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IN THIS ISSUE 2 GUEST EDITORIAL

10 PAD

A daughter’s storytelling habit sparks a surgeon’s journey toward active listening

Data supports arm vein when GSV is unavailable

13 COMMENTARY

6 CLTI

THE OFFICIAL NEWSPAPER OF OCTOBER 2026 Volume 22 Number 8

Study finds comparable long-term outcomes for peroneal and tibial bypass

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CAROTID

VASCULAR NURSING

SVN offers vascular nurses a professional home

ROADSTER 3 analysis explores role of TCAR in asymptomatic carotid disease

By Maria Gifford

underwent TCAR in the ROADSTER 3 trial.” The analysis was presented at the 2026 meeting of the Midwestern Vascular Surgical Society in Chicago, Illinois (Sept. 17-20). The primary composite endpoint was periprocedural stroke and death within 30 days, plus any ipsilateral stroke from 31 to 365 days. Among intention-to-treat patients, the 30-day stroke and death rate was 1%. In the per-protocol cohort, it was 0.7%. Notably, no deaths occurred. Through one year, one additional ipsilateral stroke was recorded, bringing the composite to 1.4% for intention-to-treat and 1.2% for per-protocol patients. All events were independently adjudicated and patients underwent independent neurological assessments. Those numbers take on additional weight when measured against CREST-2. In that trial, the 30-day stroke and death rate was 1.3% for transfemoral CAS and 1.5% for CEA — both higher than what ROADSTER 3 observed for TCAR in a comparable asymptomatic population. “The periprocedural incidence of stroke and death for asymptomatic standard surgical risk patients undergoing TCAR was low relative to the benchmarks established for transfemoral CAS and CEA in CREST-2,” said Schermerhorn. “TCAR should be considered in the shared decision-making process with patients needing carotid revascularization.” The patient population in this analysis also included characteristics that would have excluded them from the CAS arm of CREST-2. Roughly 11% had a Type III aortic arch and nearly 33% had arch atheroma — both exclusion criteria for transfemoral CAS in CREST-2 — yet TCAR was still performed with low complication rates. That anatomic distinction matters clinically, as it suggests TCAR may reach patients for whom transfemoral stenting is not a viable option. “Several anatomic features that increase risk for CEA or

Vascular patients are complex, their conditions are often invisible to the untrained eye and the nurses who care for them are too frequently working without a specialized community to lean on. The Society for Vascular Nursing (SVN) was built to change that and after more than four decades, it remains the only national organization dedicated specifically to nurses and advanced practice providers (APPs) in the vascular space. The SVN draws members from across the vascular care spectrum, including interventional cardiology, interventional radiology, vascular surgery, peripheral artery disease management and stroke nursing. With approximately 400 members split roughly 60/40 between APPs and registered nurses, the organization has grown well beyond its nursing-only origins into a broad professional home for clinicians who share a focus on vascular disease. “The purpose is to have a national society that comes together where we can all learn from each other, educate, help patients, have webinars, develop patient education materials and learn how to be speakers — all in a way that’s meaningful and collaborative,” said Suzanna Fitzpatrick, DNP, ACNPBC, FNP-BC, president of the SVN and a senior nurse practitioner at the University of Maryland Medical Center in Baltimore. “The SVN has

See page 6

See page 10

By Maria Gifford

he CREST-2 trial provided important new evidence on carotid revascularization in asymptomatic patients, but it left one question unanswered: Where does transcarotid artery revascularization (TCAR) fit? A new analysis from the ROADSTER 3 trial offers a direct look at that question. Researchers analyzed outcomes for 288 asymptomatic, standard surgical risk patients enrolled in ROADSTER 3 whose eligibility criteria closely mirrored those used in CREST-2. TCAR was not included as a treatment arm in CREST-2, a gap this analysis was designed to address. “ROADSTER 3 is the first independently adjudicated, prospective study evaluating TCAR in a standard surgical risk population,” said Marc Schermerhorn, MD, chief of the division of Vascular and Endovascular Surgery at Beth Israel Deaconess Medical Center and a professor of surgery at Harvard Medical School. “Our objective with this post hoc analysis was to assess outcomes for standard risk, asymptomatic patients, enrolled with eligibility criteria similar to CREST-2, who

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Vascular Specialist is the official newspaper of the Society for Vascular Surgery and provides the vascular specialist with timely and relevant news and commentary about clinical developments and about the impact of healthcare policy. The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society. The Society for Vascular Surgery will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services, or the quality or endorsement of advertised products or services, mentioned herein. | The Society for Vascular Surgery headquarters is located at 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. | POSTMASTER: Send changes of address (with old mailing label) to Vascular Specialist, Subscription Services, 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. | RECIPIENT: To change your address, e-mail vascularspecialist@ vascularsociety.org | For missing issue claims, e-mail vascularspecialist@vascularsociety.org | Vascular Specialist (ISSN 1558-0148) is published by the Society for Vascular Surgery. | Printed by Ironmark | ©Copyright 2025 by the Society for Vascular Surgery

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GUEST EDITORIAL ‘So, then…….’:

How my daughter jumpstarted my journey to ‘active’ listening By Bhagwan Satiani, MD “So, then……..,” (ST) was our daughter’s favorite phrase growing up. Whether it was sharing a school event or something else, there tended to be several “STs” with a blow-by-blow description of events. I kept late hours and like many of you came home exhausted and wanted a short summary of the day from our children. Most times, I tended to interrupt her after a couple of ST’s and interjected with, “So what happened?” She would then either ask me to wait a painful wait before coming to the point, accompanied by an eye roll, or turn her attention to address her mother or brother. Slowly, I did learn to listen. We may blame this lack of listening on a scarcity of time, multitasking, etc. I suspect that many of us are in a hurry when we interrupt our patients. In fact, the 1984 Beckman study showed that 70% of patients were interrupted within 20 seconds and that only 2% finished their thought. Many years later, this is still the case. Although I still do, I’ve started to understand that listening is complicated. For example, we may stay quiet, make eye contact and even nod, but we have “tuned out.” This explains why only about half of all listeners remember what they had heard shortly after someone finishes talking. Two months later, only 25% of the average listener will remember the conversation. Hearing (sound entering your ears) is very different than purposeful or “active” listening. Experts advise practicing “active listening.” Active listening has three aspects: cognitive, emotional, and behavioral. This means paying attention to the other person and trying to process their words, show interest, manage any emotional reaction and look for non-verbal cues being displayed by the speaker. Later, if you’re unsure of the direction of the conversation, ask them to repeat their message or state your understanding of the issue without judgment. Being an active listener is more about how we listen. First, become self-aware of your default listening style. Are you a ‘task oriented’ listener? That is someone like me focused on efficiency and getting to the point or reason for the conversation. An “analytic” listener is more attuned to helping the other person with a solution right from the start. A “relational” listener seeks to build a connection and probably focuses on the emotional aspect of the message. Finally, a “critical” listener is more likely to start in a judging mode. I think these listening styles align with the listener’s Myers-Briggs or Social Styles (SS) behavioral style. As a “Driver” in the SS behavioral grid, I am probably more inclined to be a task-oriented listener. However, just like leadership styles, most of us are versatile and although we have a default style, we switch styles (versatility) depending on the context, our needs and the other person in the conversation. But just like leadership, good listening starts with recognizing one’s own default listening style. As a task-oriented listener, I’m always itching to interrupt to get to the point and bring the “task” to a conclusion. This does two things. Not only does this distract the other person from making their point and leave them feeling unheard, but it also keeps me occupied thinking of ways to respond instead of truly listening. The technique of proper eye contact, nodding, etc., is for naught if I am already planning to respond. A good exercise recommended is to become a “non-directional” listener at the outset, one who is not going to interrupt and offer a critique or response unless asked. It has been hard for me to pay attention when, after the first minute or two of the conversation, I am bored and see no value to the conversation. Instead, after a question or

