European Society for Vascular Surgery

Three trials walk into an aorta and ask what the house recommends. The bartender shrugs: “Sorry, we’re randomising tonight.”

Three trials. Three leading investigators. One of the biggest unresolved questions in aortic surgery: should patients with uncomplicated type B aortic dissection undergo thoracic endovascular aortic repair (TEVAR), or is best medical therapy the better strategy?

In this episode of the ESVS Podcast, Safa Riahi brings together Professor Jacob Budtz-Lilly (SUNDAY), Professor Firas Mussa (IMPROVE-AD) and Professor Colin Bicknell (EARNEST), for an in-depth roundtable exploring the rationale, design, and challenges behind three major randomised controlled trials. From differences in patient selection and timing of intervention to aortic remodelling, procedural safety, long-term outcomes, and cost-effectiveness, we examine what each trial hopes to establish and why their results could reshape the management of uncomplicated type B aortic dissection.

We also discuss the meaning of “uncomplicated,” the limitations of our current evidence, the importance of best medical therapy, and the challenge of communicating genuine clinical uncertainty to patients. Will these trials finally help us identify who benefits from early TEVAR, when to intervene, and whether improved aortic remodelling translates into better outcomes for patients?

Three trials walk into an aorta. The answers, for now, remain anything but straightforward.

With: Professor Firas Mussa, Professor Colin Bicknell, and Professor Jacob Budtz-Lilly.

Trials discussed:

• IMPROVE-AD: https://clinicaltrials.gov/study/NCT06087029
• EARNEST: https://www.isrctn.com/ISRCTN30838068
• SUNDAY: https://clinicaltrials.gov/study/NCT05215587

In this special episode of the ESVS Podcast, we sit down with Professor Kak Khee Yeung as she begins her term as President of the European Society for Vascular Surgery.

Professor Yeung talks openly about her journey as a vascular surgeon and researcher, her passion for aneurysm biology and personalised vascular care, and the curiosity that has driven her throughout her career. From her Chinese heritage and the calligraphy featured in her inaugural lecture to artificial intelligence, teamwork and the future of vascular surgery, the conversation goes beyond the CV to explore the person behind the surgeon and scientist.

Professor Yeung also shares her thoughts on leadership, diversity, the next generation of vascular surgeons and her ambitions for the ESVS. Her passion for vascular surgery is contagious, and this conversation offers a personal glimpse into the ideas and energy she brings to her presidency.

Links:

Inaugural lecture: https://pure.amsterdamumc.nl/ws/portalfiles/portal/143254652/oratie_final_KKY.pdf

Recorded live from Belgrade at the ESVS course on complex aortic surgery.

In this episode, Joanna Halman is joined by Professors Marko Dragaš, Igor Končar and Nikola Ilić for a practical discussion on complex aortic surgery.

They discuss how to choose between open and endovascular repair, whether aortic surgery should become further subspecialised, and their approaches to aortic clamping, visceral perfusion and organ protection during open repair.

At the end of the episode, special guest Professor Germano Melissano joins the discussion to share his perspective on training and education in complex aortic surgery.

In this episode of the ESVS Podcast, we discuss one of the oldest yet most effective treatments in vascular medicine: compression therapy.

Our guest is Professor Melina Vega de Ceniga, Head of the Department of Angiology and Vascular Surgery at Galdakao-Usansolo University Hospital, Spain, and an internationally recognised expert in chronic venous disease. She is an active member of the European Society for Vascular Surgery (ESVS), she has been involved in the creation and development of the ESVS Podcast programme.

Together, we explore the physiological basis of compression therapy, its indications across a wide range of vascular conditions, the different compression systems available, and practical aspects of their application. We also discuss pressure selection, contraindications, compression therapy in patients with peripheral arterial disease and heart failure, and the management of venous leg ulcers.

Finally, Professor Vega de Ceniga shares practical strategies to improve patient adherence, prevent ulcer recurrence, and optimise long-term outcomes.

This episode provides practical guidance for vascular specialists, trainees, wound-care professionals, and all clinicians involved in the management of patients with chronic venous disease and lower-limb oedema.

