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Wysdom Radio™

Wysdom

Health & Fitness

Frequency: 1 episode/6d. Total Eps: 42

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/

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🇬🇧 Great Britain - Medicine
23/07/2026
#71

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https://doi.org/10.1016/j.ejvs.2024.10.002
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https://doi.org/10.1016/j.jvir.2024.11.030
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https://doi.org/10.1016/j.jvir.2025.10.033
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48 Hours to Failure: Anticoagulants and Portal Vein Stents

Episode 14

Wednesday, July 29, 2026 • Duration 20:16

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.

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.

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Wrist vs. Risk: Rethinking Transradial Access After MOSAIC

Episode 13

Wednesday, July 22, 2026 • Duration 06:24

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.2026.108778
Koretsune 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

Venous Stents: How Much Inflow is Enough?

Episode 12

Wednesday, July 15, 2026 • Duration 20:20

This episode breaks down two recent retrospective studies in deep venous work: a stent that looks well deployed on the table can still thrombose within weeks, because the low-flow venous system punishes any stasis. Following, there is a great commentary by Dr. Rusty Hofmann from Stanford University.

Clinical Question: Can venous stent outcomes, long treated as operator-dependent and hard to forecast, be predicted before intervention from anatomy and inflow quality alone?
Anatomical Classification: A multicenter EJVES study of 1,033 patients proposed a five-type system graded by how far chronic venous obstruction extends, from a non-thrombotic iliac lesion (type 1) to obstruction of both main inflow veins (type 5). Twelve-month primary patency dropped step by step with extent: 94.9%, 90.3%, 80.8%, 60.6%, and 39.4% for types 1 through 5.
Inflow Quality: A single-center JVIR study of 80 post-thrombotic limbs isolated inflow as the mechanism. One-year primary patency was 89.2% with no inflow disease, 57.7% with single-vessel disease, and 47.1% with double-vessel disease. Femoral vein inflow disease was the only independent predictor of failure, with an odds ratio of 10.99.
Timing and Salvage: In the JVIR cohort every primary patency loss occurred within the first 30 weeks, yet secondary patency stayed high in both studies. Stenting complex disease is best framed to patients as a re-intervention pathway, not a single definitive fix.
Limitations: Both studies are retrospective, without a core lab, and grade inflow visually rather than by any flow-volume metric, so the reported later patency numbers likely run optimistic.

Tune in to learn how anatomical extent and inflow quality can turn one of the least predictable procedures in the venous space into a risk-stratified workflow with honest expectations set up front.

Jalaie H, Barbati ME, Piao L, et al. Prognostic value of a classification system for iliofemoral stenting in patients with chronic venous obstruction. 2025;69:315-322.

14 Experts, One Consensus: How to Make Prostate Embolization Safer

Episode 11

Wednesday, July 8, 2026 • Duration 05:54

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.

Clinical Question: Can a procedure defined by wide anatomical variability and operator-dependent outcomes be standardized enough to make PAE safer and more reproducible?
Access Route: The panel reached 93% agreement that both radial and femoral access are acceptable. Radial offers same-day comfort but carries a real tradeoff: a recent prospective study found silent brain infarctions in up to 40% of cases. That risk can be significantly reduced with periprocedural anticoagulation and by cannulating the descending aorta in under 58 seconds.
Embolic Choice: With 86% agreement, 300 to 500 μm particles remain the preferred baseline. The best available randomized trial showed they deliver similar midterm effectiveness to 100 to 300 μm particles with fewer minor adverse events, helping settle a long-running particle-size debate.
Imaging: Intraprocedural cone-beam CT earned 86% agreement as a recommended step for mapping the hemipelvis, identifying nontarget vessels, and reducing procedure time and radiation.
Nontarget Protection: The panel hit 100% agreement that protective coil embolization of rectal and accessory pudendal branches is safe, with multiple studies showing no deterioration in erectile function.
Emerging Techniques: Liquid embolics and the coil-out technique are promising for the roughly 20% of patients who recur, but the consensus is clear that neither yet has the long-term data to replace standard particle embolization.