two, I should amplify and further promote the other person’s thoughts and energy as a “trampoline listener.” I have seen a few leaders demonstrate this concept. At the right time, they augment the other person’s thoughts by sharing a brief personal story to support their point. This further clarifies the speaker’s thoughts. Listening is an important, often overlooked attribute in a safetydriven healthcare environment. With the constant iPhone or beeper, it is easy to miss what is in front of us, including non-verbal cues. I learned an early lesson when I helped save a patient from an unnecessary procedure. As a second-year, every-other-night on-call General Surgery resident on the “Trauma” service at Grady Hospital, we admitted all acute abdominal problems, auto accidents and the knife & gun club members. An obese woman presented at night with a classic clinical picture of acute cholecystitis. I wheeled her to Radiology for a plain X-ray, confident that it would show a gallstone(s). Besides HIDA and daytime ultrasound scans, no other imaging was available at night. Sure enough, there was an oval calcified mass in the right upper quadrant corresponding to a single large gallstone. I waited outside, completing her paper chart while two radiology technologists shifted her back to the stretcher. One of the techs came over and asked if I had examined her back. She then sat the patient up and asked me to feel the patient’s right back. I found a large, partially calcified wart (dystrophic calcification), confirmed by a lateral decubitus film. Tired after over 12 hours on duty, I may not have listened to the technologist. Arnaud Chevallier suggests that leaders should embrace the importance of listening and adopt “question storming” where teams meet to brainstorm questions rather than answers to unleash creativity. Furthermore, leaders need to create an organizational culture of listening rather than simply dictating, for several reasons. Listening skills build strong relationships, improve engagement and communication, strengthen the work environment and ultimately improve retention of much-needed talent. Because engagement is vital to an organization’s success, leaders know disengaged employees hurt the bottom line through lost productivity and attrition. Listening to the workforce, allowing people to speak up without fear and providing feedback creates a safe environment. A recent survey shows that 86% of employees feel that they are not heard “fairly” and twothirds feel their opinion has been ignored. In fact, people are 4.6 times more likely to perform better when they feel heard. In a LinkedIn survey of 14,000 employees, only 8% of employees considered leaders to have good listening skills. Listening is a trainable skill. Why are most of us so poor at active listening? We know that while we speak at the rate of about 125 words a minute, the human brain, with 13 billion cells, must slow down considerably to adapt to someone speaking at only 125 words per minute. We are either distracted by other issues or think ahead of the speaker with things like where is the other person going, what do they want, how do I respond, observe the facial expression etc. Experts have offered a few suggestions to deal with this disparity. Since we cannot memorize numerous facts, it is better to concentrate on the other person’s ideas. Second, hear the other person out to the end, even when they look to us for a response. This technique also blunts our emotional reactions to topics we have strong opinions about and forces us to practice self-control. Listening to people to the end also avoids listening errors because the speaker will invariably repeat something to clarify a previous statement. The late Larry King, host of CNN, said, “I remind myself every morning: Nothing I say this day will teach me anything. So, if I’m going to learn, I must do it by listening.” Another memorable quote is “I never learned anything while I was talking.” Yes, I am now sure to wait until my daughter has exhausted her quota of ST’s.

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Vascular Specialist | October 2 0 2 6

ADVERTORIAL | SPONSORED BY JOHNSON & JOHNSON MEDTECH

Shockwave IVL expands options across calcified PAD

alcification remains a major challenge in peripheral artery disease (PAD), complicating vessel preparation and potentially affecting procedural durability. Kyle B. Reynolds, MD, assistant professor at Georgetown University, discusses his experience with Shockwave Intravascular Lithotripsy (IVL), advances in the technology, clinical evidence supporting its use and how Shockwave IVL has shaped his approach to calcified disease.

What is the importance and challenges of modifying calcific peripheral artery disease prior to definitive therapy?

Kyle B. Reynolds, MD: Calcification poses significant challenges to both technical and long-term success of endovascular interventions. A lot of this is based on vessel compliance. To obtain adequate vessel expansion, we inflate balloons up to high pressures against a very stiff artery, which can lead to dissections and perforations. Even at high pressures, heavily calcified vessels can recoil or have residual stenosis. Stenting, either primarily or as a bail out, may not fully expand, leading to higher rates of restenosis. Modifying the calcium in these vessels is important to improve patient outcomes.

How would you describe how Shockwave IVL works? How does this differ from alternative calcium modification strategies?

Reynolds: Shockwave IVL is based off the same technology principles that were already known for breaking up kidney stones. Energy is delivered to emitters mounted within a balloon catheter to produce ultrasonic acoustic pressure waves that help fracture and fragment calcium. It’s the same simple process that we’re already used to with balloon angioplasty, where you inflate a balloon at a low pressure to the arteries nominal size. Then as the energy is delivered to those emitters, the lithotripsy does the work with instantaneous high-energy ultrasonic waves that can help fracture the calcium.1 Shockwave IVL does this to both the superficial calcium and the deeper calcium without affecting the soft tissue.1 Alternative

calcium modification strategies focus on luminal gain and removing luminal plaque burden, but these devices don’t affect medial calcification. The safety profile between alternative devices, such as atherectomy, also differs due to the mechanism of action. With Shockwave IVL, you’re inflating a balloon and opposing it to the vessel wall, but you are not removing the plaque, you’re remodeling it. Other plaque modifying devices achieve luminal gain by cutting, shaving, or vaporizing plaque which comes with the increased risk procedural complications such as embolization, and perforations.

“With Shockwave IVL, you’re

inflating a balloon and opposing it to the vessel wall, but you are not removing the plaque, you’re remodeling it.” KYLE B. REYNOLDS, MD

What has been your clinical experience of the safety and efficacy of Shockwave IVL within various calcium morphologies?

Reynolds: Shockwave IVL has been reliably effective. It has become my workhorse when treating densely calcified lesions due to the low procedural complication profile typically associated with treating calcium morphologies. That seems to be the case with many interventionalist experiences based on Shockwave IVL’s exponential increase in utilization years before any type of reimbursement was available. For years, it wasn’t even reimbursed by the hospital, yet its usage has grown across multiple different specialties because it works so well. We felt that it was what was best for the patient. Similar to the data in both DISRUPT PAD III and DISRUPT BTK II, I’ve had no episodes of embolization or perforation and low rates of significant dissections.2,3 These factors have changed my algorithm, especially behind the knee. I have experienced both technical success and successful long-

Figure 2: Shockwave E8 redesigned Shockwave IVL catheters from tip-to-hub to prioritize deliverability. This included adding additional hydrophilic coating, changing the balloon polymer material, and improving the tip construction. term patency with IVL and a DCB, avoiding a scaffold, in calcified lesions that historically required stents.

