Phil Parmet, M.D.

Vascular and Interventional Radiologist. Minimally invasive specialist for #Cancer #Fibroids #PainManagement #Transplant #IRad

[Phil Parmet, M.D. @pparmetIR]

@DavidSacks Not really a new thing with vaccines- current FDA-approved vaccines already covered by National Vaccine Injury Compensation Program (NVICP) to prevent vaccine manufacturer lawsuits, and EUA COVID vaccines covered by similar Countermeasures Injury Compensation Program (CICP).

[Michael Barraza @JMichaelBarraza]

Trainee tip: the most reliable technique to cross an occlusion or select a challenging vessel origin is to threaten to open a different wire/catheter. The second the new one drops on the table, you’re in. #Endovoodoo

[Dr. Alex Tatem @DrAlexTatem]

I’ve historically been skeptical of #PAE, but seeing it evolve into an option for large prostates (who may not be MIST candidates) while preserving sexual function is HUGE. (Compared to #HOLEP) 🤔 #UCIMensHealthCourse

[Phil Parmet, M.D. @pparmetIR]

31 yo M w/ 3 weeks progressive left arm swelling, +DVT subclavian to brachial vein- classic Paget-Schroetter presentation.

Early thrombectomy w/ #IRad to restore central outflow with rapid relief of swelling. Next, VS referral for thoracic outlet decompression. @SIRECS @SIRRFS

[Phil Parmet, M.D. @pparmetIR]

@RodZvavanjanja @SIRspecialists @Synergyrad @SIR_ECS @SIRRFS @UTHouston_IR @HCIRad @rahulshethmd @freez_IR @keithppereira @medravi @JBuckleyMD @jdkubanMD @UTHradiology Thanks! So gratifying ...

[Phil Parmet, M.D. @pparmetIR]

70 yo F referred for IVC filter retrieval- Celect placed 11 mo prior at OSH.

Tilted filter w/ embedded hook? No problem for #IRad. Modified loop snare technique to engage apical cap for a successful #filterout. #GTFO @SIRspecialists @Synergyrad @SIR_ECS @SIRRFS

[Phil Parmet, M.D. @pparmetIR]

"For qualified #LiverCancer patients, the minimally invasive #Y90 procedure could be an option that can help in shrinking the tumors while some patients may see complete disease response."

Another way #IRad is fighting cancer #withoutascalpel

[Sirtex Medical @SirtexMedical]

Read more about the success Dr. @pparmetIR, Radiology Director at @memorialhermann provided one patient: https://t.co/RYprbgWa8k

[Phil Parmet, M.D. @pparmetIR]

@JBuckleyMD @RodZvavanjanja @UTHouston_IR @HCIRad Strong work!

[Phil Parmet, M.D. @pparmetIR]

@DHidlayVIR @SIR_ECS @Synergyrad @UTHouston_IR @memorialhermann @_backtable @SIO_Central @VarianMedSys @HCIRad @SIRRFS @GESTSymposium @SIRspecialists Thanks

Really haven't seen angiographic shunting in these smaller HCCs. On y90 side, @riadsalemIR in @JHepatology this year- LSF clinically negligible in T1/T2 HCC pts w/o TIPS.

Larger tumors- shunt embolization, larger particles, or multikinase inhibitor 1 mo to decrease LSF?

[Phil Parmet, M.D. @pparmetIR]

76 yo F w/ NASH cirrhosis, 2.7 cm dome HCC. Atrophic liver (<600 ml), bili 1.9. Challenging location for ablation; concern for tipping liver func w/ y90 rad seg.

Opted for supraselective bland embo w/ 40 um Embozene. No pain, same day discharge. CR at 6 week f/u CT. @SIR_ECS

[Phil Parmet, M.D. @pparmetIR]

@AlanAlperMD @SIR_ECS @Synergyrad @UTHouston_IR @memorialhermann @_backtable @SIO_Central @VarianMedSys @HCIRad @SIRRFS @GESTSymposium @SIRspecialists @AlanAlperMD Exactly- post embolization CBCT. Just Embospheres and retained contrast in tumor; no injection.

[Phil Parmet, M.D. @pparmetIR]

56 yo M w/ 6 hrs worsening 10/10 abd pain. CTA shows acute arterial thrombosis of SMA branches, large eccentric plaque proximally.

Early dx and #withoutascalpel intervention by #IRad to reperfuse threatened bowel, fix inflow, and avoid extensive bowel resection. @SIRRFS @SIR_ECS

[Phil Parmet, M.D. @pparmetIR]

75 yo w/ endophytic renal mass referred for ablation. Poorly seen on US and NCCT, but intra-procedural IV contrast provided precise lesion delineation for cryoablation and biopsy needle placements. Pathology confirms clear cell RCC. #IceIceBaby #bracketology @SIRRFS @SIR_ECS

[Phil Parmet, M.D. @pparmetIR]

29 yo F w/ spontaneous renal bleed and pseudoaneurysm. Initial angio reveals the culprit AML which had ruptured. Tumor branches embolized with 300-500 um Embospheres, with additional microcoils for the pseudoaneurysm supply vessel. #IRad @SIR_ECS @GESTSymposium @SIRRFS

[Phil Parmet, M.D. @pparmetIR]

Life-threatening hematochezia localized by CTA to low rectum, successfully embolized by #IRad (superior rectal artery) #withoutascalpel. But be mindful of dual rectal arterial supply from both IMA and bilat IIAs. @SIRRFS @SIRspecialists @SIR_ECS

[Phil Parmet, M.D. @pparmetIR]

@keithppereira @SIR_ECS @SIRRFS Almost feels like cheating, but take the easy win when it’s there. For all those other times, @AustinBourgeois already covered the finer points of the “spray and pray” technique for non-dilated biliary access

[Austin Bourgeois @AustinBourgeois]

For this tweetorial I will explain how to place a biliary drain in a non-dilated system (in this case, for leak):

1) advance needle
2) eventually get lucky
3) place drain

I think that pretty much covers it. #irad #radres

[Phil Parmet, M.D. @pparmetIR]

64 yo pt with painless obstructive jaundice (total bili 14, direct 12). ERCP failed CBD cannulation, but bile ducts minimally dilated on CT.

When available, gallbladder stick for PTC can make an otherwise challenging case much easier. #SmarterNotHarder #IRad @SIR_ECS @SIRRFS

[Phil Parmet, M.D. @pparmetIR]

Added challenge of MALS anatomy

[Phil Parmet, M.D. @pparmetIR]

Ruptured splenic artery aneurysm in a 23 yo pregnant patient at 19 weeks. Emergent embolization (sandwich technique) by #IRad to save both mother and baby #withoutascalpel; collateral splenic perfusion maintained. @SIRspecialists @JVIRmedia @GESTSymposium @SIR_ECS @SIRRFS

[Phil Parmet, M.D. @pparmetIR]

CTA abdomen before going to angio (Pelvis shielded)