 🌐 Websites: angiodynamics.com & auryon-system.com Follow Life of Flow 📲 Instagram: @LifeofFlowPodcast 👍 Facebook: Life of Flow Podcast 💼 LinkedIn: Life of Flow Podcast 🐦 X: @VascularPodcast If this episode gave you a clearer view of BTK care, share it with someone who’d value it. And if you’re enjoying Life of Flow, a quick review helps others find conversations like this!