How have advancements in Shockwave IVL technology further impacted your clinical practice?

Reynolds: The newer Shockwave E8 catheter has specifically been a gamechanger for below the knee revascularization, which can be more challenging. Tibial arteries have a higher prevalence of medial calcium, long lesions, and less bail-out options. The Shockwave E8 catheter has a lower crossing profile and more pulses which helps with efficiency.

was transferred from an outside hospital with a left infected foot wound. The Left Lower Extremity angiogram revealed a heavily calcified TP trunk stenosis and nearly occlusive posterior tibial artery lesion. This was confirmed with IVUS which assessed plaque morphology and appropriately sized

Can you share a case where the advancements of Shockwave E8 in terms of deliverability, balloon length or treatment capability provided a benefit? How would this case differ prior to the introduction of Shockwave E8?

Reynolds: As mentioned above, Shockwave E8’s benefits are most clear below the knee, especially when considering multi-vessel disease. A case that comes to mind took place two weeks ago. It involves an 80-yearold female with diabetes and end stage renal disease, who recently had a right aboveknee amputation and depended on her left leg to transfer and live independently. She

Figure 1: Shockwave IVL emitters are designed to prioritize safety without tradeoffs for efficacy. Initial shockwaves emerge from their spark gap origins to produce a spherical shockwave.

Figure 3: The pre-, during, and post-procedure angiograms from Dr. Reynolds’ case demonstrate the improvement in blood flow below the knee, following the use of a 3.5mm Shockwave E8 balloon.

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ADVERTORIAL | SPONSORED BY JOHNSON & JOHNSON MEDTECH the vessel. We performed Shockwave IVL in both the TP trunk and proximal peroneal artery using a 3.5mm Shockwave E8 balloon and a posterior tibial artery angioplasty using a 3.0x60mm balloon. The 80mm balloon length of Shockwave E8 along with its 400 pulses allowed me to easily treat both the TP trunk and proximal peroneal artery. While we do not have long term followup on the patient, the patient underwent a transmetatarsal amputation following the intervention. Our podiatry colleagues felt that there was excellent perfusion to the tissue, especially the plantar flap.

How have the findings of recent clinical programs such as DISRUPT PAD III OS, PAD III RCT and BTK II informed, changed or shaped your treatment algorithm for calcific PAD?

Reynolds: It has reinforced what I see in my clinical practice. One of the things that’s important to me is understanding and analyzing the data to make sure that I am providing optimal patient outcomes and not operating in a silo. Shockwave IVL catheters are the most studied IVL devices that we have available. With the DISRUPT PAD III observational study, the largest prospective study for peripheral IVL using real-world data, investigators looked at over 1,300 patients with lesions across multiple vessel beds from the iliac arteries to the tibials. The study included CTOs, 90% of lesions had moderateto-severe calcification and included not only diabetics but patients on dialysis, which is usually an exclusion criterion. The results demonstrated that Shockwave IVL was safe with predictable outcomes across all vessel

Figure 4: Johnson & Johnson MedTech has published outcomes from 7 sponsored PAD studies over the last 12 years. These studies have created a repository of data that includes all vessel beds, complex patient populations, and real-world outcomes to provide physicians with confidence when using Shockwave IVL. beds, all lesion types, and all patients. The procedural complication rates were low, less than 1% dissection, less than 1% perforations and less than 1% embolization.3 DISRUPT BTK II has published their oneyear results in over 290 lesions. What we ended up seeing similarly is that the IVL did a lot of the heavy lifting. Similarly to what we saw above the knee, in these really calcified vessels, there was a less than 1% rate of procedural complications, including embolization, dissection, perforation, and thrombosis. Even the provisional stenting rate was only 2%.2 I’m looking forward to the two-year outcomes that are about to be presented at VIVA.

With upcoming IVL technologies

The other challenge will be the scale of the Shockwave IVL portfolio. We have Shockwave E8, a workhorse catheter with smaller diameters (2.5mm to 6.0mm), Shockwave L6 in the larger sizes going up to a 12 mm balloon that allows us to treat calcified vessels with aortoiliac disease, and Shockwave Javelin which enables calcium modification in difficult-to-cross lesions. What’s really important is dedicated devices for other vessel beds, especially the upcoming Shockwave IVL carotid device that is currently being used in its IDE clinical trial. Having a device that’s been robustly studied in other vessel beds has given physicians confidence that it could be applied to the carotid space, and a dedicated device would be great. If the trial goes well, that’s going to significantly affect patient care while also making it difficult for other portfolios to match.

coming to market, what aspects of Shockwave IVL’s portfolio, proof, or performance do you find to be the most difficult to match, replicate or surpass?

Reynolds: It’s going to take time for other IVL technologies to generate as much data on the safety and efficacy of their devices across diverse patient populations and lesion characteristics. As Shockwave has been addressing this for years, there’s robust reproducible data supporting the use of Shockwave IVL. As new devices come out, we have to make sure that they also work safely and effectively. It’s a challenge that I’m looking forward to as newer devices, and newer generations of the Shockwave platform, continue to advance patient outcomes.

KYLE B. REYNOLDS, MD is an assistant

professor at Georgetown University.

Dr. Reynolds is a paid consultant for Johnson & Johnson MedTech. The thoughts and views expressed are of their own opinions and do not necessarily represent Johnson & Johnson MedTech.

References: 1.Kereiakes DJ, Virmani R, Hokama JY, et al. Principles of Intravascular Lithotripsy for Calcific Plaque Modification. JACC Cardiovasc Interv. 2021;14(12):1275-1292. doi:10.1016/j.jcin.2021.03.036 2.Chandra V, Lansky AJ, Sayfo S, et al. Thirty-day outcomes from the Disrupt PAD BTK II study of the Shockwave Intravascular Lithotripsy System for treatment of calcified below-the-knee peripheral arterial disease. J Vasc Surg. 2025;81(3):710-719.e2. doi:10.1016/j.jvs.2024.11.003 3.Armstrong EJ, Adams G, Soukas PA, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Disrupt PAD III Observational Study. J Endovasc Ther. 2026;33(2):853-862. doi:10.1177/15266028241283716 Shockwave M5, Shockwave M5+, Shockwave S4, Shockwave L6 and Shockwave E8 Safety Information In the United States: Rx only.

Indications for Use—The Shockwave Medical Intravascular Lithotripsy (IVL) System is intended for lithotripsy-enhanced balloon dilatation of lesions, including calcified lesions, in the peripheral vasculature, including the iliac, femoral, iliofemoral, popliteal, and infra-popliteal arteries. Not for use in the coronary, carotid or cerebral vasculature. Peripheral IVL is also indicated for use in renal arteries in certain jurisdictions, including the United States. Please reference Instructions For Use for country specific information. Contraindications—Do not use if unable to pass 0.014” (M5, M5+, S4, E8) or 0.018” (L6) guidewire across the lesion-Not intended for treatment of in-stent restenosis or in coronary, carotid, or cerebrovascular arteries. Warnings—Only to be used by physicians who are familiar with interventional vascular procedures—Physicians must be trained prior to use of the device— Use the generator in accordance with recommended settings as stated in the Operator’s Manual. Precautions—Use only the recommended balloon inflation medium—Appropriate anticoagulant therapy should be administered by the physician— Decision regarding use of distal protection should be made based on physician assessment of treatment lesion morphology. Adverse effects–Possible adverse effects consistent with standard angioplasty include–Access site complications – Allergy to contrast or blood thinner– Arterial bypass surgery—Bleeding complications—Death— Fracture of guidewire or device—Hypertension/Hypotension— Infection/sepsis—Placement of a stent—renal failure— Shock/pulmonary edema— target vessel stenosis or occlusion— Vascular complications. Risks unique to the device and its use— Allergy to catheter material(s)— Device malfunction or failure— Excess heat at target site. Prior to use, please reference the Instructions for Use for more information on indications, contraindications, warnings, precautions and adverse events. www.shockwavemedical.com/IFU

Shockwave Javelin Safety Information In the United States: Rx only.

