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BackTable / VI / Podcast / Transcript #380
Podcast Transcript: Managing Venous Stent Rethrombosis with the RevCore Device
with Dr. Steven Abramowitz and Dr. Angelo Marino
In this episode, host Dr. Ally Baheti interviews vascular surgeon Dr. Steven Abramowitz and interventional radiologist Dr. Angelo Marino on managing venous stent rethrombosis with the RevCore device. Steven is the Chair of Vascular Surgery at MedStar Washington Hospital and Angelo is an Assistant Professor of Interventional Radiology at Yale School of Medicine. You can read the full transcript below and listen to this episode here on BackTable.com.
Table of Contents
(1) The Etiology of Venous Stent Thromboses
(2) An Introduction to the RevCore Device
(3) Utilizing the RevCore Device: Procedure Setup
(4) The Decision Algorithm for the Venous Stent Thrombosis Procedure
(5) RevCore Device Pearls for Beginner Users
(6) The RevCore Device vs Alternative Approaches to Venous Stent Thrombosis Management
(7) A Technique for Crossing a Chronically Occluded Venous Stent
(8) Follow-up Protocol After Intervention
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[Dr. Angelo Marino]
For me, it 100% has changed the way I treat these, because in the past, it was get across, try and make a channel with angioplasty. If it's acute, then you can do some lytic therapy or thrombectomy. For the chronic stuff, it was just getting across angioplasty and then relining, not really getting much luminal gain. It's all about having a good lumen at the end, a good lumen size. What this device allows you to do is to achieve that. So I use this in 100% of my stent occlusion cases now.
[Dr. Ally Baheti]
Welcome to the BackTable podcast, your source for all things interventional and endovascular. You can find all previous episodes of our podcast on iTunes, Spotify, and on backtable.com. Now, a quick word from our sponsor. The RevCore Thrombectomy Catheter by Inari Medical is the first mechanical thrombectomy device for venous stent thrombosis. Dr. Abramowitz and Dr. Marino discuss how patients suffering from symptoms of venous stent failure, now, for the first time, have a solution to remove in-stent thrombosis to restore flow and possibly reduce the need for additional re-intervention. Now, back to the show. I'm your host, Dr. Ally Baheti, coming to you from Tacoma, Washington. My guests today are Dr. Angelo Marino, Assistant Professor in Interventional Radiology at Yale, and Dr. Steven Abramowitz, Chair of Vascular Surgery for MedStar Hospital System. Our topic today is treating venous stent re-thrombosis with emphasis on the Inari RevCore device. Doctors Marino and Abramowitz, thank you for being here today.
[Dr. Steven Abramowitz]
Thanks for having us.
[Dr. Angelo Marino]
Yeah, thanks for having us.
[Dr. Ally Baheti]
Before we get into the meat of our topic, I'd love for each of you to tell me a little bit about the practice that you're in right now. Dr. Marino, let's start with you.
[Dr. Angelo Marino]
Sure. So I work at the Academic Center at Yale. It's pretty busy. We cover about three hospitals. Over the past few years, we've built a pretty strong VTE program addressing both pulmonary embolism and DVT. My main focus at Yale is VTE treatment, venous reconstruction, superficial and deep vein disease. We are a pretty busy center. We do about five PE thrombectomies a week and several DVT thrombectomies.
[Dr. Ally Baheti]
Dr. Marino, could you give me a little bit of information about the volume of venous thromboembolism cases you see in your practice?
[Dr. Angelo Marino]
Yeah, so we're a fairly busy practice. There's about three or four of us that particularly have a focus in treating DVT, and then there's the whole group that treats PE. For DVT patients, we're treating about-- I would say about 200 a year, and much more PE patients than that.
[Dr. Ally Baheti]
Awesome. That sounds great. Sounds like you're a busy center. You mentioned that this is a recent development. Are you one of the people that built that up, built that program up?
[Dr. Angelo Marino]
Yeah, I was in private practice when-- I trained at Yale, and then I went to private practice for a few years. I was doing some venous work in private practice, and then I got recruited back to come back, built their vein program. It's just in the past few years where we've had these newer novel devices that allow us to treat more patients. It's really taken off, and we've been able to help a lot more patients with more chronic disease that we weren't able to target in the past.
[Dr. Ally Baheti]
Very cool. Dr. Abramowitz, can you tell me a little bit about your practice at MedStar?
