Wysdom Radio™

This episode breaks down a 2026 Journal of Vascular and Interventional Radiology Delphi consensus in which 14 international experts standardized the technical steps of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH). Across six procedural domains, the panel worked to turn a technically demanding, anatomy-dependent procedure into a set of evidence-based best practices. Cl...

This episode tackles the "Goldilocks dilemma" of TIPS: finding the stent diameter that stops a life-threatening variceal bleed without silently destroying a patient's cognition. Metabolic Cost: A TIPS decompresses the portal system but shunts ammonia-rich blood past the liver's filter and into the brain, where it triggers the astrocyte swelling behind hepatic encephalopathy (HE). 8mm vs. 10mm: The...

This episode breaks down the 2026 AHA/ACC/ACCP/ACPPE pulmonary embolism guidelines, highlighting the biggest changes to PE risk stratification, catheter-based interventions, and long-term follow-up. It also discusses how new randomized trials like STORM-PE and HI-PEITHO are shaping the future of interventional PE care. Biggest Change: The traditional "massive" and "submassive" PE classifications h...

This episode breaks down a 2026 Journal of Vascular and Interventional Radiology prospective case series evaluating transarterial embolization (TAE) as a minimally invasive treatment for chronic, refractory plantar heel pain. The study explores how targeting abnormal blood vessel growth may offer relief for patients who have exhausted traditional therapies. Clinical Problem: Nearly half of patient...

This episode breaks down a comprehensive 2024 Journal of Urology review on prostate artery embolization (PAE) , exploring how it compares to transurethral resection of the prostate (TURP) and medical therapy for benign prostatic hyperplasia (BPH) and why it was added to the 2023 American Urologic Association guidelines. The episode also features expert commentary from Dr. Timothy McClure of Weill...

This episode breaks down a JVIR retrospective study on Thyroid Artery Embolization (TAE) , exploring whether embolization can serve as a non-surgical alternative for high-risk patients with massive retrosternal goiters who are poor candidates for thyroidectomy.  Clinical Problem: Many patients with large compressive goiters are too medically complex for surgery, leaving few options when airway com...

This episode breaks down the newly published ARIVA trial ( Circulation ), a randomized study testing whether adding aspirin to rivaroxaban after post-thrombotic iliofemoral venous stenting actually improves stent patency or simply adds bleeding risk. Clinical Question: For years, endovascular specialists have reflexively prescribed dual therapy (anticoagulation + aspirin) after venous stenting, bu...

This episode breaks down the landmark C-TRACT trial ( NEJM 2026 ), a phase 3 randomized study testing whether iliac vein stenting plus enhanced antithrombotic therapy actually improves outcomes in patients with moderate-to-severe post-thrombotic syndrome (PTS).  The Clinical Question: Does restoring iliac venous outflow with stenting meaningfully improve symptoms and quality of life?  Result: Endo...

This episode breaks down a randomized controlled trial from Hepatology exploring whether prophylactic embolization of large spontaneous portosystemic shunts (SPSS) during TIPS can prevent post-procedural hepatic encephalopathy (HE). The Core Problem: Even successful TIPS can trigger HE by shunting toxins away from the liver, especially in patients with large preexisting SPSS.  The Key Strategy: Em...

This episode breaks down the landmark HI-PEITHO trial (NEJM, March 2026), a multicenter randomized controlled trial of 544 patients that finally brings clarity to the category of intermediate-risk PE. The Inclusion Criteria: HI-PEITHO mandated a strict "intermediate-high" entry bar: RV:LV ratio > 1.0 plus dual objective signs of distress (e.g., HR > 100, BP < 110). It isolates the cohort...

This brief covers a massive 950-patient study identifying how to predict Post-TIPS Liver Failure (PTLF), which occurs in approximately 18% of cases . The 18% Problem: With nearly 1 in 5 patients failing after TIPS, this study provides a vital roadmap for identifying high-risk candidates before they hit the table. Baseline Red Flags: Older age, a history of Hepatic Encephalopathy (HE), and celiac s...

This episode highlights the MILESTONE study , a ground-breaking first-in-human trial presented at the Society of Interventional Radiology (SIR) 2026 Annual Meeting . The research explores a novel endovascular approach to "rewiring" the body's metabolic control center to treat Type 2 Diabetes Mellitus (T2DM). A Safe Metabolic Rewire: Using a novel six-electrode catheter system , researchers perform...

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 thermal ab...

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 with flow. W...

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 waits for morning tea...

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 define the stakes of...

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 (risk...

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....