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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 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.O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2021;9.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.

Rosalinda D’Amico interviews Prof. Kevin Mani on one of the key controversies in EVAR follow-up: is aneurysm sac shrinkage truly a marker of success, or can it sometimes provide false reassurance? They discuss the current definition of sac regression, the importance of timing and sac stability and whether sac shrinkage should influence surveillance strategies. The episode also explores the role of CTA versus duplex ultrasound and the future potential of volumetric and AI-based assessment in EVAR surveillance References: Tinelli G, D'Oria M, Sica S, Mani K, Rancic Z, Resch TA, Beccia F, Azizzadeh A, Da Volta Ferreira MM, Gargiulo M, Lepidi S, Tshomba Y, Oderich GS, Haulon S; SLIM F-U EVAR, Collaborative Study Group. The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study. J Vasc Surg. 2024 Sep;80(3):937-945. doi: 10.1016/j.jvs.2024.03.007. Epub 2024 Mar 8. PMID: 38462062.

In this episode of the ESVS Podcast, we explore air pollution as an often-overlooked risk factor for peripheral arterial disease (PAD). We are joined by Professor Alberto Maria Settembrini. Professor Settembrini is a vascular surgeon in Milan in MultiMedica and Professor of vascular surgery at Unicamillus University in Rome. He is a co-author of a large Rome-based longitudinal study involving over 1.7 million individuals. The study shows that long-term exposure to PM2.5, NO₂, and black carbon is associated with increased PAD incidence, with stronger effects in males and people aged 55–69. Professor Settembrini discusses the links between different pollutants and PAD, how pollution interacts with traditional risk factors (obesity, diabetes, smoking, hypertension), the underlying mechanisms, and practical advice for vascular specialists in daily practice. During the episode, we also hear from Porto’s City Councillor for the Mobility and Transportation, Engineer Hugo Beirão, who shares the city’s efforts to improve urban health. References: 1- Ravalli S, Musumeci G, et al. Chelation therapy in patients with cardiovascular disease: a systematic review. Journal of Clinical Medicine. 2022;11(4):1033. doi:10.3390/jcm11041033 2- Serra R, Abramo A, Ielapi N, Procopio S, Marino P. Environmental pollution and peripheral artery disease. Risk Manag Healthc Policy. 2021;14:2181–2190. 3- Liao SH, Chiu CS, Jang LH, Hu SY, How CK, Hsieh VCR, et al. Long-term exposures to air pollutants and risk of peripheral arterial occlusive disease: a nationwide cohort study in Taiwan. Front Cardiovasc Med. 2022;9:796423. 4- Gwon JG, Park JH, Kim JS, Seo HM. Exposure to long-term air pollution and incidence of peripheral arterial disease in the general population: a national population-based retrospective cohort study. [Preprint]. 2021. 5- Deng Z, Duan L, Wang K. Revisiting the association between air pollution and peripheral artery disease: evidence from Mendelian randomization analysis. Eur J Intern Med. 2025;132:164–166. 6- Di Blasi C, Nobile F, Settembrini AM, Stafoggia M, Davoli M, Michelozzi P, et al. Association between long-term exposure to air pollution and incidence of peripheral artery disease: evidence from a longitudinal study. Eur J Intern Med. 2025;132:113–117.

In this episode, we’ll focus on the final sections of the guideline, which deal with rupture, trauma, and post-operative complications. These are scenarios where decisions are often made under time pressure, evidence is limited, and outcomes can be profoundly affected by organisation of care, experience, and judgement. Guests: Prof. Anders Wanhainen Dr. Carlota Fernández-Prendes Prof. Athanasios Katsargyris

Welcome back to the ESVS Podcasts. This is Suzanne Stokmans, and you are listening to part 2 of the Q&A series on the ESVS 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases. In this episode, we move from the general principles discussed in part 1 to disease-specific management. We’ll focus on acute thoracic aortic syndromes, chronic type B aortic dissection, and degenerative descending thoracic and thoraco-abdominal aortic aneurysms, conditions that make up a large part of daily aortic practice, where decision-making is often nuanced and time-critical. Full names of guests: Prof. Anders Wanhainen Dr. Carlota Fernández Prendes Prof. Athanasios Katsargyris.

In today’s episode, the first of this three-part series, we will discuss the opening section of the guideline: service standards and general considerations. Before moving to specific disease entities or operative strategies, the guideline deliberately starts with the fundamentals — how care should be organised, how patients should be assessed, and which general principles should guide our decision making. Full names of guests: Prof. Anders Wanhainen Dr. Carlota Fernández Prendes Prof. Athanasios Katsargyris.