[Dr. Steven Abramowitz]
Yeah I have the privilege of working at MedStar Health, and predominantly, I'm at Washington Hospital Center-- MedStar Washington Hospital Center. Our nine hospital system is the largest distributed care network in the DMV. So that’s the District of Columbia, Northern Virginia, and Maryland. We have a very robust VTE practice, and a lot of that has to do with an excellent collaboration that we have with interventional radiology. We've really worked hard to establish an appropriate care pathway for those patients presenting with both DVT, post-thrombotic syndrome, and other venous embolic events, including pulmonary embolism.
[Dr. Ally Baheti]
That's fantastic. So I reckon you guys probably also place a lot of venous stents in a year. Can you give me any ideas to the numbers that you see?
[Dr. Steven Abramowitz]
We do place a lot. I'll caveat this by saying that we are predominantly a post-thrombotic syndrome stenting practice. We do not have a robust NIVL practice, and that's a whole other podcast for a whole other day. We probably treat upwards of 300 to 400 people with deep venous intervention, including stenting, each year.
(1) The Etiology of Venous Stent Thromboses
[Dr. Ally Baheti]
Now, both of you are at tertiary care centers, academic centers. In your case, Dr. Marino, I'm guessing you see a lot of cases of venous stent thrombosis from the community. Can you just run me through the different scenarios that you see which cause venous stent thrombosis? Dr. Marino, we can start with you.
[Dr. Angelo Marino]
Yeah, sure. One of the most common causes that we find is when the distal landing zone is not the correct spot where the stent is placed. Then the other is if the stent is undersized or poor overlap or protruding more into the IVC than it should be. Those are the main things that we find. A lot of these patients have had multiple procedures over the years, and they've had relining of the stents and sometimes poor inflow.
[Dr. Ally Baheti]
Dr. Abramowitz, anything to add there about how you see these venous stent re-thrombosis cases present?
[Dr. Steven Abramowitz]
Yeah, I can't echo that enough. Predominantly, I really think back to [unintelligible 00:05:16] and a lot of his data and work that he's done looking at inflow disease and an assessment of inflow prior to placing a deep venous stent. When we're dealing with post-thrombotic patients or those patients who have had a venous stent placed in a setting of an acute DVT, one of the big things that we see as a predictor or a causal reason for re-thrombosis has to do with inflow and really clearing out that landing zone or a segment disease from the common femoral profunda or femoral vein confluence.
[Dr. Ally Baheti]
How often do you find yourself stenting below the inguinal ligament for a post-thrombotic syndrome patient? Dr. Abramowitz, we can start with you this time.
[Dr. Steven Abramowitz]
Pretty frequently. I think that one of the big things that we see in terms of a leading because of stent failure is when people are reticent to crossing inguinal ligament and that stent ends immediately proximal to the ligament itself. You end up with a stent almost facing downwards in the vein prior to that external iliac vein, reflecting anteriorly to come up under the inguinal ligament.
When you have post-thrombotic scarring there or narrowing of the vessel in conjunction with the anatomic predisposition for the vessel to deform around the stiffer stent, that is a prime reason for re-thrombosis. Then when you have poor inflow from [unintelligible 00:06:31] disease, [unintelligible 00:06:32] or residual thrombus burden that's become really calcinated and scarred in at the femoral profunda confluence, that is a low flow state that also predisposes patients to re-thrombotic events.
[Dr. Ally Baheti]
Anything to add there, Dr. Marino?
[Dr. Angelo Marino]
I 100% agree with everything he just said. It's really important to get good inflow and land the stent so that you're in a normal vein or a normal-ish vein, as normal as it can get post-thrombectomy or intervention.
(2) An Introduction to the RevCore Device
[Dr. Ally Baheti]
Let's move on to the topic of this podcast, which is the RevCore device. I am familiar with the device but haven't gotten to use it in clinical practice. Dr. Marino, could you just give me an introduction to the device?
[Dr. Angelo Marino]
Yeah. The RevCore device, it's a novel thrombectomy device, and it was made to debulk the thrombotic material in venous stents. The stent size that you can use it in, it ranges, but it's usually from 10 to 20 millimeters. You can also use it in native vessels, which are 6 millimeters or greater. It works over the wire. It's a catheter that consists of a coring element that you can expand, and you control it on a handle. What that does is you can basically turn it back and forth, clockwise, counterclockwise. You can push it over the wire forward and backwards, and it really helps to macerate the thrombus and pull it off of the stent wall.