Indications for Use—The Shockwave Medical IVL System with the Javelin Peripheral IVL Catheter is intended for lithotripsy- enabled modification and crossing of calcified lesions in the peripheral vasculature, including the iliac, femoral, ilio-femoral, popliteal, and infra-popliteal arteries, prior to final treatment. Not for use in the coronary, carotid, cerebral, or pulmonary vasculature. Contraindications—Do not use if unable to pass 0.014” (0.36mm) guidewire across the treatment site-Not intended for treatment of in-stent restenosis or in coronary, carotid, cerebral or pulmonary arteries. Warnings—Only to be used by physicians who are familiar with interventional vascular procedures—Physicians must be trained prior to use of the device— Use the generator in accordance with recommended settings as stated in the Operator’s Manual. Precautions—Avoid applying acoustic pressure pulses while IVL window is not filled with sterile saline—Appropriate anticoagulant therapy should be administered by the physician— Decision regarding use of distal protection should be made based on physician assessment of treatment lesion morphology. Adverse effects–Possible adverse effects consistent with standard angioplasty include–Access site complications – Allergy to contrast or blood thinner– Arterial bypass surgery—Bleeding complications—Death— Fracture of guidewire or device—Hypertension/Hypotension— Infection/sepsis—Placement of a stent—renal failure— Shock/pulmonary edema— target vessel stenosis or occlusion— Vascular complications. Risks unique to the device and its use— Allergy to catheter material(s)— Device malfunction or failure. Prior to use, please reference the Instructions for Use for more information on indications, contraindications, warnings, precautions and adverse events. www.shockwavemedical.com/IFU SPL-83185 Rev A

Vascular Specialist | October 2 0 2 6

CAROTID

Beyond CREST-2: Real-world data compare CAS, TCAR and CEA By Killian Meara

Real-world outcomes following carotid artery stenting (CAS) may differ from those reported in CREST-2, according to a study comparing stenting with carotid endarterectomy (CEA) among asymptomatic patients who met similar eligibility criteria. The analysis, presented by Gabriel Jabbour at the meeting of the Eastern Vascular Society (EVS) in Washington, D.C. (Sept. 17-19), was designed to address questions raised following CREST-2, including the lack of a direct comparison between CEA and CAS and whether outcomes achieved at highly experienced trial centers would translate to routine clinical practice. “The vascular community raised many concerns,” said Jabbour, an integrated vascular surgery resident at Yale New Haven Hospital, pointing to the lack of a head-to-head comparison, strict patient selection and medical therapy requirements

and the exclusion of transcarotid artery revascularization (TCAR). “Our goal was to add a real-world comparison of CAS and CEA following CREST-2 criteria.” Investigators first used VQI-VISION data to compare CAS with CEA, adjusting for 15 patient characteristics. Patients undergoing stenting were approximately two years older and more likely to have heart failure and coronary artery disease, while the degree of carotid stenosis was similar between groups. Unadjusted in-hospital stroke or death occurred in 1.1% of CAS patients compared with 0.7% following CEA. At approximately 44 days, stroke or death was 2.8% after CAS and 1.9% after CEA. After adjustment, CAS was associated with approximately 80% higher odds of in-hospital stroke or death and 47% higher odds of 44-day stroke or death compared with CEA. CEA, however, was associated with more inhospital myocardial infarctions. Differences persisted during longer-term

follow-up. At four years, all-cause mortality was 28% following CAS compared with 21% after CEA, while any stroke occurred in 10% and 7.8%, respectively. Investigators then used VQI data to examine transfemoral CAS (TFCAS), TCAR and CEA separately. In-hospital ipsilateral stroke occurred in 0.8% following TFCAS, 0.7% after TCAR and 0.5% after CEA. After adjustment, TFCAS was associated with approximately 80% higher odds of in-hospital stroke or death compared with CEA and 50% higher odds of stroke compared with TCAR. A sensitivity analysis limited to patients with anatomy considered favorable for stenting did not significantly change stroke rates. The researchers also examined the severity of the excess strokes observed with TFCAS. “It turns out the difference was carried entirely by minor strokes,” said Jabbour. “The major stroke did not differ between the two.” The study concluded that among asymptomatic patients meeting CREST-2like eligibility criteria, real-world stenting was associated with higher perioperative stroke or death compared with CEA, while CEA was associated with more myocardial infarction. The findings also suggest outcomes may differ between transfemoral stenting and TCAR.

FROM THE COVER:

ROADSTER 3 analysis explores role of TCAR in asymptomatic carotid disease continued from page 1 transfemoral CAS procedures do not apply to TCAR,” said Schermerhorn. “TCAR may be a feasible option for patients with these characteristics and this analysis from ROADSTER 3 adds to the evidence supporting safety and effectiveness of TCAR for asymptomatic patients.” The analysis stops short of a direct randomized comparison and Schermerhorn was direct about what the field still needs. Observational data comparing TCAR with CEA have largely shown equivalent outcomes and outcomes with transfemoral CAS have generally been inferior, yet formal randomized evidence pitting all three approaches against one another in asymptomatic patients remains absent. Schermerhorn also pointed to the ongoing challenge of patient selection, noting

CLTI

Study supports peroneal bypass when traditional tibial targets are unavailable By Killian Meara Peroneal artery bypass may provide similar long-term outcomes to anterior and posterior tibial (AT/PT) bypass in patients with chronic limb-threatening ischemia (CLTI), according to a study presented at the 2026 meeting of the Eastern Vascular Society (EVS) in Washington, D.C. (Sept. 17-19), Tibial bypass remains an important treatment for CLTI, particularly in patients presenting with rest pain or tissue loss. While the anterior and posterior tibial arteries provide direct inline flow to the foot, the peroneal artery supplies collateral flow and is often selected when the other tibial vessels are diseased, occluded or otherwise unsuitable for bypass. “Usually, the peroneal is chosen when the AT and the PT are diseased or occluded or otherwise unsuitable for bypass,” said Abhishek Rao, an integrated vascular surgery resident at NYU Langone Health, who presented the data. “Which lends itself to the question: In the long term, how does peroneal bypass compare to AT and PT bypass?” Investigators used VQI data from 2011 through 2019 to compare outcomes following peroneal bypass with AT/PT bypass. The analysis

that most asymptomatic patients ultimately do not require revascularization and that high-risk plaque characteristics should drive who is treated. “Subgroup analysis of asymptomatic patients undergoing TCAR demonstrates lower periprocedural incidence of stroke or death than the recently published CREST-2 trial of transfemoral CAS and CEA,” said Schermerhorn. “With the enthusiasm of CREST-2 reinforcing the benefit of revascularization in asymptomatic patients, we still need to improve our patient selection for these procedures based on high-risk plaque characteristics, since the majority of patients do not need revascularization and we need to focus our interventions on those at greatest risk.”

