Transatlantic multicenter experience highlights effectiveness of total endovascular aortic repair with F/BEVAR but 5% risk of major stroke
By Jocelyn Hudson
Staged total endovascular aortic repair (TEAR) utilizing arch branched and thoracoabdominal fenestrated and branched endografts is effective, but identified predictors of morbidity and mortality—including stroke—highlight the importance of individualized risk assessment to optimize outcomes. These are some of the key findings of a study presented during yesterday’s Plenary Session 3.
Submitting and presenting author Enrico Gallitto, MD, associated professor of vascular surgery at the University of Bologna in Italy, was speaking on behalf of the transatlantic TEAR study group, which includes four sites in the U.S. and 12 in Europe.
The study aimed to identify outcomes of TEAR extending from the ascending to the infrarenal aorta or iliac arteries with arch-branched en -
SVS PRESIDENT WILL STAKE ‘RECLAIMING CENTER’ IN
By Urmila Kerslake
ONE OF THE SINGULAR HIGHLIGHTS of VAM 2025—the presidential introduction and address—will take place this morning from 11 a.m.–12 p.m. on Morial CC’s First Floor (Great Hall A), with SVS President Matthew Eagleton, MD, centering his focus on the Society’s anchor in a community commitment to patients and a spirit of shared purpose. The SVS seeks to lead, unite and
10 PAD
Novel MRI technique for CLTI
12 Through the lens Pictures from the VAM conference floor
14 Medical students
The next generation of vascular surgeons
www.vascularspecialistonline.com
rebuild vascular surgery’s future, he will tell the VAM audience.
“This isn’t just a speaking opportunity—it’s a moment of reflection, connection and responsibility. A responsibility to those that welcomed me into this specialty, and a responsibility to those of you here now who are part of our current and future vascular community,” Eagleton, chief of the Division of Vascular and Endovascular Surgery at Mass General Brigham and Harvard Medical School in Boston, will say.
Like many other vascular surgeons, Eagleton’s journey into surgery came via a patient, his grandfather, who had had complications from a redo coronary bypass. The presence of a calm, focused Dr. DeWeese, who practiced both cardiac and vascular surgery, and who looked after his grandfather, profoundly
changed something in the young “uncertain and unfocused” college sophomore. As Eagleton will put it: “I did not go looking for vascular surgery, it found me.”
Even early on, Eagelton recognized that people in the vascular community exerted incredible influence on others aspiring in the field. Take the late Roy Greenberg, MD, an intern then, and Karl Illig, MD, a senior resident, who were both major influences when he started out. They would go on to grapple with the future of aortic repair, as well as introduce Eagleton to invaluable future mentors such as Dick Green, MD, and Ken Ouriel, MD—"people who didn’t just do vascular surgery, but lived it. The intensity, the pace, the sense of urgency at times—it was a world
DAY 3&4 HIGHLIGHTS SPOT LIGHT
VAM 2025 HAS PLENTY MORE TO OFFER ON DAYS THREE AND FOUR
Starting Friday at 6:30 a.m. is the International Plenary featuring research and perspectives from the wider vascular world. Plenary Session 5 follows shortly afterwards, at 8:30 a.m. in Great Hall A, promising more data on peripheral hot topics.
At 11 a.m. in the same location, Matthew Eagelton, MD, delivers the Presidential Address, offering a message of unity. Read more on this in the adjacent story.
In the afternoon, Great Hall B plays host to the Trainee Recruitment and Networking Fair, presented by SVS in collaboration with the Association of Program Directors in Vascular Surgery (APDVS), offering trainees the opportunity to connect directly with vascular surgery residency and fellowship programs.
SVS members will convene for the annual Business Meeting in second floor rooms 208–210 at 5:15–6:30 p.m.
Don’t miss the opportunity to connect with industry colleagues in the Exhibition Hall, which is open throughout the day, and reserve your spot at the Touchpoint simulation lab by using the appointment calendar online. Sessions run 1–5 p.m.
Saturday morning highlights include Plenary Session 7 taking place in Great Hall A, 8:30–9:30 a.m., which features new data on aortic and peripheral techniques.
Later that morning, the Poster Championship, running 9:30–10:40 a.m. in rooms 208–210. Jerry Goldstone, MD, delivers the John Homans Lecture at 10:45–11:15 a.m., where he will pose the question "Who put the vascular in vascular surgery?", charting a history of vascular surgery.
International Chapter highlights pressing need to document PAD and CLTI prevalence in South Asia
By Bryan Kay
There is an urgent need for epidemiological studies to map out the prevalence of chronic limb-threatening ischemia (CLTI)—and peripheral arterial disease (PAD) in general—in South Asia, attendees of the International Chapter Education Session at VAM 2025 heard yesterday morning. That was the message from Prem Chand Gupta, MBBS, clinical director and head of vascular surgery at Care Hospital in Hyderabad, India, as he peeled back a curtain on the extent of amputation and limb preservation in Asia through his native country of India, highlighting how patients on the continent present with more advanced CLTI, are more likely to require urgent intervention, and have worse postoperative outcomes compared to patients in the West.
“Asia also has the highest prevalence of diabetes and CKD [chronic kidney disease], so this makes these patients more prone to develop the disease and also makes the disease more difficult to treat,” Gupta tells VS@VAM in an interview after his talk.
“In many of our countries, we do not know the prevalence of PAD and CLTI,” he says. “And how many of our patients
are actually able to access proper care? We don’t know. Many patients end up with primary amputation as the first option.”
Gupta detailed for the VAM audience some of the reasons behind these statistics, among them a culture in rural areas where bare-foot walking remains common, and the fact the primary care physicians and general surgeons whom many patients visit for help don’t often appreciate the magnitude of the vascular problem with which they are confronted.
“We have had some attempt at studying the prevalence of disease in India but it’s grossly inadequate,” he explains to VS@VAM. Access to care varies across parts of the continent, with Southeast Asia, especially Thailand and Malaysia, technically better off, he continues, where healthcare is funded by taxes and government subsidy. In South Asian countries such as India and Bangladesh, on the other hand, public-private partnerships tend to predominate healthcare, with only pockets of excellence in the public system, Gupta continues.
We have few vascular surgeons: it’s one per 3 million of the population. Most patients, even in the urban areas where we have a lot of vascular surgeons or specialists, they quite often end up with a primary care physician or a general surgeon or sometimes with a wound care surgeon or podiatric surgeon, and they often have minor amputations.”
In this crucible, in the absence of the vascular surgeon, the wrong approach often prevails, Gupta goes on. “There is patchy presence of specialists in the public sector and preventive care is very infrequently applied to these patients.”
“In many of our countries, we do not know the prevalence of PAD and CLTI” PREM CHAND GUPTA
“In India, nearly 50% of patients will pay out of pock et for medical care, so there is no insurance scheme they are covered under,” he says. “We have expertise and infrastructure, but the numbers are grossly in adequate. Vascular surgeons perform open and en dovascular procedures and have all the latest tools available to them.”
But there are few multidisciplinary care teams, Gupta notes, “and we know that when they work together, they tend to improve outcomes.”
The gravity of the amputation and limb preservation problem in India is stark, he says. “India probably has the worst amputation epidemic in the world. The reasons?
But there are positives to healthcare in South Asia, he adds. The pace of access to a specialist, if a patient can get in front of one, tends to be quick when compared to some countries in the West. Care can be dramatically cheaper. “For example, some of the bypasses that would cost $10–20,000 in high-income countries are $1,500–3000 in India,” says Gupta.