[Dr. Ally Baheti]
Dr. Abramowitz, could you tell us a little bit about your initial case experience with this device?
[Dr. Steven Abramowitz]
We've done about 22 cases using the RevCore system since it was released. I found it to be very effective with patients and some caveats, and they aren't negative caveats. It's just this disease process and state generally tends to be more organized, more chronic. We've seen patients with calcium lining their re-thrombotic stents. We've seen patients with stent overlap zones where we have deformation of a wall stent, for example, within an Abre or another venous stent. No venous stent is more of a culprit than the other. It's just these are all considerations when using the device.
What the device really allows you to do with variable expansion and those three axes of intervention, clockwise, counterclockwise, as well as anti-grade and retrograde movements is mobilize that material. Initially, when I started using the device, I really thought of it as, well, this is just an aggressive debulking tool. I've changed my mentality, which has also changed, I think, the efficacy and my approach, where I think of it more of a lathe or a--- I'm not a cheese person, but what's that? There's that cheese knife that shaves off strips of cheese. When I think about the RevCore system as something that is grinding down or slowly eroding and working against this material, it's changed my case flow in terms of both work and that's made me more patient. That's led to, I think, great success in using the device as a tool for removing this material.
(3) Utilizing the RevCore Device: Procedure Setup
[Dr. Ally Baheti]
What's your access site when you use the device?
[Dr. Steven Abramowitz]
I'm generally a proponent of popliteal and IJ access. This is for two reasons. One, I think that the popliteal access gives you a really good assessment of the inflow, because not only do you want to clear out the material that's thrombosed or organized within the stent itself, but you also want to address any inflow lesions that may have led to stent failure and really diagnose and work on those. There are certainly patients where we've put them on the table and I've said, "You know actually, this is not a RevCore candidate because even if we open the stent, the inflow is unsalvageable and the stent is just going to re-thrombose.”
Then from an IJ approach, it really allows you to use a device like the Protrieve Sheath to aid in the collection of the material that's mobilized from within the stent. Because when we see what's gathered, it generally tends to be very organized, white calcified material, collagenated material, and it comes out in large volume pretty quickly. That's a protective tool.
The last thing I'll say in there is I have found that my use of the system is more effective and more controlled when I have a wire flossed through and through the patient. Really giving somebody the ability to pull the wire on both ends, give a rigidity to the system so that I have the utmost amount of control when engaging in anti-grade and retrograde movements has really given me the optimal outcome I'm looking for.
[Dr. Ally Baheti]
Dr. Marino, do you usually go through the Protrieve Sheath to get to the occluded stent or do you find that popliteal access works best for you, too?
[Dr. Angelo Marino]
I always get popliteal access as well. What I do is once I have popliteal access, I also make sure that the groins and the neck are prepped and I always get right IJ access for the Protrieve Sheath. The groin access sometimes is very useful because when you're going up from the popliteal, you lose some of that support when you're trying to get through these chronically occluded stents. A lot of times, I find myself puncturing directly into the stent with an 18-gauge needle and then using some sharp recanalization to find my way up. Then coming down from the IJ through that occluded stent and then connecting down to the pop to get through and through access.
[Dr. Ally Baheti]
We haven't talked much on this show about venous CTOs and how we do through and through access for them. This seems like it's the ideal scenario for it is in a post-thrombotic patient. For the uninitiated, what size is the device? What size of sheath does it go through?
[Dr. Angelo Marino]
It is a 12 French OD.
[Dr. Ally Baheti]
Cool. It sounds like you can use the RevCore through the IJ access Protrieve Sheath. Just to be clear, are you guys using Protrieve for all of these cases?
[Dr. Angelo Marino]
I use the Protrieve for all of these cases.
[Dr. Steven Abramowitz]
I am. I have used other tools, but it goes back to what is the best access for a worst case scenario. When I have used other systems, I have ultimately converted to the Protrieve Sheath for that workability from the IJ for aspiration or re-stenting or snaring or having a dual-wired system from the contralateral popliteal as well.