included patients with rest pain or tissue loss who underwent bypass using single-segment great saphenous vein, prosthetic conduit or a prosthetic-vein composite. Approximately 2,200 patients underwent AT/PT bypass and 720 underwent peroneal bypass. Patients in the peroneal group were older, with an average age of 75 compared with 70, and were more likely to have chronic kidney disease. Rates of diabetes and use of GSV conduit were similar between groups. The primary outcome was four-year amputation-free survival, which was 39.8% following AT/PT bypass and 38% following peroneal bypass, a difference that was not statistically significant. Thirty-day outcomes, including mortality, major adverse cardiovascular events and wound infection, also did not significantly differ between the groups. However, Rao noted that early mortality and major adverse events were relatively high in both cohorts. Similarly, there were no significant differences in long-term mortality, major amputation, reintervention or patency. The study was limited by its retrospective design and the lack of granular information on factors such as inflow and outflow quality, wound severity and graft length. Despite those limitations, Rao said the results support peroneal bypass when AT or PT targets are unavailable. “For patients who don’t have sufficient AT or PT quality for a distal bypass to those two targets, a peroneal artery bypass is still a valid and suitable operation,” he said.

ROBOTICS

Robotics points to the next era of vascular surgery By Killian Meara

Robotic surgery could allow vascular surgeons to combine the durability of open reconstruction with a minimally invasive approach, but wider adoption will require dedicated training pathways and experience, according to Charu Bavare, MD, of Huston Methodist Hospital. During a session at the 2026 meeting of the Eastern Vascular Society (EVS) in Washington, D.C. (Sept. 17-19), Bavare traced vascular surgery’s evolution from open aortic reconstruction to endovascular therapy, noting that less invasive approaches have transformed care but can require surveillance and secondary interventions. Bavare argued that robotics could provide another option by allowing surgeons to perform traditional vascular operations through a minimally invasive approach. “What you do as an open procedure, you can still do as a laparoscopic procedure,” he said, describing robotic instruments as “an extension of your hands inside the belly.” His own path into robotics began without an established vascular surgery training program. After completing basic robotic training, simulation and case observation, Bavare pursued additional experience with vascular anastomoses and aortic exposure before gradually expanding the procedures performed robotically. Bavare’s program now uses robotic approaches for procedures including aortic aneurysm and occlusive disease, renal vein transposition, ovarian vein procedures and selected visceral artery operations. However, he said that one challenge to broader adoption is that no formal robotic training pathway currently exists in the U.S. for practicing vascular surgeons. Still, he sees opportunities for future vascular surgeons as robotic exposure becomes more common during general surgery training. “This is where the future is for vascular surgery,” said Bavare. “We can do open vascular surgery. We know how to do endovascular surgery. What we have to learn is robotics. This is the only specialty in the world which will be able to do all three.”

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Vascular Specialist | October 2 0 2 6

ADVERTORIAL | SPONSORED BY STRYKER

ClotTriever BOLD reshapes approach to DVT thrombectomy

cute Thrombus can be difficult to predict based on symptoms alone, complicating device selection and treatment strategy for deep vein thrombosis (DVT). Nicolas J. Mouawad, MD, chief of vascular surgery at McLaren Health in Bay City, Michigan, discusses his approach to mechanical thrombectomy, the importance of minimizing residual thrombus and how long-term data has informed his focus on consistent, durable outcomes.

How reliably does symptom duration predict the type of thrombus you’ll encounter and how should that uncertainty influence first device choice?

Nicolas Mouawad, MD: The clot is variable. Symptom duration does not always tell you what you’re going to encounter. Frankly, most times I find that it’s wrong. Your symptoms or presentation can be acute– but more commonly, the clot tends to be subacute or chronic and that’s just because people present when they feel the pain or they feel that they see swelling when that change in status happens to them really acutely. However, that clot could have been forming there for weeks or months before the patient actually presents with what they feel as that area of swelling or pain. I think symptom duration is not very reliable at all to help identify exactly what the type of clot is, whether it’s fresh or not fresh. That’s very important when thinking of those patients that may benefit from treatment because you may assume that the clot is fresh because of their one or two week history of pain. But a lot of the time it’s not. Therefore, you want to consider having an option to be able to treat them with something that’s successful regardless of clot chronicity. Because it’s unreliable to tell whether the clot itself is truly acute or not, because you cannot rely completely on the presentation of the patient, I prefer having a clot agnostic device, something that would be effective regardless of clot chronicity, whether it’s acute, subacute, or chronic. I want to have a device that will work across all ranges of what the clot could be. In that consideration, a mechanical device is successful, whether it’s acute, subacute, or chronic. That’s what helps influence my first device choice because I want to be successful with one index

procedure and not need secondary procedures or not have to need extra devices in the middle of the procedure to supplement.

Aspiration can be fast when thrombus behaves as expected. Why do you find a ClotTriever BOLD-first approach more efficient across your practice?

Mouawad: Aspiration can be fast when the thrombus behaves as expected, but most times the thrombus doesn’t behave as expected. The concern is that you can find yourself not where you necessarily want to be upfront. From my point of view, a lot of times we always think about being very fast and solving the situation very quickly. I think we should change our mindset when it comes to that. You don’t want to be fast per se –you want to be efficient and effective, of course have a good outcome that is safe and durable. I find again that a ClotTriever BOLD-first approach is efficient for my practice because I don’t have to worry about the chronicity of the clot. I don’t have to worry about being right whether it truly was acute or if it was more subacute or chronic. Being able to truly manage the clot regardless of chronicity and having an effective solution with wall to wall adherence of the device to really clear out the entire clot itself gives you a more effective solution. When you don’t have wall to wall adherence, you can create channels in the clot and get some flow in the vein but you are not clearing out the entire vein. You can end up having residual venous obstruction. We know that residual venous obstruction increases your chance of recurrent failure, recurrent DVT, venous stent failure, postthrombotic syndrome and death. You want to be able to remove as much clot as possible effectively when you can. That is why it’s important to remember that being fast is not necessarily what you want. You want to be efficient and you want to be effective.

When you finish a DVT case, what endpoint are you unwilling to compromise on, and how do you know you’ve done enough?

Mouawad: My objective is straightforward. It’s to remove as much thrombus as possible, as efficiently as possible, in a single session. The goal is to ultimately make this procedure predictable, consistent and repeatable across my practice, regardless of patient presentation, clot chronicity and any other considerations that may come up. I want to make this as standardized as I possibly can. Having that wall to wall apposition that leaves as little as behind a possible is the most important thing. Even if you create a channel now and things are looking better, down the line these people may suffer from post-thrombotic syndrome. Residual venous obstruction, which might not be a problem right now, is a problem and it’s much more challenging to deal with later. These are things that I will not compromise on upfront because I want to absolutely minimize or eliminate the incidence of subsequent problems years down the line.

CLOUT followed 500 real-world patients through two years, regardless of symptom duration. How well does that evidence reflect your practice, and why does long-term follow-up matter?