Tune in to learn how 14 experts turned one of interventional radiology's most anatomically variable procedures into a standardized, safer workflow.

The TIPS Trade-Off: Bleeding vs. Brain

Episode 10

Wednesday, July 1, 2026 • Duration 19:17

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 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.

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.2025.06.023
Gong 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

New PE Guidelines: When to Intervene

Episode 9

Wednesday, June 24, 2026 • Duration 21:36

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 have been replaced with a new A through E risk framework, placing greater emphasis on dynamic clinical assessment and early recognition of patient deterioration.
High-Risk Patient: The guidelines introduce Category D2, or normotensive shock, recognizing that patients with normal blood pressure but elevated lactate or signs of end-organ hypoperfusion may require urgent intervention.
New Data Shows: Recent randomized trials demonstrated that catheter-based therapies improve right ventricular recovery and reduce clinical decompensation in intermediate-high risk PE, although long-term mortality benefits remain under investigation.
Safety Pearl: The guidelines strongly caution against routine deep sedation in acute PE, noting a markedly increased risk of cardiopulmonary collapse with propofol in unstable patients.
Bottom Line: These guidelines shift PE management from static risk categories to continuous reassessment and reinforce that interventional specialists should play an active role in both acute treatment and long-term follow-up.

Tune in to learn how the new PE guidelines could change which patients receive intervention and when. Wysdom recommends that you check out PECompass.org. It was founded by Dr. Mona Ranade from Stanford IR and also a co-author of this paper. It is a great app in which you put in the clinical information about your patient and it will calculate what category your patient fits into.

Bulman JC, Ranade M, Sista AK, Lookstein RA, Wilkins LR. The 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: Pertinent Points for the Interventional Radiologist. J Vasc Interv Radiol. Published online 2026. doi:10.1016/j.jvir.2026.108899

Embolization for Plantar Fasciitis: Technique and Early Results

Episode 8

Wednesday, June 17, 2026 • Duration 16:43

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 patients with plantar fasciitis remain symptomatic even after 10 years, and no single conservative treatment has consistently outperformed the others.
New Approach: Rather than treating the plantar fascia itself, TAE targets the abnormal neovessels that sustain chronic inflammation and pain.
Headline Result: At six months, 71% of patients responded to treatment, with major improvements in pain, quality of life, function, and a complete elimination of missed workdays among affected participants.
Safety Profile: The procedure was performed as an outpatient with zero reported major adverse events and no evidence of osteonecrosis or tissue injury on follow-up MRI.
Caveat: This was a small, single-center case series without a control group, so larger randomized trials are still needed to confirm how much of the benefit comes from embolization itself.
Bottom Line: For patients with chronic plantar heel pain who have failed standard treatments, transarterial embolization is emerging as a promising minimally invasive option that could reshape how we approach chronic musculoskeletal pain.

Tune in to learn how interventional radiology is taking on one of the most frustrating conditions in sports medicine.

Gill S, Hely R, Harrison B, Hely A, Landers S. Transarterial embolization to improve plantar heel pain: 6-month results from a prospective case series. 2026;37:108688. https://doi.org/10.1016/j.jvir.2026.108688

Why PAE Made the American Urologic Association Guidelines

Episode 7

Wednesday, June 10, 2026 • Duration 16:37

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 Cornell Medicine, who highlights the importance of patient selection in real-world PAE practice.

Clinical Question: Can PAE relieve moderate-to-severe BPH symptoms while avoiding the bleeding, recovery time, and sexual side effects of TURP?
Headline Result: Across randomized trials, PAE reduced IPSS scores by 9 to 21 points, shrank prostate volume by 20 to 30%, and outperformed both sham procedures and medical therapy in symptom relief.
Safety Advantage: PAE is a same-day outpatient procedure with no postoperative catheter, near-zero transfusion risk, and strong preservation of sexual function when performed with cone beam CT guidance.
Trade-Off: Symptom relief is strong, but urinary flow improvements and long-term durability remain inferior to TURP, with recurrence increasing over time.
Bottom Line: For patients with larger prostates who prioritize preserving sexual function, PAE is now a guideline-supported middle ground between medication and surgery. Dr. McClure also explains why identifying the right patient is key to success.

