Tad Maguire

@ChengaziMD Thanks man! This is definitely something you can learn and apply. Did this w/ SI-Bone iFuse Torq screws, take a look at their stuff. They have great clinical support and easy to see how to translate their system for fracture stabilization

@IRtmke That’s amazing work man, really threading a needle with those screws - this is a skill I wish I had

Elderly pt, previously ambulatory, admitted w/ intractable pain following a fall. Bedridden, immobilized, requiring IV narcotics. Unable to work with PT/OT. +SIJ provocative tests. Complex sacral fx, spanning Denis zones 1-3 out to SI joints, with areas of offset and impaction.

@BobTahara @ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass Personally think there’s a sweet spot for patient care in community systems that are big enough to have the resources but small enough for collegiality and collaboration to prevail over egos and turf. Thats a tide that raises all ships

@BobTahara @ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass Rural wasn’t really the operative word. I work in a rural setting, so I see rural patients & that’s where they have gotten the bulk of their historic care. Some great, thorough and thoughtful care, some not so much. Same as anywhere else.

Sometimes crossing chronic occlusions from above can facilitate finding the true lumen. Groin approach here found every collateral, switching ti jug saved time and radiation

@BobTahara @ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass 😂 been there

@IRtmke @ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass Treat not test ! Sorry my fingers and Apple autocorrect are wreaking havoc today

@BobTahara @ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass But I’ve also yet to see isolated florid GV reflux in the scenario you’re describing. I’ve seen to/fro flow & antegrade flow when it’s the site of escape. If you have that’s really interesting, definitely still learning about this spectrum of disease

@BobTahara @ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass It’s definitely a trickier w/u in some patients. In my practice I’ve more often seen the opposite unfortunately, iliac stents placed hastily out in rural cath labs that made pts no better, without an assessment for GV reflux. Those probably didn’t get IVUS either to your point.

@IR_Doctor @douglakemd Yeh it’s a decent screening tool. No idea how much we pay for it. We’re updating to something that will alert on suspicion for more acute findings. Out here helping train SkyNet

@IR_Doctor @douglakemd We use Riverain for the past year or so. Added to McKesson. It’s ok, the volumetrics are nice. Best part is hilar region stuff that hides in the vasculature. But fooled by mucous plugs and motion, frequently misses legit nodules even a humble needle jockey like myself can find.

All I want, is a PACS that will automatically load and sync the prior lung nodule/screening CT to current study and highlight the nodules. Automatic nodule measurement (volume calc best) even better.

@BobTahara @ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass But if gonadal is the route of pelvic egress, you won’t see reflux, you’ll see opposite. Wouldn’t embo in that case. Sx often tell what the main problem is. Have seen several GV insufficiency pts have what appeared to be a CIV stenosis on imaging that was not symptomatic

@ChengaziMD @IRtmke @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass Again, I would decompress the iliac first. The gonadal often acts as a decompressive pathway and I have seen too many get worse if you don’t treat the obstructive lesion first. I stent and then give it a few months to settle down and re-equitable before considering GVE

@dougbeall In reading through this my mind can only go one place.

In an obvious contrarian hit-piece article osteonsibly to decrease utilization/cost, BMJ uses selective science to badmouth proven spine procedures &refer to the following as "experts" : non-medical personnel 6, Int Med 4, students 2, PT 1. No surgeons, 1 pain doc...no experts

Recent onset nightly rest pain w/o tissue loss or discoloration. Focal calcific popliteal occlusion. 014 crossing through tiny channel, 2 mm PTA, 5 mm shockwave, 6 mm PTA/DCB at nominal. Sx resolved. Tibial/pedal stenoses not touched in absence of wound. Cont followup

@IR_Doctor @radfugee The pending Senate budget proposal reportedly has defense cuts though. So we’ll see 🤷

@IRtmke @radfugee Uggh indeed

If I understand things correctly, the US arms industry stands to continue to benefit from increasing European aid to Ukraine, while the Trump administration takes credit for cost shifting from American taxpayers to Europeans. I’m not saying I agree with their tactics and the overall strategy of disentanglement, but this could be a plus in some ways, I suppose. Just thinking out loud here.

@IR_Doctor @radfugee MIC is not being pruned in the slightest unfortunately. House budget passed for 2026, understood to be dictated by Trump’s priorities, increases defense spending $100B. It will just go to clearing land for Trump Gaza Hotel/Casino, rather than helping Europe

@radfugee MIC could use some pruning, I reckon. Defense budget so big. That’s where DOGE should be looking.

🔵Endovascular Iliocaval Reconstruction #VenousEd

@ReneLizola Very nice, had you just coiled the gonadal there? I feel like I see this and other odd renal vein collaterals pretty often in cases of gonadal vein insufficiency

⭕️ Circumaortic renal vein 🤩 #VenousEd

@ChengaziMD @ReneLizola @TobyRichardsUEL @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @Dr_Sudi @kmadass

@IRtmke @ReneLizola @TobyRichardsUEL @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @Dr_Sudi @kmadass Agreed on mechanical advantage. Regarding stenting sometimes I’ll stent CIV from below, then work backwards from neck to land inferior stents. Allows precise top and bottom stent placement, with overlaps in between

@ReneLizola @ChengaziMD @TobyRichardsUEL @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @Dr_Sudi @kmadass No way to ever know but I always start groin for the mechanical advantage when pushing and I prefer to deliver stents from below anyway to get the leading edge landed well

@ChengaziMD @TobyRichardsUEL @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @Dr_Sudi @kmadass Thanks for sharing! More and more, I find useful & time-efficient to poke from above + from below, and one will help me cross. What I haven't found yet, is a way to reliably predict which will be the winner. Thoughts?

@ChengaziMD @TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass Not a matter of “if.” Seen him make the same obnoxious nitpicky comment several times. I usually treat based on the most severe symptoms, in my experience that’s more often been the gonadal vein first and followup

@TobyRichardsUEL @Dr_Sudi @CHICKVIR @VenousForum @_backtable @keithppereira @LessneVIR @IR_Doctor @iRadRock @kmadass Ok NIVL also with gonadal venous reflux… if we’re being pedantic.