Mouawad: I think the CLOUT registry was excellent because it reflects real world practice and mirrors what I have seen in my own personal practice. In the CLOUT registry, despite patient presentation, a third of the clot was acute, a third was subacute and a third was chronic. We saw that the ClotTriever demonstrated greater than 90% complete or near complete thrombus removal. Almost 100% was at single session with a median of 26 minute device time. With follow up, we saw that down the line the veins were patent, there was still

Nicolas J. Mouawad, MD

flow confirmed in the vein and there was compressibility that we noted despite all the treatment. Even more important are the long term outcomes. The rate of postthrombotic syndrome that had no or mild symptoms was 94% at two years. It’s hard to tell what true long-term post-thrombotic syndrome is at two years but it’s a start. This is an outcome we really need to look at.

If you could ask your peers to change one thing about how they approach their next DVT cases, what would it be and what should they pay attention to?

Mouawad: What I would ask my peers is to look beyond the acute solution and think about the durability of the solution. I would recommend considering having a consistent reproducible, standardized, efficient and effective treatment plan. We know that every DVT case is not the same. Sometimes if you start with one device, it might not be effective enough and you may have to switch to another one. In these type of situations, having a mechanical device that is essentially clot agnostic, regardless of chronicity of the clot, that is effective in a single session and gives you wall to wall apposition for extraction of as much of the clot as possible allows you to be efficient. Creating a channel may be helpful but you have to also think about the long term concerns.

“I find again that a ClotTriever BOLD-first approach is efficient for my practice

because I don’t have to worry about the chronicity of the clot. I don’t have to worry about being right whether it truly was acute or if it was more subacute or chronic.” NICOLAS J. MOUAWAD, MD

Dexter, D. Final Two Year CLOUT Outcomes. Presented at VIVA 2024 (Las Vegas, NV) This is an article sponsored by Stryker Peripheral Vascular. The HCP’s sharing their views and opinions here express their experience with Stryker medical devices. The HCP’s opinions of these devices were formed independently of Stryker and may not represent every experience or outcomes with the devices. Indications for Use — The ClotTriever® Thrombectomy System is indicated for: (1) The non-surgical removal of thrombi and emboli from blood vessels. (2) Injection, infusion, and/or aspiration of contrast media and other fluids into or from a blood vessel. The ClotTriever Thrombectomy System is intended for use in the peripheral vasculature including deep vein thrombosis (DVT). Review complete Instructions for Use, Indications for Use, Warnings, Precautions, Possible Adverse Effects and Contraindications prior to use of these products. Caution: Federal (USA) law restricts this device to sale by or on the order of a physician. Stryker or its affiliated entities own, use or have applied for the following trademarks or service marks: ClotTriever. All other trademarks are trademarks of their respectiveowners or holders.PRO-4491-USA-EN-v1

Vascular Specialist | October 2 0 2 6

VASCULAR WORKFORCE

Rethinking vascular surgery recruitment in the community By Killian Meara

A growing shortage of vascular surgeons is making recruitment increasingly important for practices and health systems, with lifestyle, workplace culture and generational priorities becoming important considerations in attracting and retaining surgeons. Speaking about recruitment strategies during a session at the 2026 meeting of the Eastern Vascular Society (EVS) in Washington, D.C. (Sept. 17-19), Shelby Cooper, MD, pointed to projections suggesting vascular surgery could face one of the largest physician shortages among surgical specialties through 2038. “In the United States now, there are four open positions for every graduating vascular surgeon,” said Cooper, chief of vascular surgery at Bassett Medical Center in Cooperstown, New York. “About 83% of counties lack a single vascular surgeon, with most vascular surgeons concentrating in major centers.”

Approximately one-third of U.S. hospitals are currently recruiting vascular surgeons, he added. Without additional surgeons entering the workforce, existing vascular surgeons would need to substantially increase their productivity to keep pace with demand. Several factors contribute to the shortage, including the demanding nature of vascular surgery, heavy call responsibilities and expectations surrounding lifestyle. Historically, Cooper said limited exposure to the specialty also meant medical students often had little understanding of vascular surgery as a potential career. “I think we’re doing a better job of exposing the young candidates and medical students,” said Cooper. “Historically, I think medical students in particular did not have a great understanding of what vascular surgeons did and who they were.” As competition for vascular surgeons increases, Cooper said successf ul

PAD

‘Vein is vein’: Data supports arm vein when GSV is unavailable By Killian Meara Arm vein can provide durable patency and high rates of limb salvage when great saphenous vein (GSV) is unavailable for infrainguinal bypass, according to a nearly 20-year single-surgeon study presented at the 2026 meeting of the Eastern Vascular Society (EVS) in Washington, D.C. (Sept. 17-19), The retrospective series included 191 bypasses

recruitment requires more than simply advertising an open position. Compensation and benef its remain important, but practices also need to demonstrate what differentiates their institution, community and working environment. He pointed to his own experience recruiting vascular surgeons at Bassett, where they emphasize work-life balance, the surrounding community, opportunities to practice broadly and a team-based working environment. “We really try to use the beauty of the place to help with recruitment,” said Cooper. The practice also emphasizes the opportunity to pursue academic interests without some of the pressures associated with a traditional academic medical center. A cohesive team of surgeons, physician assistants, nurses and other staff can similarly become an important recruitment tool. Cooper emphasized working closely with institutional recruitment professionals. “The recruitment office has been vital,” he said. “Really working closely with the recruitment office and having an excellent recruitment office is incredibly helpful.” Recruitment strategies may also need to evolve as different generations move through the vascular surgery workforce. While

performed in 162 patients between 2006 and 2025. Morgan Colling, a fourth-year medical student at Johns Hopkins University, presented the data and said the study sought to examine outcomes when arm vein was routinely used by an experienced surgeon. “Despite decades of experience with arm vein, the literature is limited by heterogeneous cohorts,” said Colling, noting that previous studies have often combined results from multiple surgeons. The population largely consisted of patients with advanced disease. Nearly 85% of bypasses were performed for chronic limb-threatening ischemia (CLTI), while about half were redo operations. Three-quarters of patients had previously undergone infrainguinal bypass. About one-third of bypasses were to the popliteal artery, half to a tibial vessel and the remainder to a pedal target. Cephalic and basilic veins were the primary conduit sources. Overall primary patency was 55% at one year and

some practices may recruit experienced Generation X surgeons, millennials currently represent much of the recruitment pool, with Generation Z surgeons expected to become an increasingly important part of the workforce. For more established surgeons, priorities may include leadership opportunities, autonomy, work-life balance and financial or retirement considerations. Millennials may place greater emphasis on work-life balance, transparency, workplace culture, technology and community resources, said Cooper. Younger Generation Z physicians may bring another set of priorities, including advanced technology, career advancement, professional purpose and impact, workplace values, diversity and inclusion. Those differences mean recruitment cannot necessarily follow the same formula for every candidate. Practices should understand what candidates value and clearly communicate what both the organization and surrounding community can offer. For vascular surgery, Cooper suggested that approach will become increasingly important as demand for surgeons continues to exceed the available workforce. “Highlight your assets, culture, your group,” he said, “and don’t underestimate your recruitment office.”