(4) The Decision Algorithm for the Venous Stent Thrombosis Procedure
[Dr. Ally Baheti]
Since both of you are treating a lot of venous stent thrombosis, could you walk me through your algorithm for how you approach a venous stent thrombosis? Is RevCore your first go-to device now or do you have some other troubleshooting tips and tricks you do before you get there? Dr. Marino, let's start with you.
[Dr. Angelo Marino]
The hardest part of these cases usually is crossing the stent. Once you establish that, then I use RevCore 100% in these cases. In terms of crossing the stent, there are many different things that we use. I end up most often having to do sharp recanalization, and sometimes I'll have to use the TIPS set, or more often than not, because it's probably cheaper, the transjugular liver biopsy cannula to get me through the stent, because when you get that dip in the pelvis from the external to the iliac vein, a lot of times the sharp recan will end up wanting to poke out of the stent.
[Dr. Ally Baheti]
Then do you do all of your cases under GA if they're going to be recan cases?
[Dr. Angelo Marino]
For these cases, I do just because they can be a little uncomfortable with the balloons you use, and the sharp recan sometimes you perforate out. They take time prepping all the different sites and getting the accesses and crossing the occluded stents can take some time. I personally do them all under GA.
[Dr. Ally Baheti]
You guys alluded to this earlier, but just to clarify, when you're doing your popliteal access, it seems like the patients are supine and so you're doing them all with a frog leg. Is that right?
[Dr. Steven Abramowitz]
Yeah. I think the interesting thing for me in hearing about different anesthesia techniques and different access options is it's made me rethink about how the patient's presenting. For a lot of these patients, if they present with an acute change in their symptoms, that's some sort of indication to me that they may have had chronic instant thrombotic disease and then suddenly had an acute event. That's the type of patient where I may lyse them first or some other mechanical thrombectomy solution or rheolytic therapy to really evaluate what's happening within the stent from a chronic standpoint prior to engaging in the use of something like RevCore.
For those patients who are presenting with a wound and they walk into your office and they're like, "I've had this stent for 20 years and I've never looked at it again." Most likely that's a different algorithm. What's been surprising to me is I used to from the start say, "This is just going to be a honker of a day. Dive in with general and block out four to six hours." I've become much more open to the idea of the recanalization or the assessment of the stent being potentially a separate intervention or a separate procedure from the RevCore or from the use of another tool to treat the chronic instant disease.
[Dr. Ally Baheti]
How do you stage that procedure? Because once you've crossed your stent, if you leave it alone, won't it just re-thrombose?
[Dr. Steven Abramowitz]
Absolutely. It's definitely not a definitive intervention. I think back to a couple of patients who had had endovascular iliocaval reconstructions where an IVC filter was jailed. They were left with bilateral stents. There was some concern or confusion based on the preoperative imaging as to whether or not both stents were patent, one was occluded, other was open, whether there was disease in the IVC stent. Those are very different procedures in my mind from a workflow standpoint and potential reconstruction options, and particularly, those patients who may have an IVC filter above an occluded iliofemoral stent.
I just share this because I don't want everybody to think that it has to be a one session go. You do have the opportunity, at least from the vascular surgery perspective, of doing that diagnostic angiogram before you jump into your bypass another day. In this setting, it would be doing that venogram, having the proof of concept that you can cross, that you can balloon a pathway, and coming back another day after having a different conversation with the patient about the chronicity or complexity of the reconstruction likelihood for patency in the future.
(5) RevCore Device Pearls for Beginner Users
[Dr. Ally Baheti]
That's interesting. I haven't heard of folks staging it, but as you've explained it, it makes sense to do it that way for a lot of reasons. You both have a fair amount of experience with the RevCore device. Any initial tips and tricks that you would want to share with early users? Steven, let's start with you.
[Dr. Steven Abramowitz]
I think one of the things that I would share is to be timid, but don't be afraid. As you get used to the device, really get an assessment of the feel, the pushability of the haptics. Then at some point, if you find that you're not making progress, you can be more aggressive. You're dealing with a variable diameter revving system within a stented segment, and so you aren't likely to perf or to lacerate or to cause damage. That integrated retrograde motion over a snared wire that's through and through the body really gives you a next level ability to address the thrombus.
