Hesham H Malik

@ChengaziMD @pparikhxr @keithppereira @BeauToskichMD @t_intheleadcoat @drochohan @IRKhalsa @_backtable @kmadass @DonGarbettMD @SDhandMD If all of those afferent veins communicate with the shunt, coiling them at the inflow doesn’t really help imho as new afferents hypertrophy over time (short gastric, posterior gastric etc)

@NoLimitIR @pparikhxr @keithppereira @BeauToskichMD @t_intheleadcoat @drochohan @IRKhalsa @_backtable @kmadass @DonGarbettMD @SDhandMD Yes I got you, can see the massive outflow on the delayed venogram, and I considered. Will often do combo RTO and antegrade approach.

3 varices, 3 different embolics. Same patient. How do you plan/decide?

@ChengaziMD @pparikhxr @keithppereira @BeauToskichMD @t_intheleadcoat @drochohan @IRKhalsa @_backtable @kmadass @DonGarbettMD @SDhandMD Just to clarify, I meant would consider RTO for the gastrorenal shunt.

@NoLimitIR @pparikhxr @keithppereira @BeauToskichMD @t_intheleadcoat @drochohan @IRKhalsa @_backtable @kmadass @DonGarbettMD @SDhandMD Flow was brisk, encephalopathy improved despite TIPS - but follow up CT planned. I’ll be sure to tag you with an update.

@SDhandMD @ChengaziMD @IRKhalsa @iRadRock @keithppereira @karananandpara @AmputationSuck @kmadass @_backtable @t_intheleadcoat @IR_Doctor With the first pair of coils, detach one first, keep the other deployed but not detached. This way, coil#3 can be advanced into the initial coil pack to minimize risk of en masse migration of coil, and continue alternate deploy/detach until satisfied.

@NoLimitIR @ChengaziMD @IRKhalsa @iRadRock @keithppereira @karananandpara @AmputationSuck @kmadass @_backtable @t_intheleadcoat @IR_Doctor Loving this idea — how do you still prevent miigration of the first couple coils deployed — it’ll be high flow until inflow / outflow addresssed right?

Everyone loves the perfect angio shot But there’s lots to learn when things don’t go as planned Embo for high flow intrahepatic shunt>coil flies off>balloon trapped coil>snared in IVC>embo completed Crisis averted, case salvaged. How would you approach this case/complication?

@ChengaziMD @IRKhalsa @iRadRock @SDhandMD @keithppereira @karananandpara @AmputationSuck @kmadass @_backtable @t_intheleadcoat @IR_Doctor The second microcatheter would be tandem through the sheath (alongside base catheter). Disadvantage is relative lack of forward pushability but can be done. Nonetheless great result!

@NoLimitIR @IRKhalsa @iRadRock @SDhandMD @keithppereira @karananandpara @AmputationSuck @kmadass @_backtable @t_intheleadcoat @IR_Doctor Another great idea. Only got across with a 4F glide Cath and lost access when trying to exchange for larger Cath/sheath. After reselection, can’t fit 2micro through glidecath simultaneously - but a good thought for future cases

@IRKhalsa @SIRspecialists @SIRRFS @SIR_ECS @_backtable @SDhandMD @TheRealDoctorOs @thegestgroup PATO/CATO with STS lipiodol foam.

Holy hemorrhoids … refractory hemorrhoidal variceal bleed. Post TIPS. Any embolic preferences?

@ChengaziMD @SDhandMD @karananandpara @keithppereira @_backtable @t_intheleadcoat @Pandarock5 @DonGarbettMD @iRadRock @IRKhalsa @TheRealDoctorOs And this was all without ICE

@ChengaziMD @SDhandMD @karananandpara @keithppereira @_backtable @t_intheleadcoat @Pandarock5 @DonGarbettMD @iRadRock @IRKhalsa @TheRealDoctorOs Impressive no doubt and I’m sure ICE has really helped overcome the challenges. But IMO should only chase such times to an extent. From my perspective, it wasn’t necessary after requisite experience. 5-10 min fluoro times were quite routine as were 16-30 min procedure times.

A little hiccup at MHV selection on this one, but 19 mins from groin puncture to final pressure. 17m from IJ to Pressure. Is a 15 minute TIPS possible?

