Wysdom Radio™

Wysdom

5.0 (2)
Medicine

We deliver short, focused episodes on the main concepts and procedures you actually need to know. It’s the perfect clinical companion for your drive to work or your daily workout. Come learn IR on the go! Check us out at https://www.medicalwysdom.ai/

3d ago

Fractured IVC Filter Fragments: When to Chase the Metal

This episode breaks down a 5-year Stanford registry of 82 patients presenting with fractured IVC filters and 185 embolized fragments, with commentary from the paper's lead author, Dr. Andrew Kesselman, from Stanford Interventional Radiology. The question is which fragments to chase and which to leave alone. Triage Comes First: Only 87 of 185 fragments (47%) were deemed intravascular and amenable to removal. Retroperitoneal fragments and peripheral pulmonary artery fragments were left alone by protocol, since traction on an extravascular strut risks caval avulsion.Geographic Gradient: Technical success was 100% for caval fragments (65 of 65), 64% in the proximal pulmonary arteries, and 50% for both cardiac and hepatic vein fragments, with an overall rate of 89.7%.The Cardiac Penalty: The one major complication in the series was a cardiac tamponade during right ventricular fragment removal, giving a 12.5% major complication rate for cardiac attempts. With only 8 attempts, the confidence interval runs from 0.3% to 52.7%, so the signal is directional rather than a number to quote in consent.Natural History: Among 19 patients with retained cardiopulmonary fragments, 81% remained asymptomatic at a mean follow-up of 845 days, which supports surveillance for embedded, inaccessible metal.Tools by Zone: Rigid endobronchial forceps dissect through neointimal hyperplasia in the cava, where a snare slips off endothelialized metal. Cardiopulmonary work shifts to snares with a steerable sheath to avoid the subvalvular apparatus.Caveats: Single center with more than 90% outside referrals and over half having failed prior attempts. The headline success rate applies only to the 47% of fragments selected for an attempt, and radiation burden was never quantified.Tune in to learn why the hardest part of fragment retrieval is deciding which pieces to walk away from. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.Kesselman AJ, Hoang NS, Sheu AY, Kuo WT. Endovascular removal of fractured inferior vena cava filter fragments: 5-year registry data with prospective outcomes on retained fragments. J Vasc Interv Radiol. 2018;29(6):758-764.
Aug 26

Procedural Path to 91% Complete Pathologic Necrosis

This episode breaks down COBRAS, a 2026 Radiology multicenter study of 303 patients and 364 treatment-naive HCC tumors bridged to liver transplant with glass microsphere radiation segmentectomy. Listen to the end to hear an expert commentary by Dr. Sid Padia from UCLA Interventional Radiology. Four Parameters: Microsphere activity of at least 1,087 Bq, at least 8,000 microspheres per mL, a single-compartment dose of at least 400 Gy, and an angiosome-to-tumor ratio of 16 or greater.Stacked Result: Positive predictive value for complete pathologic necrosis rose from 74% with activity alone to 91% with all four thresholds met. Meeting none carried a 78% failure rate.Biggest Lever: ATR had the highest odds ratio in the model at 3.4, which argues for pulling the catheter proximal to cover occult parasitic feeders rather than superselecting to the tumor border.Caveats: Retrospective, glass microspheres only, limited to patients who reached transplant, and CPN remains a surrogate endpoint not yet tied to long-term survival.Tune in to learn why the physics inside the vial and the position of your catheter may matter as much as the dose number on the screen. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.Berman ZT, De la Garza-Ramos C, Montazeri SA, et al. Consortium on Bridging Radiation Segmentectomy (COBRAS): A Multicenter Study of Complete Pathologic Necrosis in Hepatocellular Carcinoma. Radiology. 2026;319(2):e251923.
Aug 20

Treat the Patient, Not the Picture: Rethinking Pelvic Venous Disease

This episode breaks down the latest Society of Interventional Radiology guidance on chronic pelvic pain of venous origin, focusing on patient selection and why technically successful procedures may not relieve pain. It concludes with expert commentary from Dr. Gloria Salazar of the UNC School of Medicine. Beyond the Old Labels: The Symptoms-Varices-Pathophysiology classification replaces older labels and distinguishes reflux from obstruction.Pain Is More Than Plumbing: Pelvic floor tension and nervous system sensitization may persist after the venous abnormality is treated.The Supine Imaging Trap: Left renal vein compression changes dramatically with position, making static imaging alone unreliable.Protect the Renal “Pop-Off Valve”: A pressure gradient above 3 mm Hg during ovarian vein occlusion may indicate essential collateral drainage.Technical Pearls: Proper sclerosis, embolic sizing, anchoring, and stent landing zones help prevent treatment failure.Stent or Embolize: Conflicting outcomes show why treatment must target the patient’s dominant pain mechanism.Tune in to learn why pelvic venous interventions should be guided by symptoms and dynamic hemodynamics, not abnormal anatomy alone. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.Kaufman CS, Winokur RS, Khilnani NM, et al. The Society of Interventional Radiology Practice Guidance Document on Venous-Origin Chronic Pelvic Pain in Women. J Vasc Interv Radiol. 2026;37:107954.
Aug 12