The other thing I would say is think about what your endpoint is. In an ideal world, I would be using the RevCore system to completely remove all of the material from within the stent. But there are situations where I'm just hoping for luminal gain. I know that I'm going to need to place another stent. I know that I'm going to need to extend an untreated segment of the external iliac vein or the common femoral vein. In that case, I think the technical endpoint that you're striving for is slightly altered. Putting that in the context of what you're hoping to accomplish, I think gives people a little bit more of that ability to feel like they can modulate their technical endpoint for the appropriateness of the case.
[Dr. Ally Baheti]
Dr. Marino, do you have any tips and tricks for early users?
[Dr. Angelo Marino]
Yeah, I agree. You want to start slow. You don't want to be too aggressive until you get a feel for it. The device works really well. You can also use it in native veins, which I was a little hesitant at first, but now I've done almost 20 cases. It works really well to get some of that chronic wool adherent thrombus, say, from the common femoral vein if you're trying to extend the stent down and you need a good landing zone.
Something to watch out for, which I found is pay close attention on fluoroscopy to see if there's a stent fracture, if some of the interstices of the stent are already fractured because you can get caught on that a little bit, especially with the wall stents when they're fractured. You just take it nice and slow. After you use it a few times, you'll get pretty comfortable. It's pretty straightforward to use.
(6) The RevCore Device vs Alternative Approaches to Venous Stent Thrombosis Management
[Dr. Ally Baheti]
That's fantastic. Sounds like a pretty low barrier to entry. I think we've really discussed the RevCore device and how to use it in our practice and how to incorporate it. Do you feel like it's really changed your approach to venous stent thrombosis as compared to before you were using the device? Dr. Marino, let's start with you for this one.
[Dr. Angelo Marino]
For me, it 100% has changed the way I treat these, because in the past, it was get across, try and make a channel with angioplasty. If it's acute, then you can do some lytic therapy or a thrombectomy. For the chronic stuff, it was just getting across, angioplasty, and then relining, not really getting much luminal gain. It's all about having a good lumen at the end, a good lumen size. What this device allows you to do is to achieve that. I use this in 100% of my stent occlusion cases now.
[Dr. Ally Baheti]
Dr. Abramowitz, what would you say?
[Dr. Steven Abramowitz]
It's definitely changed my workflow. I think there were a lot of patients that I had in surveillance patterns, not truly understanding what the implications of even a 50% IST lesion were or a 60% or 70% IST lesion were, even in the setting of a patient who may have more ipsilateral swelling on the limb of that lesion. This has given me an additional tool beyond just repeated balloon venoplasty for those patients where I find that they were predisposed to just recurrent IST. I'd like to believe that, hopefully, in the next few months, we'll have a very solidified algorithm for where it plays in. I find myself reaching for the device more frequently as a tool for addressing both chronic IST lesions in those patients who are completely occluded.
(7) A Technique for Crossing a Chronically Occluded Venous Stent
[Dr. Ally Baheti]
I'll start with you, Dr. Abramowitz. What is your technique for crossing a chronically occluded venous stent?
[Dr. Steven Abramowitz]
I think there's definitely a workflow that we go through. I'll start with telescoping or coaxial system, so an 8 or an 11 French sheath in the popliteal, then using a six or a seven angled destination sheath through that and a stiff angle glide wire. If that doesn't work, we'll try to be a little bit more aggressive with balloon expansion to center and increase pushability with conversion to either using a Chiba needle or different systems. Even going so far as to using a metal cannula to help drive up and guide myself as I'm crossing through the stent, I find that really keeping intra luminal, once you're curving in the pelvic can be a challenge for some of these really chronic and scarred occluded stents.
[Dr. Ally Baheti]
Dr. Marino, what's your algorithm for crossing a venous occlusion?
[Dr. Angelo Marino]
Yeah, similarly. When I start out with these cases, I always put a nine French sheath in, and then through that sheath, I'll put in a six or a seven catheter or sheath to guide myself. I usually use the Navicross and the glide wire advantage. Start with the front end of the wire, but more often than not, you have to go to the back end for a sharp recan. Sometimes I'll use a TriForce catheter. You make one centimeter at a time, you get through it. Sometimes you have to use a balloon to make a little channel so you can change your direction and have some room to change your direction. In the more complex cases, I find that sometimes I have to use direct puncture into the stent if it extends down to the external or the common femoral and metal cannulas, like the cannula from a transjugular liver biopsy set to help you get across.
[Dr. Ally Baheti]
For operators who maybe do this less frequently, what's the stopping point to say, "I'm not going to cross this," or do you guys cross every occlusion that you see in venous stent? Dr. Marino, let's start with you.