An attempt to unmask the extent of the CLTI burden in India through the prism of an epidemiological study is on Gupta’s radar for this calendar year. In the meantime, he says, “we need more vascular specialists, and we are working towards that. From the time when I trained in the late 90s, when we had one training program, we now have more than 50. So we are putting out more vascular surgeons every year. People are understanding the importance of multidisciplinary care teams and are tending to come together to work, and that will improve care and improve the chances of limb preservation in these patients with CLTI. We need to work on primary care physicians and general surgeons, and educate them.”
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I couldn’t turn away from,” he will say.
Eagleton was convinced, even as a fourth-year medical student, that one of the great strengths of vascular surgery was in its ability to deliver longitudinal care. And the early experience of presenting his research at a regional conference opened the door to interaction with the giants in the field, like Frank Veith, MD.
“Be prepared. Vascular surgery doesn’t hand you anything. But if you’re willing to show up, stay humble and learn fast— it gives back in ways few other fields can,” Eagleton will reflect.
The new president will forefront the successes that the SVS has achieved, but he will also list the numerous challenges, notably a heterogeneous and growing group of members that confronts the organization. The faultlines of the struggle he says lie in fragmentation and disconnection.
“Our biggest internal challenge right now is fragmentation and disunity. And it’s been a problem growing over the past several years,” he will note. “We’re not just disagreeing—we’re disengaging. And that weakens us. It weakens our credibility. It weakens our voice.
“Internally, we’re also seeing generational gaps. Different expectations. Different styles of communication. Different priorities. And unless we find ways to bridge those differences, we risk becom-
ing two—or more—societies moving in parallel at best,” Eagleton will suggest.
Yet, patients and purpose are always at the heart of vascular surgery, Eagleton will argue. And beyond this dual bedrock, he will press for a different kind of leadership, one that is layered, brave and collaborative, which can chisel a culture shift embedded in hope and meet the moment.
“We need bridge-builders. People who can bring together our fragmented membership—who can sit in a room of differing opinions and find common ground without compromising our core values,” he will say.
Vascular surgery’s relationship with other specialties—particularly inter-
“The decisions we make now—the way we lead, the way we treat one another, the way we structure this society— will define what kind of field we’re handing off”
MATTHEW EAGLETON
ventional cardiology and interventional radiology—has too often been defined by tension, Eagleton will tell attendees. And yet, the volume of vascular disease is rising fast, and “we are not enough. We can’t serve this population alone. That doesn’t mean we dilute our identity.
“It means we must instead lead with clarity, not defensiveness. We invite collaboration without losing our center. We don’t leave the table when there are disagreements. We stay. We debate. We work to discover and provide scientific evidence. We strengthen bridges. We advocate. We keep the patient the center of all of our missions.”
In his call to recommit and pull together, Eagleton will expand: “The decisions we make now—the way we lead, the way we treat one another, the way we structure this society—will define what kind of field we’re handing off. We’re at an inflection point. And we can either drift further apart, or choose to come together with clarity, courage, and conviction.”
He will define the context of the importance of this mission. “Let’s stop standing on the sidelines while others define what vascular care looks like. […] Because this is our house. And if we want it to be strong, future-ready, and worthy of the next generation—we have to take care of it.”
Prem Chand Gupta
Matthew Eagleton
How likely are your surgical patients to have disruptive bleeding?
LEARN FROM OTHER FIELDS TO ENHANCE YOUR PRACTICE, VASCULAR
SURGEON
INNOVATORS TOLD
By Will Date
“A LOT OF SOLUTIONS TO YOUR problems exist in somebody else's operating room, or somebody else's cath lab, but you never actually go there.”
These were the words of Alan B. Lumsden, MD, of the Houston Methodist Hospital in Houston, Texas, delivering the keynote talk at yesterday’s Innovation and Entrepreneurship in Vascular Surgery session, during which speakers sought to chart a course through the complex landscape that budding innovators must navigate to take potentially practice-changing ideas from the drawing board into the operating room.
“Get out of your space,” was among the abiding message from Lumsden’s presentation, where he compelled vascular surgeon innovators to bring ideas, skills and expertise from other fields—borrowing from “the other guy’s toolkit”—in order to enrich their own specialty, whether these be from other areas of medicine or further afield. Lumsden drew upon examples from as far and wide as
the plastic surgery specialty to the energy and aerospace sectors to illustrate his point that vascular surgery innovators must spread their net widely to draw on the best ideas to serve their practice.
However, speakers in the session were in agreement that translating ideas from bench to bedside is not without its risks and significant hurdles. “You are surgeons primarily. You can give up your prac tice and roll the dice, that is finan cially shaky,” Lumsden said. “You are going to have to make a decision about why you want to get involved in this space. One of the motivating factors is that you as a physician are not scalable, you treat one patient at a time. But, if you develop something you are re ally doing population health, you can affect hundreds of
thousands, potentially millions of people.”
The session laid bare the tortuous pathway facing surgeon innovators once they have chosen to take this step, with financing and intellectual property among the pain points. Presentations by Bryan W. Tillman, MD, and David Minion, MD, underscored the importance of securing intellectual property rights to protect promising ideas, but highlighted some of the challenges inherent in establishing a patent for new innovations. Stephen Von Rump, MS, delivered lessons on what financiers are looking for when they consider which start-ups to support.
The session also outlined some of the support and resources available to ease this path. To this end Jonathan Bath, MD, outlined details of ongoing work by the SVS to support innovations in the field, with the recent establishment of an Innovation Task Force with a mission to nurture new device and
“Surgeon innovators have a rich history. This is why the SVS has put an emphasis on trying to provide some resources and an actual formalized structure to help the innovators get, eventually, to a product,” said Bath. To
date there has been a shortage of guidance, resources and education to support this agenda, he noted, adding that the Task Force would seek to fill this gap.
The focus of the Task Force’s actions will be around three pillars, Bath detailed, notably education, networking, and resources, all geared to help “fertilize” the innovation process.
One of the support routes currently open to academic innovators is via biomedical accelerator programs which can provide funding, mentorship, and resources to early-stage
“It truly takes a village to turn an idea into a real-world product”
companies and research projects. Jaya Ghosh, PhD, program director of the University of Missouri (MU) Coulter Biomedical Accelerator gave an overview of how programs such as these select which projects are suitable for support, and outlined a number of areas in which they are able to help bring new concepts to commercial reality, including regulatory strategy, reimbursement, manufacturing and scalability. “It truly takes a village to turn an idea into a real-world product, and these programs offer the training, funding and project management needed to de-risk early-stage innovations and help bring visionary ideas to life,” said Ghosh.
AORTIC REPAIR WITH F/BEVAR BUT 5% RISK OF MAJOR STROKE
dovascular aneurysm repair (ARCH-BEVAR) in combination with thoracoabdominal-fenestrated/branched EVAR (TAAA-F/BEVAR).
“There are very few patients who are reported in the literature up to now,” Gallitto commented.
The investigators retrospectively analyzed 95 patients who underwent TEAR from 2014–2024. These patients had a mean follow-up of 32±29 months, the presenter noted, adding that 45 (47%) and six (6%) had undergone previous ascending and TAAA surgery, respectively.
“I’d like to stress the concept that these patients were historically treated by aortic arch replacement followed by open thoracoabdominal aneurysm repair, with high postoperative morbidity and mortality, and for these reasons up to 40% of patients did not complete the second procedure; thanks to this less invasive approach, the rate of not completed procedure was 3%,” Gallitto told VS@VAM following his presentation.