This episode has been supported by Urgo Medical

References

1. De Maeseneer MGR, Kakkos SK, Aherne T, et al. ESVS 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63:184–267.
2. O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2021;9.
3. Gohel MS, Heatley F, Liu X, et al. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. N Engl J Med. 2018;378:2105–2114.

Join us for another ESVS podcast where we discuss the important but often neglected topic of pain management in patients undergoing amputation. In this episode, we are joined by consultant vascular surgeon Mr David Bosanquet from Cardiff, UK to discuss why these patients can be very difficult to manage. During the discussion, the importance of multi-model analgesia is highlighted and also the role of peri-neural nerve blockade both pre and post operatively. What is the evidence for intra-operative nerve catheters and are there any new techniques evolving to solve chronic post amputation pain? Does Targeted Muscle Re-innervation (TMR) and Regenerative Peripheral Nerve Interface (RPMI) have a role? All will be answered!

In this episode, Professor Santi Trimarchi discusses the ESVS Clinical Practice Consensus Statement on Ascending Thoracic Endovascular Aortic Repair (aTEVAR). He provides a comprehensive scientific overview of the document, helping listeners gain a concise yet thorough understanding of its key recommendations and expert consensus.

During the episode, we explore the unique anatomical challenges of the ascending aorta for endovascular repair, patient selection, and situations in which conservative management may be preferred over intervention. We also discuss landing zone requirements, stent graft sizing strategies, vascular access considerations, cardiac output control during stent graft deployment, contraindications for aTEVAR, the prevention and management of endoleaks, post-procedural surveillance, and future research priorities.

For a detailed review of the recommendations and supporting evidence, listeners are encouraged to consult the full consensus document.

References:

Trimarchi S, Czerny M, Haulon S, van Herwaarden JA, de Kort JF, Roselli EE, Schermerhorn ML, Upchurch GR Jr, Wanhainen A, on behalf of the ESVS Guidelines Steering Committee. European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Consensus Statement on Ascending Thoracic Endovascular Aortic Repair. European Journal of Vascular and Endovascular Surgery. 2025;70:10–23. doi:10.1016/j.ejvs.2025.05.023

The publication of CREST-2 has reignited one of the longest-standing debates in vascular medicine: should asymptomatic carotid stenosis still be treated invasively in the era of modern best medical therapy? In this episode, Laurence Bertrand and Rosalinda D'Amico discuss the trial with Barbara Rantner and Caitlin Hicks, exploring its methodology, controversial findings, and the implications for the management of asymptomatic carotid stenosis.

Full name of guests:

Dr. Barbara Rantner – TUM University Hospital, Munich, Chair of ESVS and DGG guideline writing committee

Dr. Caitlin Hicks, Johns Hopkins University School of Medicine, Member of the writing committee ESVS and SVS guidelines

Shownotes:

Brott TG, Howard G, Lal BK, Voeks JH, Turan TN, Roubin GS, Lazar RM, Brown RD Jr, Huston J 3rd, Edwards LJ, Jones M, Clark WM, Chamorro Á, Llull L, Mena-Hurtado C, Heck D, Marshall RS, Howard VJ, Moore WS, Barrett KM, Demaerschalk BM, Sangha N, Aronow H, Foster M, Sternbergh WC 3rd, Shawl F, Lanzino G, Rapp J, Tran HS, Ecker R, Mackey A, Ali V, Given C 2nd, Teal P, Kashyap VS, Mukherjee D, Harrigan M, Silverman S, Koopmann M, Wadley VG, Zhang Y, Rhodes JD, Chaturvedi S, Meschia JF; CREST-2 Investigators. Medical Management and Revascularization for Asymptomatic Carotid Stenosis. N Engl J Med. 2026 Jan 15;394(3):219-231. doi: 10.1056/NEJMoa2508800. Epub 2025 Nov 21. PMID: 41269206; PMCID: PMC13148431.

Halliday A, Bulbulia R, Bonati LH, Chester J, Cradduck-Bamford A, Peto R, Pan H; ACST-2 Collaborative Group. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet. 2021 Sep 18;398(10305):1065-1073. doi: 10.1016/S0140-6736(21)01910-3. Epub 2021 Aug 29. PMID: 34469763; PMCID: PMC8473558.