41% at five years. With surveillance and reintervention, primary-assisted patency reached 75% at one year and 64% at five years. Five-year secondary patency was 68% overall, including 90% for popliteal, 60% for tibial and approximately 50% for pedal bypasses. Five-year limb salvage was 87%. Importantly, the risk of secondary patency loss largely plateaued after 18 months. Among grafts that remained patent at one year, 87% remained patent through five years. Distal bypass targets and active smoking were associated with secondary patency loss, while vein type, splicing and redo status were not. Colling said the findings emphasize the importance of close surveillance and intervention during the first 18 months after surgery. “When a single-segment great saphenous vein is unavailable, arm vein should not be considered a lesser substitute,” said Colling. “In experienced hands, vein is vein.”

FROM THE COVER

SVN offers vascular nurses a professional home continued from page 1 a wide variety of participants.” The organization’s annual conference, held in the days preceding the Society for Vascular Surgery’s annual meeting, is a core gathering point for members spread across the country. But the SVN’s programming extends beyond that single event. Members have access to the Journal of Vascular Nursing, a peerreviewed bi-monthly publication written largely by nurses and APPs, as well as a robust library of webinars covering both disease-specific clinical education and professional development topics. “From a research standpoint, we have the Journal of Vascular Nursing, where you can submit, be a peer reviewer, or read it as a membership benefit,” said Fitzpatrick. “Our webinars can range from professional development and research to a specific vascular condition and nursing-specific education. We also collaborate with other organizations

throughout the country, so if we want to focus on wounds, feet, or aortas, we have that collaborative ability.” One of the SVN’s most practical offerings is its vascular boot camp, a core curriculum designed for nurses entering the vascular field. Fitzpatrick noted that standard nursing and nurse practitioner programs provide very little vascularspecific training, leaving new clinicians to fill significant knowledge gaps on the job. The SVN also offers patient education resources, including visual aids that help explain vascular conditions to patients, who often struggle to grasp what is happening inside their bodies. That deeper clinical knowledge, Fitzpatrick said, has measurable downstream effects on patient outcomes. “Having a nurse who is specialized in vascular care and has a deep understanding of that patient population can make a real difference,” said

Fitzpatrick. “It can improve patient satisfaction, medication compliance, outpatient follow-up, continuity of care and overall care delivery inside the hospital. A deeper understanding of vascular conditions is only going to help a nurse who is working on a vascular floor.” For nurses on the fence about joining the SVN, Fitzpatrick pointed to something beyond education: the value of professional community, especially in a post-pandemic environment where nursing retention and burnout have become defining challenges for the field. “If you’re considering joining, you should,” said Fitzpatrick. “It’s a great place not just to meet people, but to meet people who really care about the work you’re doing. Having a space where we can be together, learn from each other, ask questions thoughtfully and feel supported and included is a wonderful thing.” Fitzpatrick also spoke from personal

experience. She joined the SVN five years ago, arrived with gaps in her knowledge and found in the society exactly the kind of environment she needed to grow. That experience shapes how she thinks about the organization’s value, not just for new clinicians, but for experienced ones who might still wrestle with self-doubt. “Many of us have imposter syndrome, feeling like we can’t do enough, don’t know enough, or aren’t smart enough to be in the room,” said Fitzpatrick. “Being with the SVN’s board of directors and society members at the conference reminds you how important this work is and that we all have the ability to grow together. The people we’re surrounded by are incredibly accomplished and it’s empowering to see that with learning, education and pushing forward, you can become anything you want to be.”

VS www.vascularspecialistonline.com

EVS

‘Standing on the shoulders of giants’: Jackson reflects on mentorship, resilience and collaboration

By Killian Meara

MENTORSHIP, RESILIENCE AND COLLABORATION EMERGED AS central themes of a presidential address that used 10 proverbs to reflect on a career in vascular surgery. Speaking at the 2026 meeting of the Eastern Vascular Society (EVS) in Washington, D.C. (Sept. 17-29), Bejamin Jackson, MD, looked back at the people and experiences that shaped him. The first lesson centered on Isaac Newton’s well-known observation about “standing on the shoulders of giants,” which served as a starting point for recognizing mentors who helped guide Jackson toward medicine, surgery and ultimately vascular surgery. That importance of mentorship continued throughout the address, extending from established surgeons who influenced his career to the residents and fellows Jackson later helped train. Many of those former trainees, he said, have already surpassed him in many ways. “These are the current and future leaders of vascular surgery in our country,” he said. Resilience was another recurring theme. Using the Japanese proverb, “Fall seven times and stand up eight,” Jackson recalled returning home exhausted after his first night on call as a general surgery intern and questioning whether he could make it through training. He said the experience illustrated the persistence required throughout a surgical career. Jackson also stressed the importance of adapting as vascular surgery changes. He acknowledged being slow to embrace some newer techniques before eventually incorporating them into his practice, arguing that a willingness to learn can expand what surgeons are able to offer their patients. Teamwork provided another lesson. Invoking the Ethiopian proverb, “When spiders unite, they can tie down the lion,” he recognized the surgeons, trainees, nurses, operating room teams, society leaders and industry partners who supported his work throughout his career. Jackson concluded by thanking the society’s membership, leadership, committees, trainees, colleagues, friends and family for their support during his EVS presidency. “It’s been a pleasure and an opportunity of a lifetime,” he said.

VASCULAR HISTORY By Killian Meara

Tracing four decades of the Eastern Vascular Society

Anton Sidawy, MD, marked the 40th anniversary of the Eastern Vascular Society (EVS) with a look back at how a small group of vascular surgeons created the regional organization and how it evolved. During his keynote at the 2026 annual meeting in Washington, D.C. (Sept. 17-19), Sidawy gave a historical review that traced the society’s roots to the 1980s, when several smaller vascular organizations represented surgeons across the eastern United States but no larger regional society brought them together. At the time, regional vascular organizations had already been established in New England, the South, Midwest and West. The effort to fill that gap began to take shape in 1985, led largely by Brooke Roberts, MD, then president of the Delaware Valley Vascular Society, and Norman Rich, MD, a prominent vascular surgeon who was closely involved with surgical organizations. Following a national meeting in Baltimore, Roberts wrote to Rich proposing the formation of a society for vascular surgeons in the eastern U.S. Roberts had already discussed the idea with leaders from other societies and sought Rich’s advice before moving forward. Rich supported the effort and encouraged Roberts to contact the leadership of other societies throughout the region. Over the following months, support grew among organizations including the Chesapeake Vascular Society, Delaware Valley Vascular Society, New York Vascular Society, Upstate New York Vascular Society and Vascular Society of New Jersey. The process moved quickly. By September 1985, representatives from the societies had met and agreed to move forward with the new organization. Early discussions included establishing a registry, requiring membership in a local vascular society and developing a scientific program in which members could present research. The Journal of Vascular Surgery, which had published its first issue only the year before, was also discussed as a potential home for work presented through the organization. Several possible names were considered, including the Mid-Atlantic Sectional Society, Northeastern Vascular Society and Eastern Regional Vascular Society. Ultimately, the group selected the Eastern Vascular Society, the name it continues to use today. The society held its first meeting in Washington, D.C., at the Willard Hotel, beginning a connection between EVS and the nation’s capital that continues today. Norman Rich served as the first president, followed by James DeWeese, MD, while Roberts — the surgeon credited with much of the early work required to establish EVS — became its third president. EVS continued to change as vascular surgery evolved. Meetings eventually shifted from the spring to September to reduce conflicts with national vascular meetings and some of the original requirements were discontinued. The organization also continued efforts to build relationships with other regional societies. Four decades later, Sidawy pointed to the number of young surgeons attending the annual meeting and the leadership roles its members have gone on to hold nationally as evidence of the organization’s continued influence. “Few people created this society, but there are so many that came after them,” said Sidawy, describing EVS as a vibrant organization with a growing generation of young vascular surgeons.