Gallitto reported that a staged approach, with the first stage involving ARCH-BEVAR followed by TAAA-F/BEVAR, was consistently used, with a mean time between two stages of 11±5 months.
One (1%) rupture occurred between the staged procedures, the presenter reported, detailing that this was successfully managed with off-the-shelf TAAA-BEVAR.
Gallitto specified that custom-made and off-the-shelf TAAA-F/BEVAR devices were used in 79 (83%) and 16 (17%) cases, respectively. Among 351 abdominal target arteries, he continued, 208 (59%) utilized fenestrations, and 143 (41%)
continued from page 1
branches. Iliac branch devices and prophylactic cerebrospinal-fluid drainage were used in 33 (35%) and 11 (12%) cases, respectively.
Gallitto reported that there were 12 (13%) transient ischemic attacks (TIAs)/strokes (10 associated with ARCH-BEVAR and two with TAAAs-F/BEVAR), with five (5%) having a modified Rankin Scale score (mRS) >3. He detailed that independent determinants of stroke included degenerative TAAAs and previous TAAA surgery.
Furthermore, it was noted that 16 (17%) patients experienced SCI (two associated with ARCH-BEVAR and 14 with TAAAs-F/BEVAR) with three (3%) cases of paraplegia. Independent determinants of SCI included major adverse events and iliac branch device use.
Regarding mortality, Gallitto noted that four (4%) patients died within 30 days, with independent determinants of 30day mortality including stroke with mRS >3, and that aortic-related mortality was 2%.
Out of 67 (71%) patients with available one-year follow-up, Gallitto shared that there were six (9%) target artery instabilities and five (7%) cardiovascular events, respectively.
The estimated three-year survival and freedom from reintervention rates were 79% and 66%, respectively, with Gallitto noting that independent predicted of survival included previous abdominal aortic surgery, postoperative acute kidney injury, and cardiovascular events within one year.
Concluding, Gallitto informed the VAM 2025 audience that staged TEAR utilizing ARCH-BEVAR in combination with TAAAs-F/BEVAR is effective, “demonstrating satisfac-
tory early and midterm outcomes, with low aortic-related mortality and acceptable freedom from reintervention and target artery instability rates.”
Additionally, Gallitto warned that the risk of stroke and SCI remain “significant” and “must be carefully weighed during patient selection and treatment planning.” In addition, the presenter noted that cardiac dysfunction at one year is not rare—citing a rate of 7%—and affects mortality. With this in mind, he suggested that specific cardiac evaluation is needed to investigate the potential role of aortic stiffness.
Gallitto also outlined some limitations of the study, underscoring its retrospective nature and the fact that the timeframe of 10 years introduces the variables of technological innovations and operators’ learning curves. He added that the small sample size, limited follow-up, and the inclusion of only a single brand—Cook Medical—within the study are further limitations.
In the discussion following Gallitto’s presentation, session co-moderator Thomas Forbes, MD, professor and chair of the Division of Vascular Surgery at the University of Toronto in Toronto, Canada, brought up the time between stages. “I notice that the time interval between stage one and stage two was a mean of 11 months, with some variability. That seems a little long to me,” he commented, going on to ask for an explanation. “This is a great point, because 11 months is probably too high in our routine clinical practice,” Gallitto responded, noting that one of the main determinants would have been the factor of recovery time from the first stage of the procedure.
Alan B. Lumsden
Increased experience with off-the-shelf
TAAA endograft sees
reduction in complications but no effect on mortality
By Jocelyn Hudson
MICHELE PIAZZA, MD, INFORMED ATTENDEES OF yesterday’s Plenary 3 that increased experience with the E-nside (Artivion) off-the-shelf preloaded inner branch endograft for branched endovascular aneurysm repair (BEVAR) leads to a “significant” reduction in intraprocedural complications, but does not affect early mortality, major adverse event, or midterm results.
“The E-nside is an off-the-shelf preloaded inner-branched device for thoracoabdominal aortic aneurysm (TAAA) repair that was introduced in the European market in 2020,” Piazza, of the University of Padua in Italy, explained. He noted that several cases have been performed with the device in the five-year period since then, with the objective of the present study being to report on the impact of the learning curve on the outcomes for the E-nside.
Piazza shared that he and colleagues used data from the multicenter, prospective Italian branch registry of E-nside
SPINAL DRAINS
Researchers examine safety of prophylactic spinal fluid drainage in open and endovascular TAA and TAAA patients
“SPINAL FLUID DRAINAGE SHOULD be considered when the risk of spinal cord injury from the procedure is greater than the risk of severe complications from spinal fluid drainage.” This was one of the concluding findings of a study presented during yesterday’s Plenary 3 by submitting and presenting author Lucas L. Skoda, DO, assistant professor of anesthesiology at the University of Wisconsin in Madison, Wisconsin.
Skoda was presenting the results of a study that aimed to review the use of prophylactic spinal fluid drainage (SFD) for the prevention of spinal cord injury (SCI) in open and endovascular thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) repair and evaluate the complications of SFD.
Skoda and colleagues’ study included all patients treated at a single institution from 1987–2023 for open and endovascular TAA and Crawford type I, II, III and IV TAAA. Skoda noted that prophylactic SFD was used in open TAA and TAAA surgery and
endograft (INBREED) for the study, using data from 2021–2024. The endpoints included technical success, mortality, intraprocedural adverse events, and major adverse events. The presenter noted that patients were divided into early and late cohorts based on the median date of the procedure in each center.
“Of a total of 215 cases, what was interesting was that, in the late phase, there was an increased selection of anatomical characteristics like those patients with chronic degenerative aneurysm or dissection, or degenerative aneurysm with a narrow paravisceral aorta less than 25mm,” Piazza commented, detailing patient characteristic insights.
Looking at the intraoperative technical results, Piazza reported that there was an increase in the use of femoral access with steerable sheaths over preloaded systems from the arm, an increase in the number of balloon-expandable bridging stents used, and a reduction in the number of adjunctive thoracic endografts deployed.
Highlighting results on the center-specific learning curve, Piazza noted that centers that faced more complex cases like extent II and III TAAAs or urgent cases “have an increase in the learning curve.” With regard to major adverse events, he underscored the fact that those centers with a low volume of cases had an increase in the learning curve over the first period which stabilized after the first five cases.
In conclusion, Piazza shared that experience with the E-nside led to a shift in patient selection, procedural techniques and materials. He continued that increased experience led to a significant reduction in intraprocedural complications, but stressed that this did not affect early mortality, major adverse event or midterm results.
“What did have an impact on the learning curve was the number of cases performed with this device”
Piazza highlighted a reduction in the number of intraoperative complications that was statistically significant in the late cohort, but no difference in either technical success or major adverse event rates.
Stroke was reduced in the late cohort, Piazza continued; however, he specified that this was not statistically significant, and that there was no difference in the rate of freedom from target vessel instability at two years.
“Overall, the national trend showed a reduction in intraoperative complications,” Piazza commented, “but there were no differences between the early and the late phase for major adverse events.”
endovascular surgery planning >12cm of aortic coverage.
SFD was part of a multifactorial strategy to reduce SCI, and cardiac anesthesiologists placed all drains and managed spinal fluid drainage according to a strict protocol, including rescue drains placed for delayed SCI, the presenter detailed.
Of 1,445 patients included in the study, Skoda shared that 1,007 had prophylactic SFD, a figure that included 777 open repairs and 230 endovascular repairs.
