Wysdom Radio™

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 presentation appearing 4-8 weeks post-procedure: significant jaundice (Bilirubin >3) and ascites in the absence of tumor progression.

The "Combined Insult" Theory: The discussion highlights that this injury is often synergistic, occurring when the liver is "primed" by prior systemic chemotherapy, making the tissue far more vuln...

Duration: 00:10:50

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.

The "Hidden" Drivers: Learn why an exhaustive workup is mandatory, as up to 52% of these patients have an underlying prothrombotic disorder (like JAK2 mutations) alongside local inflammation.

Interventional Strategy: The conversation highlights...

Duration: 00:15:03

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) to determine when to use this aggressive diagnostic maneuver.

The Safety Surprise: Despite intentionally provoking bleeding with TPA and Nitroglycerin, the study revealed zero major bleeding adverse events, thanks to "first-pass hepatic metabolism" clearing the drugs before they hit t...

Duration: 00:13:06

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 from 2D pictures, leading to poor device sizing and missed complications like dissections.

The IVUS Advantage: IVUS provides a 360-degree blueprint from inside the artery, allowing for precise sizing and detection of calcified plaque that angiography misses.

Rea...

Duration: 00:13:10

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 Gauge Paradox): We explain why lower numbers mean bigger needles (e.g., an 18-gauge is larger than a 21-gauge) and how to use the "Fit Rule" to match needles to wires (e.g., a 0.035" wire needs at least an 1...

Duration: 00:05:02

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" vacuum method—and why you must always hold syringes horizontal or tip-up during injection.

Expert Grip: Learn why precise tools (scalpels) need a "pencil grip," while clamps should be "palmed" (avoiding the finger loops) to utilize the then...

Duration: 00:04:45

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 rule: hold the internal stiffener stationary while pushing the catheter off it to ensure it curls correctly inside the fluid collection.

The Anatomy of a Stick: Effective hemostasis requires understanding that the hole in the artery is superior (high...

Duration: 00:03:58

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 & Plugs (The "Proximal" Blockers): Master mechanical occlusion. We cover simple pushable coils, high-precision detachable coils, and the "big guns" like vascular plugs. We also cover the golden rule of 20-30% oversizing. Liquid Embolics (The "Casting" Agents): Get a h...

Duration: 00:12:26

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 anticoagulation). The "How": The cardinal rule of placement: always deploy infrarenally and why this is critical. The "What's Next": The new standard of care—why filters are retrievable and the serious complications (thrombosis, pe...

Duration: 00:06:27

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 into the procedure for knee osteoarthritis. Learn about the evidence supporting it, who makes a good candidate, and how it provides durable pain relief and functional improvement. Shoulder Embolization: How this technique is used to treat...

Duration: 00:14:14

🎙️ 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 freezing the nerve to a precise temperature range (below -20°C but warmer than -100°C) to destroy the pain pathway while preserving the nerve's outer structure, allowing for healthy regeneration and avoiding painful neuromas.

The Role of Advanced Imaging: Learn w...

Duration: 00:15:19

🎙️ 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 stopping the immediate bleed (89% technical success at 30 days), the patient's underlying disease severity remains a major factor in overall survival.

The Crucial Role of Non-Bronchial Arteries: The CF data highlights the need for optim...

Duration: 00:15:18

🎙️ 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: Covered stents are now standard, and smaller 8mm stents are preferred to minimize the risk of Hepatic Encephalopathy (HE).

Trade-Off: It reduces the risk of bleeding but increases the risk of HE (brain fog/confusion).

RTO/ATO (Retr...

Duration: 00:16:43

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 significantly superior to AC alone, resulting in:

A greater than twofold reduction in deadly right ventricular (RV) strain within 48 hours.

A threefold higher chance of RV normalization.

A 100% resolution of high heart rate (tach...

Duration: 00:16:28

🎙️ Wisdom Radio: Managing Parastomal Variceal Bleeding—Embolization vs. TIPS

This episode dives into the high-stakes management of Parastomal Variceal Bleeding (PVB), a rare but life-threatening complication of portal hypertension, often seen in patients with significant comorbidities (like metastatic cancer) where a TIPS procedure is initially contraindicated.

The Clinical Dilemma: We explore a case study of a patient ruled out for TIPS due to metastatic disease, shifting the entire burden of hemorrhage control to local embolization techniques like Percutaneous Antegrade Transhepatic Venous Obliteration (PATVO).

Technical Mastery: The episode breaks down the critical need for a multi...

Duration: 00:13:59

🎙️ CREST-2 Results—A Paradigm Shift in Carotid Care

This episode unpacks the long-awaited results of the CREST-2 Trial, a landmark study that challenges the standard of care for treating asymptomatic carotid stenosis (narrowing of the carotid artery without recent stroke symptoms).

The Big Question: Does adding invasive revascularization (Endarterectomy or Stenting) to Intensive Medical Management (IMM) prevent more strokes than medication and lifestyle changes alone?

The Clear Verdict: After 10 years of research, the trial was stopped early for "futility," meaning the results were conclusive: there was no significant difference in stroke or death rates b...

Duration: 00:16:29