Frank Arko's guest appearances

Frank Arko

BackTable Vascular & Interventional

David Sacks

John Martin

David Wood

David Kim

Karen Brown

Justin Lee

David Liu

Eric Keller

Preston Smith

David Ball

Mike Watts

Chris Thomson

Susan Jackson

John Lipman

Aaron Shiloh

OwlTail

Saher Sabri

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Saher Sabri and vascular surgeon Dr. Frank Arko about their perspectives on a July 2023 New York Times article about the ethics of peripheral arterial disease (PAD) treatment in outpatient based labs (OBLs) and ambulatory surgery centers (ASCs).---SHOW NOTESDr. Arko emphasizes the importance of approaching articles as an unbiased reader. He acknowledges that sensationalism in the news is common, and while bad actors do exist, he personally knows talented OBL/ASC practitioners. He also notes that the article fails to mention that the majority of these practitioners follow society guidelines to provide appropriate and effective treatment for their patients, rather than prioritizing financial gain. He believes that most non-surgical specialists have the clinical insight to know when patients would be better candidates for open bypasses as opposed to endovascular interventions. Dr. Arko describes the split response to the article within vascular surgeons on social media, based on their personal philosophies of open versus endovascular interventions for PAD.Dr. Sabri believes that PAD and critical limb-threatening ischemia (CLTI) are not very well known by the general public, this article was a missed opportunity to bring attention to these conditions and disparities in treatments depending on patients’ geographic locations and ethnicities. The article may have the effect of scaring patients away from seeking treatment for PAD and CLTI, as well as receiving care at OBLs, which were originally founded to make interventions more efficient and patient-friendly. Additionally, the article could foster divisiveness between vascular surgeons, interventional radiologists, and interventional cardiologists and as a result, increase barriers to collaboration.It is important to differentiate between PAD and CLTI and the stage at which patients present to medical care. Limb salvage rates and decisions to intervene and/or amputate are multifactorial and are not as straightforward as the article may imply. Both doctors agree that specialty societies share the responsibility of monitoring their members for overuse of interventions.In terms of rebates and volume discounts from device companies, the doctors discuss the ethics of cost savings that benefit a hospital system versus savings that benefit a physician-owned OBL. Dr. Arko recognizes that financing an OBL with device company partnerships can be a smart business decision if devices are used appropriately and only when indicated. He speaks about the need for societies to support more randomized control trials that compare the effectiveness of each atherectomy device. We also discuss implications for insurance coverage of PAD/CLTI interventions. Dr. Sabri believes that it is unfortunate when insurance companies become the decision-maker of patient treatments.---RESOURCES“They Lost Their Legs. Doctors and Health Giants Profited” (NY Times, July 2023 article):https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.htmlBEST-CLI:https://www.bestcli.com/“Blocked Artery in Your Leg? Here’s What You Should Know” (ProPublica, June 2023 article)https://www.propublica.org/article/what-to-know-about-peripheral-artery-diseaseOutpatient Endovascular Interventional Society (OEIS):https://oeisweb.com/Society of Vascular Surgery (SVS) Position Statement:https://vascular.org/news-advocacy/articles-press-releases/svs-response-new-york-times-article-overuse-interventions

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Saher Sabri and vascular surgeon Dr. Frank Arko about their perspectives on a July 2023 New York Times article about the ethics of peripheral arterial disease (PAD) treatment in outpatient based labs (OBLs) and ambulatory surgery centers (ASCs). --- SHOW NOTES Dr. Arko emphasizes the importance of approaching articles as an unbiased reader. He acknowledges that sensationalism in the news is common, and while bad actors do exist, he personally knows talented OBL/ASC practitioners. He also notes that the article fails to mention that the majority of these practitioners follow society guidelines to provide appropriate and effective treatment for their patients, rather than prioritizing financial gain. He believes that most non-surgical specialists have the clinical insight to know when patients would be better candidates for open bypasses as opposed to endovascular interventions. Dr. Arko describes the split response to the article within vascular surgeons on social media, based on their personal philosophies of open versus endovascular interventions for PAD. Dr. Sabri believes that PAD and critical limb-threatening ischemia (CLTI) are not very well known by the general public, this article was a missed opportunity to bring attention to these conditions and disparities in treatments depending on patients’ geographic locations and ethnicities. The article may have the effect of scaring patients away from seeking treatment for PAD and CLTI, as well as receiving care at OBLs, which were originally founded to make interventions more efficient and patient-friendly. Additionally, the article could foster divisiveness between vascular surgeons, interventional radiologists, and interventional cardiologists and as a result, increase barriers to collaboration. It is important to differentiate between PAD and CLTI and the stage at which patients present to medical care. Limb salvage rates and decisions to intervene and/or amputate are multifactorial and are not as straightforward as the article may imply. Both doctors agree that specialty societies share the responsibility of monitoring their members for overuse of interventions. In terms of rebates and volume discounts from device companies, the doctors discuss the ethics of cost savings that benefit a hospital system versus savings that benefit a physician-owned OBL. Dr. Arko recognizes that financing an OBL with device company partnerships can be a smart business decision if devices are used appropriately and only when indicated. He speaks about the need for societies to support more randomized control trials that compare the effectiveness of each atherectomy device. We also discuss implications for insurance coverage of PAD/CLTI interventions. Dr. Sabri believes that it is unfortunate when insurance companies become the decision-maker of patient treatments. --- RESOURCES “They Lost Their Legs. Doctors and Health Giants Profited” (NY Times, July 2023 article):<a href="https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.html" rel="nofollow" target="_blank">https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.html</a> BEST-CLI:<a href="https://www.bestcli.com/" rel="nofollow" target="_blank">https://www.bestcli.com/</a> “Blocked Artery in Your Leg? Here’s What You Should Know” (ProPublica, June 2023 article)<a href="https://www.propublica.org/article/what-to-know-about-peripheral-artery-disease" rel="nofollow" target="_blank">https://www.propublica.org/article/what-to-know-about-peripheral-artery-disease</a> Outpatient Endovascular Interventional Society (OEIS):<a href="https://oeisweb.com/" rel="nofollow" target="_blank">https://oeisweb.com/</a> Society of Vascular Surgery (SVS) Position Statement:<a href="https://vascular.org/news-advocacy/articles-press-releases/svs-response-new-york-times-article-overuse-interventions" rel="nofollow" target="_blank">https://vascular.org/news-advocacy/articles-press-releases/svs-response-new-york-times-article-overuse-interventions</a>