Outlining the study results, Skoda revealed that six (0.6%) patients had neurologic complications from spinal fluid drainage—five (0.77%) in open repair and one (0.43%) (0.43%) in endovascular repair. Four of the six patients with neurologic deficits from SFD died.
Concluding, Skoda stated that severe complications from SFD should be defined as those resulting in neurologic deficit, and that the appearance of bloody fluid during SFD is an indicator of possible intracranial blood, but without neurologic symptoms it is benign.
The presence of prophylactic SFD can be performed with “acceptable risk of severe complications” in open and endovascular repair, Skoda continued, adding that safer SFD requires “consistent teams and management protocols.” The senior author for this paper was Martha M. Wynn, emeritus professor at the University of Wisconsin School of Medicine & Public Health in Madison.—Jocelyn Hudson
PREVIEW
During subsequent discussion time, an audience member asked Piazza if he could “dive a little bit deeper” into the learning curve comparing centers who had had a “robust experience,” perhaps with other platforms, versus those for which the E-nside was their “entry-level platform.”
Piazza responded that the study included two main different center experiences: those with an initial experience with BEVAR overall and those with a large experience with a different device before moving to the E-nside.
“In general,” he said, “what happens is that the second group is based on high-volume centers that all have experience in BEVAR, so this aspect by itself did not impact on the learning curve. What did have an impact on the learning curve was the number of cases performed with this device.” Piazza was the presenting author for this paper.
DIALYSIS ACCESS
ACELLULAR
TISSUE
ENGINEERED VESSEL OUTPERFORMS AVF IN HIGH-RISK HEMODIALYSIS PATIENTS
RESULTS FROM THE CLN-PRO-V007 RANDOMIZED CONTROLLED TRIAL OF Humacyte’s acellular tissue engineered vessel (ATEV) are set to be shared today during Plenary 6 (10–11 a.m., First Floor, Great Hall A), showing several clinical benefits when compared to arteriovenous fistula (AVF) in hemodialysis (HD) patients with a high risk of fistula maturation failure.
“ATEV provides better functional patency, usability, and a comparable access-related complication profile to AVFs in high-risk subgroups of ESKD [end-stage kidney disease] patients,” submitting and presenting author Mohamad A. Hussain, vascular and endovascular surgeon and assistant professor of surgery at Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues write in their abstract.
The authors write that this key conclusion “makes ATEV a promising alternative to vulnerable populations requiring HD access and highlights its potential to address unmet needs in patients with complex clinical profiles.”
The objective of CLN-PRO-V007—a phase 3, prospective, multicenter, two-arm, randomized controlled trial—was to compare the efficacy and safety of ATEV with autologous AVFs in ESKD patients on HD. Patients were randomized 1:1.
At VAM 2025, Hussain is set to share that functional patency at six months and secondary patency at 12 months were significantly higher in ATEV recipients compared with AVF among 110 high-risk ESKD patients included in the trial out of 242 enrolled in total.
In addition, Hussain will report that duration of access usability over the first year trended higher in the ATEV group, further noting that these results were consistent across individual subgroups of female patients and male patient with a body mass index (BMI) ≥30kg/m2 and diabetes.
With regard to safety, the authors found similar rates of serious adverse events (SAEs) for ATEV patients and AVF patients and comparable infection rates between the two groups.—Jocelyn Hudson
Michele Piazza
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VAM 202 5
FRIDAY
6:00
6:00 a.m.
6:30 a.m.
6:30
6:30 a.m.
7:00 a.m.
7:00 a.m.
7:00 a.m.
Session: Carrying the Weight: Parenthood in Vascular Surgery Morial CC, Second Floor, Room 208-210
8:00 a.m. – 9:30 a.m. Plenary Session 5 Morial CC, First Floor, Great Hall A
8:00 a.m. – 5:00 p.m. Crossroads@VAM: Boston Scientific Morial CC, Second Floor, Room 207
8:00 a.m. – 5:00 p.m. Crossroads@VAM: Cook Medical Morial CC, Second Floor, Room 202
8:00 a.m. – 5:00 p.m. Crossroads@VAM: Gore Morial CC, Second Floor, Room 206
8:00 a.m. – 5:00 p.m. Crossroads@VAM: Surmodics- By Appointment Only Morial CC, Second Floor, Room 203/204
9:00 a.m. – 5:00 p.m. SVS Central@VAM
Morial CC, First Floor, Great Hall Pre-Function
9:30 a.m. – 10:00 a.m. Coffee Break in the Exhibit Hall Morial CC, First Floor, Hall B
9:30 a.m. – 10:00 a.m. Vascular Live: Surmodics Presents: Belowthe-knee Thrombectomy Case Insights and Outcomes using the Pounce™ LP Thrombectomy System
9:30 a.m. – 2:00 p.m. Career Fair
9:30 a.m. – 2:00 p.m. Exhibit Hall
10:00 a.m. – 11:00 a.m. Plenary Session 6
Morial CC, First Floor, Hall B
Morial CC, First Floor, Hall B
Morial CC, First Floor, Hall B
Morial CC, First Floor, Great Hall A
11:00 a.m. – 12:00 p.m. Presidential Introduction & Address Morial CC, First Floor, Great Hall A
12:00 p.m. – 1:30 p.m. Lunch in Exhibit Hall
12:10 p.m. – 1:35 p.m. Vascular Live: Boston Scientific (Silk Road) Presents: TCAR: The Effective, Efficient, and Clinically Proven Choice for Carotid Interventions (not eligible for CME credit)
12:30 p.m. – 1:30 p.m. Industry Symposia: Solventum Presents: Reducing Surgical Site Complications: Innovative Techniques and Technologies
1:20 p.m. – 1:45 p.m. Vascular Live: Terumo Presents: Advancing Abdominal Horizons with TREO: Where the Physician Becomes the Tailor
Morial CC, First Floor, Hall B
1:30 p.m. – 2:00 p.m. Coffee/Beignet Break in the Exhibit Hall Morial CC, First Floor, Hall B
2:00 p.m. – 3:30 p.m.
Educational Session: Ambulatory Vascular Care (SAVC) Section Session 1
2:00 p.m. – 3:30 p.m. Educational Session: The Critical Role of Vascular Surgeons in the Children’s Hospital
2:00 p.m. – 3:30 p.m.
2:00 p.m. – 3:30 p.m.
Educational Session: Enhanced Recovery After Surgery (ERAS): Focus on Best Practices for Pain Management
Session: Thoracic
Morial CC, First Floor, Hall B
Morial CC, First Floor, Hall B
CC, First Floor, Hall B 12:45 p.m. – 1:10 p.m. Vascular Live: Gore Presents: Optimizing Outcomes with Large Diameter Tapered TEVAR Devices. Clinical Experiences in Difficult Anatomy
1:00 p.m. – 5:00 p.m. Touchpoint@VAM
Morial CC, First Floor, Hall B
Morial CC, First Floor, Rivergate Room
Join us for the inaugural SVS advocacy and leadership conference
THE SOCIETY FOR VASCULAR SURGERY (SVS) will host its inaugural SVS Advocacy and Leadership conference from Sept. 14–16 in Washington, D.C. This landmark event will unite vascular surgeons, trainees, fellows and other professionals nationwide to engage directly in the policymaking process and champion the needs of the specialty and the patients we serve.
Over 2.5 days, participants will learn about key legislative and regulatory issues through various sessions and develop their advocacy skills through interactive training and expert-led discussions.