The Inguinal Ligament Myth: What Really Drives Stent Failure

This episode pairs a 22-year Stanford retrospective of 1,094 lower extremity venous stents in 406 patients with the 3-year VIVO IDE trial of the Zilver Vena stent, and asks whether crossing the inguinal ligament actually dooms a venous stent. Where the Rule Came From: The recommendation against stenting below the lesser trochanter traces back to citations from 1987 and 1997 that evaluated surgical bypass grafts, not endovascular stents.Apples to Oranges: Mabud reports 57.3% five-year primary patency against VIVO's 90.3% three-year ultrasound patency, but Mabud counts any reintervention as failure. Its five-year assisted patency is also 90.3%.Below the Ligament: Stents extended below the ligament in 32.5% of VIVO patients, with statistically identical 30-day safety (96.2% vs 96.9%, P = .76) and no significant patency difference at 12 months (83.3% vs 93.0%, P = .31). The higher reintervention rate tracked with worse baseline disease: lesions averaged 15.6 cm versus 7.1 cm and were four times more likely to be fully occlusive.Hardware Is Not the Problem: Across roughly 1,459 stents spanning 30 years of technology, including stents landed in the common femoral, femoral, and popliteal veins, there were zero reported fractures.Practical Rule: Normal vein to normal vein, securing at least 8 mm of healthy inflow, downsizing to 10 to 12 mm infra-inguinally. Post-stent, a DOAC alone is sufficient, since adding aspirin increases bleeding without improving patency.Tune in to learn why inflow quality, not an anatomic landmark, should decide where your stent lands. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.Mabud TS, Cohn DM, Arendt VA, et al. Lower extremity venous stent placement: a large retrospective single-center analysis. J Vasc Interv Radiol. 2020;31(2):251-259. Comerota AJ, Gagne P, Brown JA, Segbefia E, Hofmann LV; VIVO Clinical Study Investigators. Final 3-year study outcomes from the evaluation of the Zilver Vena venous stent for the treatment of symptomatic iliofemoral venous outflow obstruction (the VIVO clinical study). J Vasc Interv Radiol. 2024;35(6):834-845.
Aug 9

The TIPS Trade-Off: Bleeding vs. Brain

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. Listen to the end to hear the expert commentary from Ziv Haskal from University of Virginia. 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 Huang meta-analysis found that 8mm stents delivered better one- and three-year survival and lower HE risk than 10mm stents, despite slightly more shunt dysfunction.6mm vs. 8mm: The Zhang RCT randomized 144 cirrhotic patients to 6mm or 8mm stents. The 6mm group had a higher 2-year rebleeding rate (35.2% vs. 24.1%) but far less overt HE (20.3% vs. 42.0%), with nearly identical survival (84.6% vs. 83.0%).Population Question: The Gong meta-analysis backs this up across mostly Asian cohorts, showing 6–7mm stents roughly halve HE risk versus 8mm without hurting survival. But the data leans on smaller Asian liver volumes and may not translate directly to Western patients.Guideline Shift: EASL now recommends small-diameter stents for patients at high risk of HE, reflecting a shift toward accepting a bit more rebleeding risk to protect the brain.Caveats: The Zhang trial was single-center and open-label, and Gong's conclusions lean on retrospective data that can't fully settle the shunt-dysfunction debate the way Huang's harder data can.Tune in to learn why the field is moving from "bigger is safer" to personalized stent sizing based on individual liver anatomy. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field. Zhang W, Zhang M, Xiao J, et al. Efficacy of 6-mm and 8-mm Transjugular Intrahepatic Portosystemic Shunt for Variceal Bleeding: A Randomized Controlled Trial. Clin Gastroenterol Hepatol. 2026;24(1):161-171. doi:10.1016/j.cgh.2025.06.023Gong J, Xia Z, Zhou Z, Chen L, Wang X, Zhou F. Effectiveness and prognosis of covered stents with different diameters in transjugular intrahepatic portosystemic shunt: a meta-analysis. Eur J Gastroenterol Hepatol. 2024;36(2):229-237. doi:10.1097/MEG.0000000000002696Huang Z, Yao Q, Zhu J, He Y, Chen Y, Wu F, Hua T. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis. Diagn Interv Imaging. 2021;102(5):279-285. doi:10.1016/j.diii.2020.11.004
Aug 5