Ep. 351 Discussing the Recent NYT Article with Dr. Frank Arko and Dr. Saher Sabri

Interventional Radiologist Sabeen Dhand talks with Vascular Surgeon Frank Arko about endovascular treatment of Type B Aortic Dissections (TBAD), including patient selection, appropriate sizing, and complications to avoid.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Hv2gx0---SHOW NOTESIn this episode, vascular surgeon Dr. Frank Arko and our host Dr. Sabeen Dhand give an overview of type B aortic dissections, which includes different methods of classifying dissections, workup and imaging, thoracic endovascular aortic repair (TEVAR), potential complications, and timeline for follow up care.Dr. Arko starts the episode by defining vocabulary terms related to aortic dissections. He describes the Stanford and DeBakey classification systems that are used to signify the location of the dissection and the method of treatment (medical management or surgical/endovascular repair). He also distinguishes between complicated/uncomplicated dissections, as well as acute/subacute/chronic dissections.When Dr. Arko discusses TEVAR, he mentions three important complications to be aware of: retrograde type A dissection, stroke, and spinal cord ischemia. He emphasizes that in the debate between optimal medical therapy and early TEVAR, more research on how to minimize these complications is needed before recommending widespread use of early TEVAR. During his walk through of the procedure, Dr. Arko also gives his insight on adjunct techniques such as PETTICOAT.Finally, the doctors discuss special considerations for patients with pleural effusion, chronic hypertension, type II thoracoabdominal aneurysms, and connective tissue disorders.---RESOURCESINSTEAD-XL Trial- https://pubmed.ncbi.nlm.nih.gov/23922146/

Interventional Radiologist Sabeen Dhand talks with Vascular Surgeon Frank Arko about endovascular treatment of Type B Aortic Dissections (TBAD), including patient selection, appropriate sizing, and complications to avoid. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: <a href="https://earnc.me/Hv2gx0" rel="nofollow" target="_blank">https://earnc.me/Hv2gx0</a> --- SHOW NOTES In this episode, vascular surgeon Dr. Frank Arko and our host Dr. Sabeen Dhand give an overview of type B aortic dissections, which includes different methods of classifying dissections, workup and imaging, thoracic endovascular aortic repair (TEVAR), potential complications, and timeline for follow up care. Dr. Arko starts the episode by defining vocabulary terms related to aortic dissections. He describes the Stanford and DeBakey classification systems that are used to signify the location of the dissection and the method of treatment (medical management or surgical/endovascular repair). He also distinguishes between complicated/uncomplicated dissections, as well as acute/subacute/chronic dissections. When Dr. Arko discusses TEVAR, he mentions three important complications to be aware of: retrograde type A dissection, stroke, and spinal cord ischemia. He emphasizes that in the debate between optimal medical therapy and early TEVAR, more research on how to minimize these complications is needed before recommending widespread use of early TEVAR. During his walk through of the procedure, Dr. Arko also gives his insight on adjunct techniques such as PETTICOAT. Finally, the doctors discuss special considerations for patients with pleural effusion, chronic hypertension, type II thoracoabdominal aneurysms, and connective tissue disorders. --- RESOURCES INSTEAD-XL Trial- <a href="https://pubmed.ncbi.nlm.nih.gov/23922146/" rel="nofollow" target="_blank">https://pubmed.ncbi.nlm.nih.gov/23922146/</a>

Ep. 142 Type B Aortic Dissections with Dr. Frank Arko