Attendees will have the opportunity to meet with members of Congress and senior policy staff during scheduled Capitol Hill visits. The event also offers a platform to connect with peers and policy leaders, helping build a stronger, unified voice for vascular surgery. Space is limited; to register, visit vascular.org/AdvocacyConference25
Compiled by Marlén Gomez
VOTE FOR YOUR FAVORITE PROJECTS AT THE POSTER COMPETITION
DON’T MISS THE CHANCE TO WITNESS THE CREATIVITY AND hard work of the Poster Competition participants as they compete for top honors, taking place Friday afternoon from 12:30–2 p.m. in First Floor, Hall B.
This competition offers an opportunity to engage with innovative research, showcasing 10 rows of posters featuring up to 12 projects. Each row will have a dedicated moderator from the Program Committee to guide the process.
Presenters will kick off the competition by delivering three-minute presentations for each poster, followed by a two-minute discussion. After each discussion, attendees will participate in a quick voting session using their mobile devices. Participants will have the opportunity to evaluate each poster on a scale of one to 10.
After all presentations, winners of each row will be announced, and the first-place recipients will advance to the Championship Round on Saturday morning. In that final round, they will compete for significant cash prizes: $1,500 for first place, $1,000 for second, and $500 for third.
KEY LEADERSHIP UPDATES SLATED FOR SVS ANNUAL BUSINESS MEETING
THE SOCIETY FOR VASCULAR SURGERY (SVS) INVITES ALL MEMBERS TO its 2025 Annual Business Meeting, set for Friday evening from 5:15–6:30 p.m. in Room 208-210 on the second floor of the Morial CC The program will feature key updates from SVS leadership. President Matt Eagleton, MD, will present on the overall state of the organization, while Treasurer Thomas Forbes, MD, will provide a financial overview. SVS Secretary Bill Shutze, MD, will share information relating to membership and branding. The Nominating Committee will also present the slate of officers for the 2025–2026 term with the transition of the presidency from Eagleton to President-Elect Keith Calligaro, MD, marking a significant milestone for the SVS.
Catch the Last Day of the Career Fair
DON’T MISS THE FINAL DAY of the Career Fair today from 9:30 a.m. to 2 p.m. on the First Floor, Hall B—a prime destination for those seeking opportunities in vascular surgery. As an extension of the SVS Job Bank, the Career Fair is complimentary for conference attendees and provides an effective opportunity for vascular surgery professionals to meet with potential employers in person.
The Career Fair can also help attendees build their professional networks through continued conversations with organization representatives after the event.
Access the 2025 SVS Career Fair Featured Employers Guide, which contains information on all the organizations recruiting vascular surgery professionals during and after the Career Fair. The guide offers attendees the opportunity to browse open positions, access career resources and establish connections to advance their careers. Learn more at vascular.org/CareerFairGuide
Novel MRI technique for CLTI poised to address ‘medieval problem in modern medicine’
By Éva Malpass
“We want to change global standards. What we’re doing isn’t working. Patients are getting hurt and devices are failing— we want to be able to make sure devices we’re using today are safe, so that we can build new devices that are going to meet our needs for tomorrow.”
This was the statement made by Trisha Roy, MD, from Houston Methodist Hospital in Houston, Texas, during her Plenary Session 4 talk on image-guided precision in peripheral arterial disease (PAD) management. Her talk introduced a novel magnetic resonance imaging (MRI) method aimed to turn “clinical failures into new innovations,” tackling the “often demoralizing” battle to save limbs in the treatment of chronic limb-threatening ischemia (CLTI).
Referencing Wednesday’s session titled “Who should not undergo endovascular treatment for CLTI,” Roy admitted that the average VAM attendee came away with “more questions than answers.” In her view, “a big problem [with treatment for CLTI] is that we’re making these life-altering decisions based on diagnostic angiograms that show you contrast in lumen, but nothing about plaque, its composition, or about how hard, soft or malleable [the lesion] is going to be. And I don’t think that’s acceptable in 2025.”
To address this, Roy described the three-pronged approach
Analysis puts new focus on generalizability of BASIL-2 in real-world practice
OPTIMAL TREATMENT OF PATIENTS with chronic limb-threatening ischemia (CLTI) remains a keenly debated topic within the vascular community, and the recent addition of randomized data from two major trials—BEST-CLI and BASIL-2—has brought renewed vigor to the discourse in recent years.
Results of a new analysis will be presented during today’s Plenary Session 5 (8–9:30 a.m., First Floor, Great Hall A), in which researchers applied the inclusion criteria used in one of the trials— BASIL-2—among real-world patients undergoing first-time revascularization for CLTI, aiming to validate the findings of the study.
“We hope it stimulates a conversation about what outcomes are most vital for these patients who have such high rates of major adverse limb events, reintervention
that she and her colleagues take to treating CLTI—see it, treat it, know it. First, Roy described her team’s novel MRI method that addresses which patients have problematic lesions in advance of treatment.
“CLTI is a medieval problem in modern medicine, even with imaging and endovascular treatment we still have a very high immediate technical failure rate, mostly due to an inability to cross the lesion,” said Roy. To provide lesion characteristic details to potentially address this failure rate, Roy and colleagues’ MRI method uses T2 weighted and ultra-short at-the-time imaging to provide “unique signatures that show you whether something is fat, thrombus, soft matrix or hard materials like collagen and calcium,” Roy explained.
“When we use this in our prospective patient study, MRI predicted endovascular failure, need for adjunctive devices and reintervention rates. I think it’s important because not only are you identifying modes of failure—or who’s going to be high risk—but you can plan your procedures and set yourself up for success by knowing what tools you need,” continued Roy.
Addressing their second pillar: treat it, Roy placed emphasis on using “failure as a blueprint for innovation.”
“You know, we have a lot—a lot—of tools at our disposal. We don’t really know how to choose them appropriately,” Roy stated. “We’ve had so many recent device recalls and failures and I think those were preventable.” She described her team’s peripheral vascular device core which tests “real devices in real patients to identify failure modes before they become clinical events.”
“Even with imaging and endovascular treatment, we still have a very high immediate technical failure rate”
TRISHA ROY
and amputation, and also what procedure type, most importantly, benefits patients best,” Jeremy D. Darling, MD, tells VS@ VAM ahead of his presentation this morning.
BASIL-2, a 345-patient open-label, pragmatic, multicenter, randomized trial performed predominantly in the United Kingdom demonstrated that a best endovascular treatmentfirst revascularization strategy was associated with better amputation-free survival than a vein bypass-first strategy in those who required an infrapopliteal repair.
“It was a pretty drastically different finding than what was in BEST-CLI, and we wanted to investigate that a little bit further,” Darling says, alluding to the somewhat conflicting results seen in BASIL-2 against those of BEST-CLI, in which investigators found that endovascular intervention was inferior to open surgery.
“One of the big differences, aside from differences in patient population, is the outcomes that they chose. The primary outcomes in BEST-CLI are major adverse limb events or death, and the primary outcome in BASIL-2 is amputation-free survival.”
Using data from their own institution
BEST-CLI: NEW ANALYSIS SUPPORTS DRUG-COATED TECHNOLOGIES IN CLTI
USE OF PACLITAXEL-COATED DEVICES yielded fewer major reinterventions without an uptick in mortality, according to a new analysis of the BEST-CLI trial looking at patients treated using endovascular therapy for chronic limb-threatening ischemia (CLTI) and femoropopliteal disease.