From CTA to the Angio Suite: A GI Bleeding Playbook

This episode breaks down the 2024 ACG/Society of Abdominal Radiology consensus statement alongside a 2025 Duke University update, mapping out exactly which imaging test to reach for at each stage of a GI bleed and when IR should step in. Dr. Rusty Hofmann from Stanford University closes with his commentary. CTA Takes First-Line: For unstable patients or high clinical suspicion, CTA now leads with ~95% accuracy, and even a negative scan is useful, it predicts lower rebleeding and reintervention rates.The RBC Scan's Blind Spot: Reserved for stable, post-negative-colonoscopy cases, tagged RBC scans carry a 10-33% localization error, enough to send an IR team down the wrong vessel entirely.CTE Over Capsule for Small Bowel: CT enterography is now preferred first-line for small bowel bleeding, especially with capsule-retention risk or suspected GISTs that a pill camera would miss.Coils Beat Particles: At the vasa recta, particle embolization carried 5.3% severe ischemia risk versus 0% for coils alone, a strong case for targeted, extravasation-confirmed embolization.The Break-Glass Option: When all standard imaging fails, provocative mesenteric angiography proved safe via first-pass hepatic clearance of TPA, but only pays off with hematochezia plus a prior positive study; melena with clean imaging predicts a wasted procedure.Tune in to build a modality-by-modality protocol, from first scan to break-glass angiogram. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.ACG and SAR Consensus Statement on GI Bleeding Imaging: Sengupta N, Kastenberg DM, Bruining DH, et al. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology. 2024;310(3):e232298Duke University Provocative Angiography Study: Benvenuti et al. Provocative Mesenteric Angiography for Obscure Gastrointestinal Hemorrhage: An Update on Outcomes, Safety, and Predictors of Success. J Vasc Interv Radiol. 2025;36:1558-1566
Jul 29

48 Hours to Failure: Anticoagulants and Portal Vein Stents

This episode breaks down a 2026 JVIR retrospective study from the Mayo Clinic (Bretzman et al.), examining portal vein stent outcomes in 182 pancreatic cancer patients, and why the usual fixes for early stent failure may be missing the real cause. At the end, Dr. Rusty Hofmann from Stanford University adds his commentary on the paper. The Surprise on Hardware: Covered vs. bare metal stents showed no significant patency difference, and residual stenosis over 30% didn't predict failure either. This runs counter to standard mechanical assumptions.Fast, Not Slow, Failure: With 74.6% patency at one year, the stents that do fail occlude fast, a median of just 2 days, pointing to acute thrombosis rather than gradual tumor ingrowth.The Real Driver: The strongest predictors were pre-existing portal occlusion, periportal inflammation, and robust collaterals, evidence for "immunothrombosis," where tumor-driven inflammation triggers clotting at the stent itself.The Anticoagulation Question: Despite 74.7% of patients on anticoagulation, it showed no significant patency benefit, though study limitations leave room for debate.Dr. Hofmann's Take: He pushes back in his closing commentary, arguing that dosing and drug choice matter more than the paper suggests, and that tissue factor from direct tumor invasion, not anticoagulation intensity, is the real culprit.Tune in to find out whether it's the blood thinner or the biology calling the shots. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field. Bretzman J, Andrews J, Ge S, Kassmeyer B, Fleming C. Portal vein stent placement in a pancreatic cancer cohort: outcomes and predictors of portal stent occlusion. J Vasc Interv Radiol. 2026;37(8):108852. doi:10.1016/j.jvir.2026.108852.
Jul 22

Wrist vs. Risk: Rethinking Transradial Access After MOSAIC

This episode unpacks a letters-to-the-editor debate sparked by the MOSAIC study (a Japanese multi-center trial in JVIR) and turns it into a practical framework for reducing embolic stroke risk during transradial visceral and hepatic interventions. Of 55 patients who underwent transradial access, 9 (16.4%) showed silent brain infarction on post-procedure MRI. It's the Plaque, Not the Angle: Eight of nine stroke patients were over 70 (mean age 80). The letters argue calcified arch plaque, not subclavian angulation, is the real culprit, and propose a pre-procedural chest CT for patients over 70, defaulting to femoral if significant arch plaque is found.Time in the Arch Matters: Stroke cases averaged 9 minutes to reach the descending aorta versus 1 minute for non-stroke cases. The fix: minimize arch exchanges and favor a microcatheter/micro-guidewire combo with soft J-tip wires over angled hydrophilic ones.Rethinking Anticoagulation: ACT-guided heparin dosing is unreliable transradially, risking silent under-heparinization. The proposed alternative is a fixed protocol: 3,000–5,000 IU upfront, then 1,000 IU every 30 minutes, ignoring ACT entirely. Tune in to learn how patient selection, wire technique, and a rethought anticoagulation strategy can keep silent strokes off your transradial cases. This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.Iezzi R, Bilhim T, Pua U, et al. Radial access in interventional radiology and the risk of stroke: lessons learned. J Vasc Interv Radiol 2026; 37:108778. https://doi.org/10.1016/j.jvir.2026.108778Koretsune Y, Sone M, Higashihara H. Authors' reply to "Radial access in IR and the risk of stroke: lessons learned." J Vasc Interv Radiol 2026; 37:108777. https://doi.org/10.1016/j.jvir.2026.108777

5

out of 5

2 Ratings

We deliver short, focused episodes on the main concepts and procedures you actually need to know. It’s the perfect clinical companion for your drive to work or your daily workout. Come learn IR on the go! Check us out at https://www.medicalwysdom.ai/

Creator

Wysdom
Years Active

2025 - 2026
Episodes

47
Rating

Clean
Copyright

© 2026 Wysdom
Show Website

Wysdom Radio™

Medicine

Medicine

Updated Weekly
Medicine

Medicine

Updated Weekly
Medicine

Medicine

Updated Biweekly
Business

Business

Updated Semiweekly