@ChengaziMD @SDhandMD @kmadass @keithppereira @IR_Doctor @TheRealDoctorOs @_backtable @t_intheleadcoat @linemonkeymd @IRKhalsa @iRadRock Harris you will continue to do great with this ethos. I just pray that IRs like you don’t fall victim to DR chairmen pulling rank to curry favor with other hospital services. I’m not speaking from experience at all ……

Value of clinical #VIRad - consulted for chole tube placement - ended up reinterpreting imaging, tying together complex pathophys, and chiming in on multiple problems with a breadth not many other specialties can. This is why I love my specialty. #livertwitter #medtwitter

@ChengaziMD @Rishabh2970 @NevdeK @TheRealDoctorOs @_backtable @t_intheleadcoat @kmadass @RajWellnessMD @MoonJustaniah @IRKhalsa @keithppereira Would be good to see if redirection of flow is enough to decompress the duodenal varices. This may not always happen as the varices serve as conduit for occluded mesenteic veins.

@ChengaziMD @Rishabh2970 @NevdeK @TheRealDoctorOs @_backtable @t_intheleadcoat @kmadass @RajWellnessMD @MoonJustaniah @IRKhalsa @keithppereira Nice case. The shortest viatorr is 4 cm covered which would inevitably cover some unintended branches but a good use in this palliative scenario.

#mesocaval shunt was popular, another 4DCT case Invasive Pancreatic ca, recurrent duodenal GIB. Pt couldn’t be discharged for chemo. Mesocaval shunt allowed for safe discharge and chemotherapy (tolerating well). Blunt Hawkins allowed navigation around stomach/mesentery. #chogazi

@IR_Doctor @IRKhalsa @linemonkeymd @t_intheleadcoat @SDhandMD @shamitsdesai @keithppereira @TheRealDoctorOs Sexually active

@NoLimitIR @IRKhalsa @linemonkeymd @t_intheleadcoat @SDhandMD @shamitsdesai @keithppereira @TheRealDoctorOs Same. Now define "younger." :)

Intraprostatic collateral to IPA. Do you coil or flow redirect?

Are you looking for a minimally invasive procedure to treat your BPH? Consider PAE: prostate artery embolization. hubs.la/Q03d6Rqp0 #BPH

@iRadPulse @JVIRmedia How does using an ultrasound machine reduce hospital stay by a day?

1/6 🚨 IVUS-guided TIPS reduced hospital stays by nearly a day but led to a net cost increase of $1,484.96 per case 📉 Check out this new study from @JVIRmedia comparing IVUS-guided vs non-IVUS-guided TIPS!👇 #TIPS #Hepatology #InterventionalRadiology

Join us for a Happy Hour hosted by IR Centers during the Annual @SIRspecialists Meeting! 🗓 When: March 31st at 6:00 PM 📍 Where: Harriet’s Rooftop, #Nashville Mingle with fellow physicians, residents, and fellows, and connect with the #IRCenters team. Learn how we’re shaping the future of healthcare through innovation and collaboration. This is your chance to relax, network, and discover our mission to revolutionize interventional radiology and beyond! 👉 RSVP is mandatory for tickets. Secure your spot now: forms.gle/8ZTtHeP9s9BC5M… Space is limited, so RSVP today! You will get a confirmation email when the guest list is finalized as well. We can’t wait to see you there! @SIRRFS @IR_SchwartzMD @AbinSajanMD @AriIsaacsonMD @AlexPavidapha @marcus8j @NoLimitIR @SuiteLifeofIR @DonGarbettMD @SIR_ECS @bonesz @RajNarayanan67 @pryce227 @riadsalemIR @SamMouli @brianswongmd @UsaProstate @IRcenters

Changing the future of #Irad ⁦@SIRRFS⁩ ⁦@SIRspecialists⁩ ⁦@AriIsaacsonMD⁩ ⁦@AlexPavidapha⁩ ⁦@NoLimitIR⁩ ⁦@UsaProstate⁩ ⁦@IRcenters⁩ linkedin.com/posts/sandeep-…

@northwoods1980 The thorax is dislocated from the humerus

@JamesNNY1 @dr_cellini @JamesNNY1 you say you are some PD as if that was some amazing accomplishment. If you are blind to what’s happening in IR, you are the problem bud. Why don’t you take the lead since you are a director? Are you training people to smell roses or practice conscientious medicine?!

@dr_cellini Wow. As a residency PD we need better ability to identify doctors like this and NOT pick them. I wonder who was just after you on the rank list. You wasted a training slot. We all have parts of the practice that stink.

Hanging up the lead today….for at least the foreseeable future…. Things I won’t miss as an Interventional Radiologist: 🧵