Vascular Specialist | October 2 0 2 6

YOUR SVS

SVS executive director announces transition plans

he Society for Vascular Surgery (SVS) Executive Director Kenneth M. Slaw, PhD, has discussed his plans for retirement and transition with SVS President Linda Harris and SVS President-elect Andy Schanzer. An agreement was reached to begin a planned transition and search for the next SVS executive director, culminating in a transition around June 17, 2027, after the 80th anniversary of SVS, which is being celebrated at VAM 2027 in San Diego, California. Dr. Slaw has served as SVS executive director for 10 years and will have completed his 11th year by the time of transition. “The SVS, its mission, its members and staff are truly remarkable and it is a true honor and privilege to contribute and serve the society,” said Slaw. SVS leadership developed a comprehensive succession and transition plan in 2026, outlining a 12-month transition to ensure stability. “I am dedicated to the society and its leadership and want to make sure my succession and transition occurs as smoothly and optimally as possible,” said Slaw. “Given the desired transition time, it made sense to get started sooner than later so SVS and the executive board can take the time they need, with no pressure, to plan for the future.”

Until June 17, 2027, it will be business as usual for the SVS while the leadership engages in a recruitment effort for the next executive director. Dr. Harris has selected a search committee to begin this fall, chaired by Schanzer, with the goal of bringing a new executive director aboard before VAM in late spring. “The SVS is grateful to Ken for his leadership and many contributions to our mission and our Society,” said Harris. “He will be difficult to replace and we are deeply appreciative that Ken is giving us the time, space and stability to plan for the future without pressure.” The search committee held its first meeting on Oct. 6 to begin discussing the desired skills and attributes of the next executive director. The committee also retained Tuft & Associates — which specializes in executive recruitment for associations, medical societies and nonprofit organizations — to lead the search. As the transition proceeds, members will continue to be updated. “This may be one of the most consequential decisions the SVS executive board will make in the next 10 to 15 years,” said Schanzer. “We need to take the time necessary to get this right for the society.”

“

The SVS, its mission, its members and staff are truly remarkable and it is a true honor and privilege to contribute and serve the society.” KENNETH M. SLAW, PHD

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COMMENT&ANALYSIS

BEYOND THE HOSPITAL: VASCULAR CARE TODAY

General surgery resident education for the community surgeon By Carlos E. Pineda, MD, RPVI, FSVS I still remember reading Dr. William to their lack of involvement. We sought to Nolen’s book The Making of a Surgeon with change this with our residents. great interest, dismay, but ultimately, awe. In our program, I sit down with the It felt quite informative, though the surgical trainees and discuss the goals of the content reflected an era of rotation that go beyond the required curriculum. We training that I could only have specific skills that they partially connect with. As I started my training in general need to become proficient surgery in 2008, I picked up a in during the rotation that copy of Dr. Craig Miller’s The are level appropriate. The Making of a Surgeon in the 21st skills are divided in different Century. This felt more in line categories: endovascular, with the training I received. open and vascular imaging. That said, in 2026, the Endovascular skills include training of general surgery getting ultrasound guided residents looks very different vascular access, getting “up and despite barely making it and over,” the correct use of out of the “Young Surgeons” guidewires and catheters, etc. category of the SVS (I’m 10 Open skills include operative years and three months exposure of arteries in the into practice), I cannot Carlos E. Pineda, MD, RPVI, FSVS neck, abdomen, upper and lower extremities, say I fully understand what general surgery training entails in the use of a Fogarty catheter, etc. For vascular imaging we review non-invasive studies, current era. Working in a tertiary community hospital as well as the correct identification of that runs a 100 year-old general surgery vascular pathology on CT and conventional training program, we have the privilege angiography. As we go through the rotation we seek of working with trainees during their internship, third year and chief resident specific tasks where the trainee will have year. I attend the morbidity and mortality the opportunity to work on a step or steps conference for the entire department and of a case. Over the years I’ve had residents every year I hear new acronyms, learn successfully gain difficult access (supine about new procedures and feel relief when access of occluded popliteal veins for venous certain surgical principles have not changed thrombectomy), cross arterial occlusions, (we still do not mess with the pancreas). correctly identify vascular pathology on Our residents learn the pathophysiology, imaging, safely get open vascular control relevant anatomy, new classification in the abdomen and know what steps to systems and the role of different types take next. For those concerned with losing of surgical interventions, its indications efficiency when operating with trainees, and complications. However, it seems since we are working on very specific tasks, that the repertoire of classifications and unless they have fully gained proficiency in interventions has increased significantly. all the steps needed for a given procedure, I Moreover, when I review the curriculum am still doing most of it myself. on what’s expected for them to know about There’s nothing like seeing a resident vascular surgery, or the specific tools we are light up when they’re able to achieve a task given to evaluate them on our service, they they did not think they could perform, do not really capture all the pathology and although we know better since the process typically leads to the desired outcome procedures that they are exposed to. Clearly, there has been a tremendous (trust the process). It has gotten some of evolution in all surgical disciplines and our residents interested in pursuing vascular we are all very familiar with the changes surgery fellowship. However, that is not brought on by the endovascular revolution. our goal. We are interested in training safe With this change, I have heard over the years and competent general surgeons. One of that general surgery trainees all “love open the highlights has been getting a call from vascular surgery” (I mean, who wouldn’t?), a former trainee who went on to perform but they do not enjoy the endovascular a breast surgery fellowship in New York, procedures. I believe that part of this is due her attending got into an axillary vein and

she was able to repair it with the skills she learned on our service. Finally, another important point I try to instill with the residents is that they are not allowed to say “I’m bad at X” in my operating room. Unless they are holding

with intention by setting up expectations and goals, the results are great for the trainee, the attending surgeon and more importantly, for the patients they treat in the future, regardless of whether they pursue further training in vascular surgery.

“Clearly, there has been a tremendous evolution in

all surgical disciplines and we are all very familiar with the changes brought on by the endovascular revolution. With this change, I have heard over the years that general surgery trainees all “love open vascular surgery” (I mean, who wouldn’t?), but they do not enjoy the endovascular procedures.” CARLOS E. PINEDA, MD, RPVI, FSVS

the micropuncture needle backwards, I reiterate that they are not yet proficient at a specific task. I also remind them that not being proficient at one specific step in a case does not mean they cannot perform other parts of the case. In summary, working with general surgery residents can be very rewarding to the vascular surgeon in community practice. When training is performed

If anyone has interest in reviewing our curriculum, please feel free to reach out. I am not a professional educator (no formal pedagogical training), but I do perform my procedures the same way every time so it’s been relatively easy to come up with specific steps for each procedure. So go ahead and let go of that wire (well, after making sure the resident has it pinned).

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The Vascular World Is Coming Together In New York In November 2026 . . .

And You’re Invited!

Tuesday, November 17 - Saturday, November 21, 2026

Register Now! www.VEITHsymposium.org This activity has been approved for AMA PRA Category 1 Credits.TM LOCATION: New York Hilton - Midtown 1335 Avenue of the Americas (between 53rd and 54th Streets)