The as-treated dataset from the trial—in which investigators compared revascularization treatment strategies among CLTI patients—will be presented during this morning’s Plenary Session 5 (8–9:30 a.m., First Floor, Great Hall A).
With a spotlight on the trial’s 341 patients treated using endovascular therapy in the femoropopliteal segment, the analysis by Jeffrey J. Siracuse, MD, and colleagues assessed three-year outcomes after initial technical success.
Outcomes evaluated include major adverse limb events (MALE)/death, above-ankle amputations, major reinterventions including new bypass, interposition graft, thrombectomy, or thrombolysis, minor reintervention and death.
Siracuse, an attending vascular surgeon at Boston Medical Center and professor of surgery and radiology at Boston University, is set to show that on Kaplan-Meier unadjusted analysis, interventions with paclitaxel technologies are associated with fewer major reinterventions than their non-paclitaxel counterparts.
Over the same three-year timeframe, the analysis shows rates of minor intervention, MALE/ death, above-ankle amputation and death to be comparable between the two therapeutic options.—Will Date
captured between 2005–2022, Darling and colleagues retrospectively reviewed all patients undergoing a first-time lower extremity infrapopliteal revascularization, using one-to-one propensity score matching to approximate the inclusion criteria from BASIL-2. Their primary outcome was amputation-free survival, whilst secondary outcomes included major reintervention, major amputation, major adverse limb events and survival.
Darling
The researchers looked at 1,184 limbs to have undergone a first-time infrapopliteal intervention for CLTI over the study’s 17-year lifespan, including 492 bypass and 692 angioplasty or stenting. After matching, 620 patients fit the criteria, with no baseline differences noted between groups.
Darling will report that there were no differences in perioperative mortality (3.9% vs. 4.5%), stroke (0% vs. 1.1%), myocardial infarction (1.3% vs. 2.9%), or acute kidney injury (12% vs. 14%), and that bypass did not demonstrate any difference in amputation-free survival compared to angioplasty (36% vs. 39%, p=0.77), major reintervention (15% vs. 19%, p=0.06), major amputation (24% vs. 22%, p=0.75), major adverse limb events (32% vs. 36%, p=0.08), or survival (42% vs.
47%, p=0.56) at five years.
However, when performing a subanalysis comparing patients undergoing bypass with single-segment great saphenous vein to angioplasty, bypass patients were noted to have significantly lower rates of both major reintervention (12% vs. 19%; p=0.02) and major adverse limb events (29% vs. 36%; p=0.04).
“A big distinguishing feature between our population and BASIL-2 is the number of patients who were dialysis dependent,” says Darling, reflecting on the differences seen in the results of this propensitymatched analysis when weighed against the trial’s headline results.
“In BASIL-2 it is between 3–6%, and in ours it is somewhere between 17–19%. A big limiting factor with any randomized controlled trial is the sterility of how they are performed, and a big aspect of BASIL-2 was that they excluded any patients who had an estimated survival of under six months. In our data, we did not exclude those patients.”
The latest study follows on from a similar piece of research performed by Darling and colleagues, in which they propensity matched real-world CLTI patients against the criteria used in the BEST-CLI trial, results of which pointed towards “generalizability” of the trial.—Will Date
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VAM THROUGH THE LENS » 25
Thursday was filled with the more scientific and educational content covering the breadth of the vasculature. It also included the opening of the Exhibit Hall, Vascular Live content and the Women’s Networking Event.
The excitement of Bourbon Street came inside the Great Hall as the vascular community experienced the spirit of New Orleans for day two of VAM 2025. Attendees enjoyed palm readings and performances by magicians during SVS Connect@ VAM: Welcome to New Orleans! Attendees also celebrated the opening of the Exhibit Hall, showcasing new innovations. and technology, and honored luminary figures at the Award Ceremony.
“A single idea from any of you, when materialized, can give us an important edge, maybe even transform the face of our specialty”
ENRICO ASCHER
OPEN SURGERY ASSOCIATED WITH BETTER OUTCOMES FOR TREATMENT OF
NUTCRACKER SYNDROME, STUDY FINDS
By Éva Malpass
CONTEMPORARY MANAGEMENT
of patients with Nutcracker Syndrome (NCS)—a rare vascular disease characterized by anatomic compression of the left renal vein—with open surgery has significantly higher primary patency and requires fewer reinterventions despite a high symptom recurrence rate.
This was the key takeaway delivered by resident physician Aravind S. Ponukumati, MD, during yesterday’s Plenary 4 session. He and his colleagues at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire evaluated NCS in Vascular Low Frequency Disease Consortium (VLFDC) data and set out to examine diagnostic work-up and outcomes of operative and non-operative treatment.
“Nutcracker syndrome is an exceedingly rare phenomenon, and the lack of diagnosis and procedure codes makes it difficult to study and track,” Ponukumati told a VAM 2025 audience. The team identified 240 pa-
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tients across 17 institutions who were diagnosed with NCS; patients were predominantly female, white and had an average age of 37 years. Presenting symptoms included flank pain (58%), chronic pelvic pain/dyspareunia (49%), hematuria (48%), non-positional abdominal pain (47%), and varicocele (3.3%).
“Approximately half of the cohort underwent at least one prior abdominal operation, which were mostly characterized by c-sections and appendectomy,” detailed Ponukumati. Further, he stated that many of these patients reported no symptom relief following operative treatment.
Ponukumati and colleagues found that diagnostic work-up of NCS included computed tomography (CT) imaging of the pelvis (84%), venogram (63%), duplex ultrasound (35%) and magnetic resonance imaging (MRI; 17%). The team’s findings showed that, on duplex ultrasound, the mean peak systolic velocity (PSV) of the left renal vein was 108.9±99 cm/s at the compression point
Two-year data show continued clinical improvement with VenoValve
IMPLANTATION OF THE VENOVALVE (ENVVENO Medical) continues to promote stabilization of symptoms in patients with deep venous reflux at two-year follow-up. This is the headline finding of data set to be shared today during Plenary 6 (10–11 a.m., First Floor, Great Hall A).
In the abstract outlining their findings, submitting and presenting author Cassius Iyad Ochoa Chaar, MD, associate professor of surgery at Yale School of Medicine in New Haven, Connecticut, and colleagues highlight that patients with advanced venous disease and deep venous reflux have no surgical options for treatment.
The VenoValve, they note—a bioprosthetic monocusp valve surgically implanted into the femoral vein—is currently being tested in a clinical trial to address this clinical need.
In the prospective, multicenter SAVVE trial, patients with deep venous reflux and no superficial venous reflux or venous outflow obstruction underwent surgery for symptoms of advanced venous disease consistent with CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification C4b–C6.
“The one-year results showed significant improvement in clinical endpoints and quality-of-life measures,” the authors share. The goal of their present paper was to outline the two-year results of the total cohort of patients.
At VAM 2025, Chaar and colleagues are set to report that clinical improvement—as measured by revised Venous Clinical Severity Score (VCSS)—showed sustained benefit at two years in the 43 patients who reached this follow-up milestone. Specifically, the mean rVCSS at two years was 9.8, which was slightly lower than the mean score at one year, but “significantly lower” than the baseline score of 15.6. Among several other data points, Chaar and colleagues will report on pain scores. The authors note in their abstract a slight decrease in Visual Analogue Scale (VAS) score from 2.2 at one-year follow-up to 1.9 at the two-year mark. Again, however, this was “significantly lower” than the baseline of 4.3.—Jocelyn Hudson
and 21.7±9.5 cm/s at the hilum, while venography demonstrated a mean renocaval pressure gradient of 3.92±2.4 mmHg.