How should we approach intervention thresholds, repair strategies, and lifelong surveillance in patients with genetic aortopathies? Prof. Sherene Shalhub (Oregon Health & Science University) and Prof. Rana Afifi (McGovern Medical School at UTHealth Houston) discuss the practical challenges, controversies, and unanswered questions that shape decision-making in the management of these complex patients.

Shownotes:

Lian T, Pai CW, Woznicki E, et al. Nonsyndromic familial type B aortic dissection exhibits distinct clinical profiles and operative outcomes. J Vasc Surg. 2026. doi:10.1016/j.jvs.2026.04.022.

MacCarrick G, Afifi RO, Allen R, et al. Loeys-Dietz Syndrome: 2026 updated care management primer. Genet Med. 2026. doi:10.1016/j.gim.2026.102577.

Lian T, Bhandari A, Shalhub S. What Every Vascular Surgeon Should Know About Vascular Ehlers-Danlos Syndrome. Ann Vasc Surg. 2026. doi:10.1016/j.avsg.2026.03.032.

Calderon-Martinez E, Velasco WV, Guo D, et al. Differences in Arterial Events in Vascular Ehlers-Danlos, Loeys-Dietz, and Marfan Syndrome. J Am Coll Cardiol. 2025;85:2355-2367. doi:10.1016/j.jacc.2025.04.023.

Shalhub S. The aortic and arterial vulnerability spectrum: A conceptual biological framework for risk stratification and precision surgical decision-making in aortopathy and arteriopathy. J Vasc Surg. 2025;82:722-739.e4. doi:10.1016/j.jvs.2025.04.028.

Dittman JM, Prakash SK, Gupta PC, et al. Practice Patterns and Barriers to Vascular Genetic Testing Among Vascular Surgeons. Ann Vasc Surg. 2024;105:140-149. doi:10.1016/j.avsg.2024.01.032.

Shalhub S, Byers PH. Endovascular repair of a common iliac artery aneurysm with an iliac branch device in a patient with vascular Ehlers-Danlos syndrome due to a null COL3A1 variant. J Vasc Surg Cases Innov Tech. 2023;9:101192. doi:10.1016/j.jvscit.2023.101192.

Dittman JM, Saldana-Ruiz N, Newhall K, et al. Open repair of abdominal aortic aneurysms in patients with vascular Ehlers-Danlos syndrome. J Vasc Surg Cases Innov Tech. 2023;9:101194. doi:10.1016/j.jvscit.2023.101194.

Shalhub S, Nkansah R, El-Ghazali A, et al. Splenic artery pathology presentation, operative interventions, and outcomes in 88 patients with vascular Ehlers-Danlos syndrome. J Vasc Surg. 2023;78:394-404. doi:10.1016/j.jvs.2023.04.007.

Regalado ES, Morris SA, Braverman AC, et al. Comparative Risks of Initial Aortic Events Associated With Genetic Thoracic Aortic Disease. J Am Coll Cardiol. 2022;80:857-869. doi:10.1016/j.jacc.2022.05.054.

Recorded live at the ESVS Vascular Graft and Endograft Infection Workshop in Groningen, this episode explores one of the most challenging complications in vascular surgery. We spoke with Prof. Ben Saleem, Prof. Xavier Berard, and workshop participants about diagnosis, treatment strategies, difficult clinical decisions, and the key lessons learned from this unique hands-on course. A practical discussion on managing vascular graft infections, featuring expert insights and real-world experience from across Europe.

In this podcast, we are joined by Dr Alex Crichton, researcher at the Trisha Roy Vascular laboratory at Houston Methodist Hospital, Texas, to discuss how QISS MRA can be used to image tibial vessels that are often missed by more conventional forms of imaging such as CT angiography, ultrasound duplex imaging or digital subtraction angiography. Diabetic patients can be especially challenging in selecting target vessels for treatment because of the presence of calcium in the vessel wall and the distal nature of the disease. Furthermore, many of these patients have impaired renal function where the use of contrast media can be detrimental. In this episode, Dr Crichton explains the work being done with QISS MRA to enable visualisation of these so called “hibernating vessels” and also how it can be used to characterise plaque morphology and the suitability for endovascular intervention.