George Behrens's guest appearances

George Behrens

BackTable Vascular & Interventional

The Kinked Wire

Mary Costantino

Sandeep Bagla

Dan Sze

Kathy Krol

David Wood

David Kim

Karen Brown

Justin Lee

David Liu

Eric Keller

Derek West

Raj Shah

Preston Smith

David Ball

Eric Wang

OwlTail

In this episode, host Dr. Chris Beck interviews interventional radiologist Dr. George Behrens about how he built a robust multidisciplinary portal hypertension clinic in a community hospital, tips for common challenges during a TIPS, and post-TIPS management.---CHECK OUT OUR SPONSORArgon Medical Scorpion Portal Vein Access Serieshttps://www.argonmedical.com/scorpion---SHOW NOTESWe begin by discussing Dr. Behrens portal hypertension practice. He sees patients in conjunction with hepatology and transplant surgery. The model of his clinic is the opposite of the standard practice. The specialists come to the community hospital, and their clinic gets referrals from tertiary hospitals in Chicago. This took years to build, and they received enormous pushback. This model encompasses patient-centered care because it removes many of the barriers that patients face to travel into Chicago for the workup and management plan of portal hypertension. In this clinic, they also evaluate the underlying cause of cirrhosis including more uncommon causes such as hemochromatosis, Wilson disease, and alpha 1 antitrypsin deficiency.Next, Dr. Behrens details the typical procedure and provides tips for commonly encountered challenges during a TIPS (transjugular intrahepatic portosystemic shunt). He does all TIPS under general anesthesia. He drains ascites, then uses a multipurpose catheter to enter the hepatic vein, without a preference for which hepatic vein he is in. He uses a Launcher AL 11 1 ½ or 2 if he is having difficulty entering a hepatic vein. He then does a CO2 portogram. Next, he advances the cannula into the hepatic veins, unsheathes the cannula, then brings it back to about 2cm from the pedicle, close to the ostium of the hepatic vein. He discusses the differences in technique between the Rösch-Uchida and the Scorpion. He likes to place his stent with the proximal portion where the diaphragm crosses the right atrium and the distal part at the entry site of the portal vein. He uses a VIATORR stent, and always dilates to 8mmHg first, then re-measures pressures. His general rule for dilation is less than 12mmHg for bleeding and less than 8mmHg for ascites.Dr. Behrens discusses follow-up for patients and post-procedure care. All patients are started on rifaximin 2 weeks prior to TIPS. If ascites drained was 4L or more, he gives 100g albumin and 20mg Lasix. He measures pressures via a right heart cath before and after the procedure. Depending on the MELD, he may send patients to the floor or home same day, while others go to the ICU. He starts all patients on lactulose and zinc 220mg BID the day of the procedure. He advises all patients against using PPIs due to the increased risk of encephalopathy. He maintains pre-procedure Lasix and spironolactone dosing for the first 3 months. At one month, patients get a TIPS US with velocities, CMP, CBC, and INR. At 3 months they get cross-sectional imaging and repeat labs. He starts managing diuretics at 3 months. After this, he sees patients every 6 months and screens for hepatocellular carcinoma.---RESOURCESArgon Scorpion:https://www.argonmedical.com/products/scorpionCook Rösch-Uchida:https://www.cookmedical.com/products/ir_rups_webds/Gore VIATORR:https://www.goremedical.com/products/viatorrMedtronic Launcher:https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/catheters/launcher.htmlMELD score:https://www.mdcalc.com/calc/78/meld-score-model-end-stage-liver-disease-12-older

In this episode, host Dr. Chris Beck interviews interventional radiologist Dr. George Behrens about how he built a robust multidisciplinary portal hypertension clinic in a community hospital, tips for common challenges during a TIPS, and post-TIPS management. --- CHECK OUT OUR SPONSOR Argon Medical Scorpion Portal Vein Access Series<a href="https://www.argonmedical.com/scorpion" rel="nofollow" target="_blank">https://www.argonmedical.com/scorpion</a> --- SHOW NOTES We begin by discussing Dr. Behrens portal hypertension practice. He sees patients in conjunction with hepatology and transplant surgery. The model of his clinic is the opposite of the standard practice. The specialists come to the community hospital, and their clinic gets referrals from tertiary hospitals in Chicago. This took years to build, and they received enormous pushback. This model encompasses patient-centered care because it removes many of the barriers that patients face to travel into Chicago for the workup and management plan of portal hypertension. In this clinic, they also evaluate the underlying cause of cirrhosis including more uncommon causes such as hemochromatosis, Wilson disease, and alpha 1 antitrypsin deficiency. Next, Dr. Behrens details the typical procedure and provides tips for commonly encountered challenges during a TIPS (transjugular intrahepatic portosystemic shunt). He does all TIPS under general anesthesia. He drains ascites, then uses a multipurpose catheter to enter the hepatic vein, without a preference for which hepatic vein he is in. He uses a Launcher AL 11 1 ½ or 2 if he is having difficulty entering a hepatic vein. He then does a CO2 portogram. Next, he advances the cannula into the hepatic veins, unsheathes the cannula, then brings it back to about 2cm from the pedicle, close to the ostium of the hepatic vein. He discusses the differences in technique between the Rösch-Uchida and the Scorpion. He likes to place his stent with the proximal portion where the diaphragm crosses the right atrium and the distal part at the entry site of the portal vein. He uses a VIATORR stent, and always dilates to 8mmHg first, then re-measures pressures. His general rule for dilation is less than 12mmHg for bleeding and less than 8mmHg for ascites. Dr. Behrens discusses follow-up for patients and post-procedure care. All patients are started on rifaximin 2 weeks prior to TIPS. If ascites drained was 4L or more, he gives 100g albumin and 20mg Lasix. He measures pressures via a right heart cath before and after the procedure. Depending on the MELD, he may send patients to the floor or home same day, while others go to the ICU. He starts all patients on lactulose and zinc 220mg BID the day of the procedure. He advises all patients against using PPIs due to the increased risk of encephalopathy. He maintains pre-procedure Lasix and spironolactone dosing for the first 3 months. At one month, patients get a TIPS US with velocities, CMP, CBC, and INR. At 3 months they get cross-sectional imaging and repeat labs. He starts managing diuretics at 3 months. After this, he sees patients every 6 months and screens for hepatocellular carcinoma. --- RESOURCES Argon Scorpion:<a href="https://www.argonmedical.com/products/scorpion" rel="nofollow" target="_blank">https://www.argonmedical.com/products/scorpion</a> Cook Rösch-Uchida:<a href="https://www.cookmedical.com/products/ir_rups_webds/" rel="nofollow" target="_blank">https://www.cookmedical.com/products/ir_rups_webds/</a> Gore VIATORR:<a href="https://www.goremedical.com/products/viatorr" rel="nofollow" target="_blank">https://www.goremedical.com/products/viatorr</a> Medtronic Launcher:<a href="https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/catheters/launcher.html" rel="nofollow" target="_blank">https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/catheters/launcher.html</a> MELD score:<a href="https://www.mdcalc.com/calc/78/meld-score-model-end-stage-liver-disease-12-older" rel="nofollow" target="_blank">https://www.mdcalc.com/calc/78/meld-score-model-end-stage-liver-disease-12-older</a>