Non-operative management with oral analgesics, nutritional counselling/feeding regimen, or simple expectant management was used in 107 (29%) patients and was reported as successful in 85 (79%)—a “largely successful” outcome, Ponukumati said, stating that patients reported symptom relief at a mean follow-up of 328 days. “However, one-fifth of these patients failed non-operative management, and nearly all of this subgroup progressed to needing surgery,” he pointed out.
Next, they examined the outcomes of patients managed operatively, either as an initial treatment or after non-operative failure, which accounted for 146 patients—60
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underwent left renal vein transposition, 43 gonadal/ovarian vein transposition, 18 renal auto-transposition and 19 endovascular therapies.
The overall three-year primary and secondary patency for operative management of NCS was 65% and 95%, respectively. Approximately one-third of patients required reintervention by three years after operative intervention. Ponukumati stated that, “despite excellent long-term secondary patency, 40% of patients have symptom recurrence by three years.”
Ponukumati and colleagues also performed a subgroup analysis of patients who underwent endovascular therapy versus open surgery, which showed the former had inferior three-year primary patency and freedom from symptom recurrence compared to patients who underwent the latter: 35% and 46%, compared to 67% and 61%, respectively.
The speaker reflected that the evaluation shows endovascular therapy to be a poor option for patients with NCS, requiring “numerous reinterventions in contrast to open surgery.” Yet, speaking pragmatically, Ponukumati stated that “patients have a significant rate of symptom recurrence regardless of chosen treatment modality,” yet concluded that it is “reasonable” to offer non-operative management for NCS as an initial treatment strategy. As a final recommendation Ponukumati advised that, due to the high rate of symptom recurrence, all patients should remain on long-term surveillance.
THE PEOPLE AND DEVICES THAT PUT ‘THE VASCULAR IN VASCULAR’
THE PEOPLE, DISCOVERIES, innovations and events that brought the vascular surgery profession to where it is today will form the subject matter for this year’s John Homans Lecture—“Who put the vascular in vascular surgery?”—at VAM 2025.
Jerry Goldstone, MD, an adjunct professor at Stanford University College of Medicine, will pore over some of the most important developments in the field since the founding of the SVS in 1946, which set the stage for the modern vascular surgical specialty.
“When the 31 founding members were gathered for their first meeting in 1947, how could they possibly have imagined what vascular surgery is like today,” Goldstone mused in an interview with VS@VAM ahead of his lecture, which takes place tomorrow morning on Morial CC’s Second Floor (Room 208–210) from 10:45–11:15 a.m. “They formed this organization because there was no organization devoted to vascular surgery. Most were general surgeons with a special interest in vascular, some were cardiac people with a special interest in vascular.”
What they helped shape yielded some tremendously important advances over the years, minting vascular surgery as a bona fide, standalone specialty in its own right, Goldstone says. After canvassing colleagues in the field,
he landed on “about 10 of the most important things that got us from zero to a place, now, where there is one big society, 6,000 members, our own journals, recognition internationally, good science.”
Among the topics he will chart are the formation of the SVS and its merger with the American Association for Vascular Surgery (AAVS), previously the North American Chapter, International Society for Cardiovascular Surgery (NA-ISCVS); the development of grafts; the coming of the vascular lab and duplex ultrasound; carotid endarterectomy (CEA); two innovations in venous disease in the shape of the the Greenfield filter for pulmonary embolism (PE) and laser ablation of the great saphenous vein; the founding of the Journal of Vascular Surgery (JVS); and the birth of the vascular surgery fellowship. The rise of CEA helped push the vascular specialty forward, Goldstone remarks. “After all, we are a surgical specialty, and known by the operations we do, and one of the most common and distinctive is CEA,” he explains.
“It put vascular surgeons into contact with other people, in other specialties, and elevated the profession beyond its own little cocoon, as maybe a little different from general surgery. It put vascular surgery as a profession on the map in a broader sense.”—Bryan Kay
Aravind S. Ponukumati
MEDICAL STUDENTS LEARN WHY VASCULAR SURGERY MATTERS
By Marlén Gomez
BRIGHT AND EARLY YESTERDAY morning, first- and second-year medical students gathered with light breakfasts in hand to attend a session focused on the critical importance of vascular surgery and the current need for vascular surgeons in the workforce.
SVS President-Elect Linda Harris, MD, delivered impactful opening remarks on how the students could absorb the information presented during the session and apply it among their peers.
“Take this back to your friends and help them understand that we exist. It’s an exciting and wonderful field,” said Harris. “It’s important that you form mentorships with some of us here so we can help show you what vascular surgery is all about.”
Presenters shared key takeaways, providing data and advice on the vascular surgery journey. Omar Selim, MD, of Brigham and Women's Hospital in Massachusetts, explained that vascular surgeons must respond quickly to intraoperative procedural challenges and manage life- or limb-threatening complications, likening their role to that of firefighters.
He shared a retrospective review of operating room cases conducted over 15 years,
revealing a total of 419 emergency intraoperative consultations. More than 80% of these consultations were related to controlling hemorrhage or revascularization. Over 75% of the cases involved elective surgeries that required unexpected vascular consultations.
“There is a significant and pressing need for vascular surgeons in various situations to provide excellent care in contemporary healthcare,” said Selim. “You will be called upon to assist patients in many different settings, and that’s something we take great pride in.”
Session moderator Gabriela VelazquezRamirez, MD, provided an overview of the vascular surgery workforce, sharing data that outlined how there is one vascular surgeon for every 130,000 people in the U.S. and that approximately 40% of these vascular surgeons are over the age of 55, which raises concerns about the future workforce. To meet the growing demand for vascular surgery, a 22% increase in relative value units (RVUs) will be necessary by the year 2040. Additionally, by 2035, the country will need an extra 400 vascular surgeons to address this shortage.
Velazquez-Ramirez warned that limited
training positions and a shortage of faculty members are currently causing significant training bottlenecks. The situation has serious implications, including increased workload for existing surgeons, a higher risk of burnout and delays in patient care. As of 2023, the estimated number of actively licensed and board-certified vascular surgeons in the U.S. stands at 3,432, with women making up only 15% of this workforce.
“Vascular surgery will be a rewarding career for you, and there will always be people who need your help and care. That’s why we are making a concerted effort to recruit early, even before individuals start medical school, because the need is so high,” said VelazquezRamirez.
The 2025 integrated Match had approximately 77 vascular surgery programs offering 102 positions. In total, 172 applicants were received, but only 102 were matched successfully.
“It’s a very competitive specialty, and I’m not telling you this to scare you. Rather, I want you to know that now is the best time to gain exposure, find mentors and prepare your research. It is competitive, which is
exactly what we want. We need you to become part of our workforce and help us,” said Velazquez-Ramirez.
The current training landscape presents several challenges and considerations, as outlined by Velazquez-Ramirez. One significant issue is the need to balance open surgical skills with endovascular skills. Additionally, the field faces workforce shortages and geographic disparities that affect access to training and healthcare. Diversity, equity and inclusion are also critical factors that must be addressed to create a more supportive training environment, said Velazqez-Ramirez. Trainee well-being is a further concern, as burnout has become increasingly prevalent among those in training programs. Ultimately, evolving technology necessitates ongoing adjustments and updates to training needs, ensuring that practitioners are well-equipped to meet modern demands.