Tune in to learn which BPH patients are best suited for PAE and when surgery still makes the most sense.

Mouli S, Salem R, McClure TD. Prostate artery embolization for benign prostatic hyperplasia. J Urol. 2024;212:216-219. https://doi.org/10.1097/JU.0000000000003976

Can Thyroid Embolization Replace Surgery for Nodular Goiter?

Episode 6

Tuesday, June 2, 2026 • Duration 05:34

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 compression and hyperthyroidism worsen symptoms.
Endovascular Strategy: Using a femoral approach with selective embolization of thyroid feeders, operators intentionally leave at least one artery patent to achieve volume reduction while avoiding total gland necrosis and hypoparathyroidism.
Headline Result: At six months, dominant thyroid nodule size and retrosternal extension were dramatically reduced, with most patients experiencing meaningful mechanical decompression and improved airway anatomy.
Hormonal Benefit: Among patients with non-Graves hyperthyroidism, most became euthyroid after embolization, suggesting TAE may improve both compressive and endocrine symptoms.
Caveat: This was a small retrospective study with mixed imaging modalities, short follow-up, and real procedural risks: including transient hyperthyroidism, hoarseness, and a reported 1.8% 30-day mortality rate.
Bottom Line: For carefully selected poor surgical candidates with massive retrosternal goiters, thyroid artery embolization may offer a promising minimally invasive debulking strategy, but long-term durability still needs prospective study.

Tune in to learn whether IR may soon have a larger role in managing patients traditionally sent straight to thyroid surgery.

Yilmaz S, Arıoz Habibi H, Yildiz A, Altunbas H. Thyroid embolization for nonsurgical treatment of nodular goiter: a single-center experience in 56 consecutive patients. 2021;32:1449-1456. https://doi.org/10.1016/j.jvir.2021.06.025

Anti-platelets and venous stents: Lessons from ARIVA and C-TRACT

Episode 5

Tuesday, May 26, 2026 • Duration 16:21

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, but ARIVA asks whether aspirin is actually improving outcomes in low-flow venous systems.
Result: Primary patency at six months was nearly identical, 94.8% with rivaroxaban + aspirin versus 92.4% with rivaroxaban alone, suggesting no meaningful benefit to routinely adding aspirin.
Bleeding Trade-Off: While major bleeding was absent in both groups, clinically relevant non-major bleeding was more than tripled with dual therapy (8.2% vs. 2.4%), with menorrhagia emerging as a major issue in this predominantly younger female cohort.
Why This Matters: When synthesized with C-TRACT, ARIVA suggests we may be overtreating venous stent patients by applying arterial antiplatelet logic to fundamentally different venous biology.
Caveat: ARIVA was stopped early and excluded patients with active cancer or poor medication adherence, meaning high-risk populations still require individualized decision-making.
Bottom Line: For most standard post-thrombotic iliofemoral stenting cases with good inflow and optimized IVUS-guided deployment, full-dose rivaroxaban alone may be enough without the added bleeding burden of routine aspirin.

Tune in to learn whether it is finally time to stop reflexively prescribing aspirin after venous stenting.

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 articles cited below. The content was reviewed and edited by multiple healthcare professionals in the field.

Barco S, Jalaie H, Sebastian T, et al. Aspirin plus rivaroxaban versus rivaroxaban alone for the prevention of venous stent thrombosis among patients with post-thrombotic syndrome: the multicenter, multinational, randomized, open-label ARIVA trial. 2025;151:835-846. https://doi.org/10.1161/CIRCULATIONAHA.124.073050Vedantham S, Kahn SR, Marston WA, et al. Endovascular therapy for post-thrombotic syndrome — a randomized trial. 2026. https://doi.org/10.1056/NEJMoa2519001

Wysdom Radio™ – Details, episodes & analysis

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Wysdom Radio™ – Details, episodes & analysis

Podcast details

Recent rankings

Apple Podcasts

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