Ep. 222 New Tools for TIPS with Dr. George Behrens

I am originally from a third-world country. When I moved to the United States, I couldn’t believe all the resources that were being wasted in America. And I feel that, for the first time in America, we are learning that. We are learning that we have to be cautious about wasting resources. —George Behrens, MDWarren Krackov, MD, FSIR, speaks with George Behrens, MD, an interventional radiologist in Chicago, about the COVID-19 impact on his city, changes his practice has made in response, and how his native Venezuela has been faring during the pandemic.  Find IR resources for COVID-19 planning, staffing, personal protective equipment and more at the SIR website, sirweb.org.Listen to more interventional radiologist perspectives on COVID-19:July 21: New York, N.Y. (Akhilesh K. Sista, MD, FSIR)June 9: Atlanta, Ga. (Janice Newsome, MD, FSIR)May 20: Miami, Fla. (Costantino S. Peña, MD, FSIR)April 29: Palo Alto, Calif. (Raj Shah, MD)April 20: Seattle, Wash. (R. Torrance Andrews, MD, FSIR)Note: This episode was recorded on May 1, 2020.  Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show

I am originally from a third-world country. When I moved to the United States, I couldn’t believe all the resources that were being wasted in America. And I feel that, for the first time in America, we are learning that. We are learning that we have to be cautious about wasting resources. —George Behrens, MDWarren Krackov, MD, FSIR, speaks with George Behrens, MD, an interventional radiologist in Chicago, about the COVID-19 impact on his city, changes his practice has made in response, and how his native Venezuela has been faring during the pandemic.  Find IR resources for COVID-19 planning, staffing, personal protective equipment and more at the <a href="http://sirweb.org" rel="nofollow" target="_blank">SIR website, sirweb.org</a>. Listen to more interventional radiologist perspectives on COVID-19:<ul><li>July 21: <a href="https://www.buzzsprout.com/846361/4639286" rel="nofollow" target="_blank">New York, N.Y.</a> (Akhilesh K. Sista, MD, FSIR)</li><li>June 9: <a href="https://www.buzzsprout.com/846361/4028699" rel="nofollow" target="_blank">Atlanta, Ga.</a> (Janice Newsome, MD, FSIR)</li><li>May 20: <a href="https://www.buzzsprout.com/846361/3775232" rel="nofollow" target="_blank">Miami, Fla.</a> (Costantino S. Peña, MD, FSIR)</li><li>April 29: <a href="https://www.buzzsprout.com/846361/3526324" rel="nofollow" target="_blank">Palo Alto, Calif.</a> (Raj Shah, MD)</li><li>April 20: <a href="https://www.buzzsprout.com/846361/3385813" rel="nofollow" target="_blank">Seattle, Wash. </a>(R. Torrance Andrews, MD, FSIR)</li></ul> Note: This episode was recorded on May 1, 2020.   <a href="mailto:irq@sirweb.org?subject=Kinked Wire podcast">Contact us</a> with your ideas and questions, or read more about about interventional radiology in <a href="http://sirweb.org/irq" rel="nofollow" target="_blank">IR Quarterly magazine</a> or SIR's <a href="https://www.sirweb.org/patient-center/" rel="nofollow" target="_blank">Patient Center</a>. (c) <a href="http://sirweb.org" rel="nofollow" target="_blank">Society of Interventional Radiology</a>.<a href="https://www.sirweb.org/corporate-gateway/advertising/" rel="payment nofollow" target="_blank">Support the show</a>

Special update: IR perspectives on COVID-19: Chicago | Guest: George Behrens