Issam Koleilat, MD, from RWJ Barnabas Health in Toms River, New Jersey, provided attendees with insights on how to gain more exposure to vascular surgery. The approach depends on the resources available at one's home institution, he added.
“We are making a concerted effort to recruit early, even before individuals start medical school, because the need is so high”
GABRIELA VELAZQUEZ-RAMIREZ
Medical Editor Malachi Sheahan III, MD
Associate Medical Editors
Bernadette Aulivola, MD | O. William Brown, MD | Elliot L. Chaikof, MD, PhD
| Carlo Dall’Olmo, MD | Alan M. Dietzek MD, RPVI, FACS | John F. Eidt, MD | Robert Fitridge, MD | Dennis R. Gable, MD | Linda Harris, MD | Krishna Jain, MD | Larry Kraiss, MD | Joann Lohr, MD
| James McKinsey, MD | Joseph Mills, MD | Erica L. Mitchell, MD, MEd, FACS | Leila Mureebe, MD | Frank Pomposelli, MD | David Rigberg, MD | Clifford Sales, MD | Bhagwan Satiani, MD | Larry Scher, MD | Marc Schermerhorn, MD | Murray L. Shames, MD | Niten Singh, MD | Frank J. Veith, MD | Robert Eugene Zierler, MD Resident/Fellow Editor
Saranya Sundaram, MD
Executive Director SVS
Kenneth M. Slaw, PhD
Senior Director for Public Affairs and Advocacy
Megan Marcinko, MPS
Communications Specialist
Marlén Gomez
Published by BIBA News, which is a subsidiary of BIBA Medical Ltd.
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Managing Editor Bryan Kay
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Editorial contribution Jocelyn Hudson, Will Date, Éva Malpass and Urmila Kerslake
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Letters to the editor vascularspecialist@vascularsociety.org
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Senior Section advocates for individualized approaches in surgical retirement
DURING THE SVS SENIOR SECTION SESSION YESTERDAY AFTERNOON, Caron Rockman, MD, chair of vascular surgery at Hackensack Meridian School of Medicine, delivered a presentation addressing the complex and sensitive issue of aging within the surgical profession. She emphasized the need for thoughtful, individualized approaches over rigid mandates.
“Age-related changes in cognition, vision and skilled performance are inescapable, as they are in all people. We may not always recognize these changes in ourselves. However, confidence is better determined by objective information or functional abilities rather than chronological age, as there is great variation in individual capabilities,” said Rockman.
Rockman, a member of the Senior Section Steering Committee, began by highlighting a demographic shift: more than 40% of U.S. physicians will be 65 or older within the next decade.
The presentation explored how age-related declines—such as reduced fine motor skills, slower reaction times and diminished memory—can affect a surgeon’s ability to perform. Despite these changes, older surgeons often achieve excellent outcomes due to their clinical wisdom and experience, Rockman said.
Although the U.S. lacks a mandatory retirement age for physicians, other high-risk professions, such as aviation and military service, impose compulsory retirement ages. Rockman proposed structured, career-long competency evaluations that incorporate physical, cognitive and clinical performance metrics. These assessments, ideally integrated into institutional quality assurance programs, would help identify when a surgeon might benefit from transitioning to non-operative roles.
Rockman also stressed the importance of mentorship and transition planning. Her advice to surgeons nearing retirement was to move into roles in education, administration or community outreach, thereby preserving their contributions while ensuring patient safety. Rockman advocated for a nuanced, supportive approach to managing the aging surgical workforce. She called on professional societies, such as the SVS, to take the lead in developing flexible, evidence-based policies that uphold high standards of care while honoring the legacy and expertise of senior surgeons.—Marlén Gomez
AWARDS
LIFETIME ACHIEVEMENT AWARDEES UNVEILED
DURING YESTERDAY MORNING’S AWARDS ceremony, SVS President Matthew Eagleton, MD, presented two vascular surgery leaders—and two of his predecessors as president—with the SVS Lifetime Achievement Award, the highest honor given by the Society.
Bruce Perler, MD, of John Hopkins School of Medicine in Baltimore, and Anton Sidawy, MD, of George Washington University Medical Center in Washington, D.C., are the latest recipients to gain the recognition that marks out members who exemplify outstanding leadership in the specialty, maintain exceptional personal integrity and adhere to the highest standards.
“While I accept this award with incredible humility and gratitude, I want to accept this in part on behalf of all of you because I think all of you, as vascular surgeons and specialists, are career achievers. It’s been said it is impossible to have a great life unless it’s a meaningful life, and it is difficult to have a meaningful life without meaningful work, and what you do every day is incredibly meaningful work,” said Perler.—Marlén Gomez
Textbook outcome predicts better five-year survival for females
undergoing carotid revascularization procedures
ALTHOUGH A GREATER PROPORTION of males achieve a textbook outcome compared to females undergoing carotid revascularization procedures, when a textbook outcome is achieved, females demonstrate better five-year survival after carotid endarterectomy (CEA) and transfemoral carotid artery stenting (tfCAS). These are the deductions made by resident Angela D. Sickels, MD, and colleagues at the University of Alabama at Birmingham in Birmingham, Alabama, who are set to share the findings of their review during tomorrow's Plenary Session 8 (12:23–12:30 p.m., Second Floor, Room 208–210).
“Textbook outcome represents an important quality metric that may help address sex disparities that are historically seen in carotid revascularization, as it has a significant association with long-term survival,” Sickels told VS@VAM ahead of her talk. “Examining risk factor profiles unique to women for failure to achieve a textbook outcome and ensuring appropriate preoperative medical therapy can assist in shared decision-making regarding revascularization approach and potentially
improve textbook outcome rates,” she stated.
Using Vascular Quality Initiative (VQI) CEA and carotid stenting databases, the research team identified cases performed for symptomatic disease between January 2016 and October 2024 and found that males more commonly achieved a textbook outcome than females following CEA, transcarotid artery revascularization (TCAR), and tfCAS.
Characteristics common to a nontextbook outcome in females include greater incidence of chronic obstructive pulmonary disease, extreme body mass index (BMI), and chronic kidney disease compared to non-textbook males. Textbook outcome males had a lower five-year survival rate compared to textbookoutcome females for CEA and tfCAS, while both groups had similar survival when having undergone TCAR.—Éva Malpass
ARTIFICIAL INTELLIGENCE IN VASCULAR SURGERY
TOMORROW’S PLENARY SESSION 7 (8–9:30 a.m.) taking place on the Second Floor (Room 208–210) will drill into some of the artificial intelligence (AI) technologies and applications making inroads in the world of vascular surgery.
Moderated by Thomas Forbes, MD, professor and chair of vascular surgery at the University of Toronto in Toronto, Ontario, Canada, Ravi Ambani, MD, a vascular surgeon at the Cleveland Clinic in Cleveland, Ohio, and Christine Shokrzadeh, MD, an assistant professor of vascular surgery at the University of Texas Medical Branch in Galveston, will hear from a range of speakers looking at AI applications across the vasculature.
The talks include data on the use of large language models in abdominal imaging, machine learning in mortality risk prediction following major lower extremity amputation and the application of AI in correlating carotid plaque imaging characteristics with clinical and histological features.
The session will open with a paper that explores a prediction model for safe contrast volume thresholds to prevent acute kidney injury after endovascular abdominal aortic aneurysm repair.—Bryan Kay
The 2025 Lifetime Acheivement awardees recieve their plaques