[Dr. Angelo Marino]
I've been lucky enough so far that I've been able to cross most occlusions, but they can be challenging and they can take a really long time. I think a stopping point would be if you really perforate out or if you have some kind of injury to the adjacent artery, then I would stop. You have to make sure you do a lot of obliques. You do intravascular ultrasound. We have Cone-beam CT available to us too, just in case we want to have some extra imaging. If you use all the tools available, you should be able to cross.
[Dr. Ally Baheti]
Dr. Abramowitz, what's your take on that?
[Dr. Steven Abramowitz]
Yeah, I totally agree. I think the other thing is just always going back to indications. The patient who has C3 disease or some minimal swelling is very different from the patient who has an active ulcer or progressing hemosiderosis. Those are the patients where I find myself much more aggressive and will then tolerate a perforation, or even potentially the need to-- I've only had to do it once or twice, but place a covered stent in the arterial system after a perforation, but just to keep on persevering.
(8) Follow-up Protocol After Intervention
[Dr. Ally Baheti]
Got it. Then what's your follow up for these patients after you've crossed and opened their occlusion? When do you see them in clinic, and when do you do repeat imaging? Dr. Abramowitz, let's start with you.
[Dr. Steven Abramowitz]
That's a great question. I tend to be very aggressive with these patients, because once they occlude their stents, I find that I don't want to have to go through all the work I did again. Typically, I will bring the patient back for a duplex at one month. I keep them on an antiplatelet agent and lifelong anticoagulation, and then I will reimage them at three months, six months and a year, and then keep them on a bi-yearly or a biannual surveillance plan. Usually one of the imaging studies is a duplex, and I will be very aggressive, and the other will be either an MR or a CT.
[Dr. Ally Baheti]
Dr. Marino, what's your follow up algorithm?
[Dr. Angelo Marino]
I do pretty much almost the exact same thing. If there's any questions, sometimes, depending on the patient’s body habitus. If we can't get a good view of the stent cell, I'll get a CT venogram, but most often, it's just ultrasound. Similarly, 1, 6, 12 months. Sometimes I'll do three months if I'm really worried about the patient.
[Dr. Ally Baheti]
Very cool. Do you have an anticoagulant of choice that you like for these patients? Dr. Marino?
[Dr. Angelo Marino]
A lot of these patients have been in anticoagulation for a long time. For stents, I typically try and do Lovenox for at least a month in the beginning and then switch to a DOAC with antiplatelet therapy like Plavix and then lifelong aspirin, if necessary. The patients who don't like giving themselves injections can be a problem, but usually they go on the DOAC. I try and do Lovenox first, at least for a few weeks.
[Dr. Ally Baheti]
That seems to be a prevalent theory amongst folks who do a lot of venous reconstruction, the month at least of Lovenox to help with anti-inflammatory effects and keeping the stents open. Dr. Abramowitz, what's your anticoagulation algorithm?
[Dr. Steven Abramowitz]
Very similar. We do have issues sometimes with the insurance approval for a short term enoxaparin or Lovenox bridge, and in those cases, I'll take anything over or for nothing, but generally two weeks to four weeks of Lovenox if I can get it, and then transitioning to a DOAC.
[Dr. Ally Baheti]
Very good. Thank you, both, for your introduction to this device. I look forward to trying it out myself. It sounds like it's really been a game changer for venous stent thrombosis. Dr. Marino, thank you for being on the show.
[Dr. Angelo Marino]
Pleasure to be here. Thank you.
[Dr. Ally Baheti]
Dr. Abramowitz, thank you so much for being on the show.
[Dr. Steven Abramowitz]
Thanks for having me.
Podcast Contributors
Dr. Steven Abramowitz
Dr. Steven Abramowitz is a practicing vascular surgeon at MedStar Georgetown University Hospital in Washington, D.C.
Dr. Angelo Marino
Dr. Angelo Marino is an interventional radiologist with Yale Medicine in Connecticut.
Dr. Aparna Baheti
Dr. Aparna Baheti is a practicing Interventional Radiologist in Tacoma, Washington.
Cite This Podcast
BackTable, LLC (Producer). (2023, October 30). Ep. 380 – Managing Venous Stent Rethrombosis with the RevCore Device [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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