Wysdom Radio™

The COLLISION Explained This episode breaks down the practice-changing COLLISION Trial (Lancet Oncology, 2025) and explores how the IR community must scale its skills to meet the new standard of care. The Mic Drop: For decades, surgical resection was the undisputed gold standard for Colorectal Liver Metastases (CRLM). The COLLISION trial randomized patients eligible for both surgery and therm...

AHA/ACC 2026 Guidelines for the Evaluation and Management of Acute Pulmonary Embolism The alphabet soup of societies (AHA/ACC/ACCP/ACP) has officially released the 2026 Multi-Society PE Guidelines. These guidelines move the field away from the blunt submassive labels and into a new era of granular, physiology-driven care. Categories Classifications A–E: The 2011 AHA labels are officially retired....

Stanford IR's Dr. Lynne Martin on PAVM Treatment This episode covers the critical paradigm shift in treating Pulmonary Arteriovenous Malformations (PAVMs) as detailed by Dr. Lynne Martin from Stanford Interventional Radiology. We discuss why the old "block the pipe" method is obsolete and how to achieve durable, definitive occlusion. The Silent Neurological Threat: We explore why intervention isn'...

TIPS for TIPS: The "Best Chance" Protocol This episode tackles one of the most technically demanding procedures in IR, breaking down   Dr. John Louie’s   protocol to transform the traditional "blind stick" of a TIPS procedure into a visualized, scientific process. The Visualization Crisis: Standard iodinated contrast fails to opacify the portal vein 75% of the time because it washes out...

Thyroid Interventions: RFA vs. Microwave & The Embolization Solution This episode breaks down the evolving landscape of benign thyroid management, pitting the two thermal ablation titans against each other and exploring the vascular solution for massive goiters. The 12-Month Divergence (RFA vs. MWA): A 2025 meta-analysis reveals that while short-term results are similar, Radiofrequency Ablatio...

Provocative Mesenteric Angiography: Safety and Efficacy in Occult GI Bleeding This episode tackles one of the most frustrating clinical challenges in Interventional Radiology: the patient with a recurrent occult GI bleed who has failed endoscopy and standard imaging. We analyze the largest retrospective cohort study to date (22 years of data) on TPA-based Provocative Mesenteric Angiography (PMA) t...

Dr. Rusty Hofmann , Professor of Interventional Radiology and founder of Wysdom, drops essential night-call wisdom after 25+ years of taking call: when & why to come in, how residents/fellows should present cases, and his famous   6 Cs mnemonic   to never forget critical prep at 2–3 AM. Key takeaways: Only come in for life- or limb-threatening emergencies   — everything else wai...

Y-90 High Lung Shunt: The Mitigation Playbook This episode is inspired by  Professor of Interventional Radiology Dr. John Louie from Stanford IR and  moves beyond the standard safety guidelines to provide a practical "playbook" for managing the high lung shunt patient, focusing on how to prevent fatal Radiation Pneumonitis (RP) without canceling the case.  The Hidden Threat: We defi...

Portal Vein Embolization, Liver Venous Deprivation, and the DRAGON Trial Data This episode synthesizes the latest CIRSE standards and DRAGON trial findings to guide Interventional Radiologists in maximizing the Future Liver Remnant (FLR) and minimizing Post-Hepatectomy Liver Failure (PHLF). The Limitation of Standard PVE: We discuss why Portal Vein Embolization (PVE) alone often isn't enough, with...

GAE for Knee Osteoarthritis: The Resorbable Solution This episode explores the first-in-human trial of Sakura, a novel resorbable alginate microsphere designed specifically to solve the safety trade-offs of Genicular Artery Embolization (GAE) for knee osteoarthritis. The Problem with Current Agents: We discuss why Interventional Radiologists have been stuck between using permanent particles (...

In this episode, Dr. Kim Scherer, Assistant Professor of Radiology at Weill Cornell and Associate Program Director, shares her top five pieces of advice for navigating the challenges of an Interventional Radiology residency. You Get Out What You Put In: Residency isn't medical school; there are no weekly tests. Success requires self-guided learning, reading every night, and showing up early to see...

Y-90 Liver Toxicity: Understanding and Preventing REILD This episode investigates the specific, aggressive liver injury that can follow Y-90 Radioembolization—Radioembolization-Induced Liver Disease (REILD)—defining it not as simple radiation necrosis, but as Hepatic Sinusoidal Obstruction Syndrome (SOS), essentially Veno-Occlusive Disease (VOD). The Clinical Picture: We identify the hallmark pres...