In this episode of the ESVS Podcast, supported by Servier, we explore the importance of therapy adherence in chronic venous disease (CVD). The episode opens with short patient testimonies, highlighting real-world reasons for non-adherence. To explore this further, we are joined by Professor Denisa Celovska and Professor Atul Pathak. Professor Celovska is an Associate Professor of Angiology and Internal Medicine at the University Hospital and Comenius University in Bratislava, Slovakia. She is currently the President of the Slovak Angiology Society. Professor Pathak is the Head of the National Institute of Cardiology, Cardiac Surgery and Interventional Cardiology in Luxembourg. In this episode, they share their clinical perspective on why patients frequently disengage from treatment, the most common barriers to adherence in daily practice, and practical strategies to improve long-term treatment persistence. The episode also includes insights from a community pharmacist, offering a complementary view on what happens between prescription and real-life use, particularly regarding venoactive drugs. We conclude by emphasising that effective CVD management extends beyond prescribing treatment. Patient education, shared decision-making, follow-up, and human connection are essential to improve adherence and long-term outcomes in CVD. References: Kim H, Cho S, Lee K, Lee SH, Joh JH. A nationwide study of compliance of venoactive drugs in chronic venous disease patients. Ann Surg Treat Res. 2023 May;104(5):288-295. doi: 10.4174/astr.2023.104.5.288. Epub 2023 Apr 28. PMID: 37179697; PMCID: PMC10172027.Burnier M. The role of adherence in patients with chronic diseases. Eur J Intern Med. 2024 Jan;119:1-5. doi: 10.1016/j.ejim.2023.07.008. Epub 2023 Jul 20. PMID: 37479633.Mezalek ZT, Feodor T, Chernukha L, Chen Z, Rueda A, Sánchez IE, Ochoa AJG, Chirol J, Blanc-Guillemaud V, Lohier-Durel C, Ulloa JH. VEIN STEP: A Prospective, Observational, International Study to Assess Effectiveness of Conservative Treatments in Chronic Venous Disease. Adv Ther. 2023 Nov;40(11):5016-5036. doi: 10.1007/s12325-023-02643-6. Epub 2023 Sep 20. Erratum in: Adv Ther. 2024 Jan;41(1):464-465. doi: 10.1007/s12325-023-02722-8. Erratum in: Adv Ther. 2024 Jun;41(6):2540-2541. doi: 10.1007/s12325-024-02857-2. PMID: 37728696; PMCID: PMC10567827.Bogachev, V., Arribas, J.M.J., Baila, S. et al. Management and evaluation of treatment adherence and effectiveness in chronic venous disorders: results of the international study VEIN Act Program. Drugs Ther Perspect 35, 396–404 (2019). https://doi.org/10.1007/s40267-019-00637-5Golna C, Poimenidou C, Giannoukari EE, Saridi M, Liberopoulos E, Souliotis K. Assessing a pharmacist-enabled intervention to improve adherence to medication for hypertension, dyslipidemia, and chronic venous circulation disorders in Greece. Patient Prefer Adherence. 2023;17:3341–3352. doi:10.2147/PPA.S4208116. Branisteanu DE, Munteanu AE, Dolofan BM, Popescu EG, Vittos O. Adherence to pharmacological treatment in chronic venous disease: results of a real-world, prospective, observational cohort study. Life (Basel). 2025;15(3):377. doi:10.3390/life15030377. 7. Ulloa JH, Guerra D, Cadavid LG, Fajardo D, Villarreal R, Bayona G, Hoyos AS, Garcia G. Nonoperative approach for symptomatic patients with chronic venous disease: results from the VEIN Act program. Phlebolymphology. 2018;25(2):123 Servier is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Servier. Always consult the Instructions for Use (IFU) prior to using any medical device.

In this episode of the ESVS Podcast, we tackle one of medicine’s most deceptively simple challenges : agreeing on what we’re actually talking about. Vascular graft and endograft infections (VGEI) are rare, serious, and universally dreaded, but when it comes to defining them, classifying them, and reporting outcomes, it turns out the vascular world hasn’t always been speaking the same language. Safa Riahi is joined by Dr Thomas Wyss and Dr Karl Sörelius to discuss a recent international Delphi consensus that brought together 43 multidisciplinary experts to do something surprisingly difficult: agree on definitions. From the long-standing debate over early versus late infection, to the subtle but clinically important difference between graft-enteric erosion and fistula, to the brave attempt to define what “cure” actually means in a disease that likes to relapse when you least expect it, this episode explores how a shared vocabulary might finally help researchers compare studies, registries make sense, and multidisciplinary teams argue a little more productively. As it turns out, building a common language might be one of the most important steps toward better science; and better care; in VGEI. The Delphi consensus discussed in this episode can be accessed here: https://www.ejves.com/article/S1078-5884(25)00707-5/