European Society for Vascular Surgery

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.