This episode provides a deep dive into the management of Acute Porto-Mesenteric Venous Thrombosis (PVT) in non-cirrhotic patients, a condition with a 30-day mortality rate of up to 32% if the clot extends into the mesenteric veins. The Limitations of Meds: We discuss why systemic anticoagulation often fails, achieving complete recanalization in only 50% of patients due to the sheer volume of clot....

Provocative Mesenteric Angiography: Safety and Efficacy in Occult GI Bleeding This episode tackles one of the most frustrating clinical challenges in Interventional Radiology: the patient with a recurrent occult GI bleed who has failed endoscopy and standard imaging. We analyze the largest retrospective cohort study to date (22 years of data) on TPA-based Provocative Mesenteric Angiography (P...

Evidence for IVUS in PAD This episode uncovers the compelling evidence behind   Intravascular Ultrasound (IVUS), a technology that is revolutionizing the treatment of Peripheral Artery Disease (PAD) by fixing the fundamental flaw of traditional angiography: its "2D shadow" limitation. The Problem with Angiography:   Standard X-ray imaging forces doctors to guess the size of 3D arteries f...

IR Procedural Best Practices: Setup, Grip, and Wire Handling This episode moves beyond basic instrument knowledge to focus on the subtle physical habits and organizational tricks that distinguish expert operators from novices, aiming to maximize efficiency and safety. Air Bubble Management: We review the three techniques for removing deadly air bubbles—inversion, flicking, and the "push-pull" vacu...

IR Basics: Needles, Wires, Catheters, and Sheaths This episode provides a rapid-fire masterclass on the four foundational tools of Interventional Radiology and how to navigate the complex sizing systems that dictate their use. The Sizing Headache: We demystify the three conflicting measurement systems—Gauge, French, and Inches—that every interventionalist must juggle simultaneously. Needles (The G...

IR Procedural Skills: Pigtail Catheters and Manual Hemostasis This episode breaks down the mechanics of two foundational interventional skills—drainage catheter deployment and arterial compression—where proper technique is the only line of defense against complications. The Pigtail Mechanism: We explain how the "locking loop" secures the catheter to prevent migration and the critical deployment ru...

This fundamental episode builds your mental toolbox by outlining the three main categories of embolic agents you'll use every single day. We break down the core principles, "why," and critical safety rules for: Particulates (The "Downstream" Stuff):   Learn the difference between temporary (Gelfoam) and permanent (PVA, Embospheres) agents. When do you use each for trauma, UFE, or TACE? Coils...

What if chronic joint pain from osteoarthritis and tendinopathy isn't just "wear and tear"? This episode explores the cutting-edge, minimally invasive world of Musculoskeletal Embolization. Discover the science behind how this procedure targets abnormal blood vessels (angiogenesis) and nerves that contribute to chronic pain. Tune in to learn about: Genicular Artery Embolization (GAE): A deep dive...

This episode is a complete introduction to IVC filters, designed for the IR trainee. We cover all the essentials you need to know from the initial consult to long-term follow-up. What you'll learn: The "Why": Why filters are not first-line therapy and are only used to prevent PE. The "When": The two absolute indications for filter placement (contraindication to anticoagulation and failure of antic...

🎙️ Wysdom Radio: BAE Insights from the Experts This episode of Morning Rounds delivers a direct line to critical research on Bronchial Artery Embolization (BAE), the life-saving procedure used to stop massive hemoptysis (coughing up blood). CF Patient Effectiveness: We analyze a long-term Stanford study on BAE in adults with Cystic Fibrosis (CF), revealing that while BAE is highly effective at sto...

🎙️ The Evolution of Cryoneurolysis: Regulatory Shifts and New Targets This episode explores Cryoneurolysis, a cutting-edge interventional radiology technique that uses extreme cold to precisely disable nerves and stop chronic pain without addictive opioids. The "Sweet Spot" of Freezing: We break down the critical science of achieving a Sunderland Grade 2 injury (axonotmesis). This requires freezin...

🎙️ Wysdom Radio:   Portal Hypertension, TIPS, and RTO—Latest AASLD Guidance This episode breaks down the critical differences between the two main endovascular strategies for managing variceal bleeding in patients with portal hypertension: TIPS (Transjugular Intrahepatic Portosystemic Shunt): A procedure that acts as an internal bypass to lower the overall portal pressure. New Guidance:...

This episode dives into the STORM PE Randomized Control Trial, which fundamentally shifts how we treat patients with intermediate high-risk Pulmonary Embolism (PE)—those who look stable but have hidden heart strain. ⚡ Key Findings Rapid Decompression: The trial compared standard anticoagulation (AC) alone to AC plus Computer-Assisted Vacuum Thrombectomy (CAVT). Superior Efficacy: CAVT was signifi...