September 2025 | Issue 107
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6 Chronic limb-threatening ischaemia Is TADV worth pursuing?
10 Venous disease New guidelines published
14 Profile
Dawn Coleman
22 Radiation safety
Impact of online course assessed
ESVS
First official ESVS consensus statement consolidates expert opinion on “truly novel” aTEVAR procedure
The application of artificial intelligence (AI) is becoming an increasingly prominent topic on the agendas of key vascular meetings and the contents pages of vascular surgery journals. At this juncture, Vascular News looks at some of the recently shared research and opinion on the topic, highlighting a need for “guardrails” amid significant clinical potential.
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everal papers on the emerging uses of AI in vascular surgery were presented at the recent 2025 Vascular Annual Meeting (VAM; 4–7 June, New Orleans, USA). Among these were two papers from Ben Li (University of Toronto, Toronto, Canada) and colleagues—one looked at developing an AI model to predict one-year mortality after major lower extremity amputation, the other to predict one-year successful clinical use of an arteriovenous access for haemodialysis. The team found that their two models—both of which were trained on Vascular Quality Initiative (VQI) patient data—could “very accurately predict” outcomes and performed better than logistic regression. “Having that kind of information preoperatively helps the clinician and the patient decide the best treatment plan moving forward,” Li comments, considering the clinical implications of the work. Another paper presented at VAM 2025 looked at the use of a large language model to accurately extract aortic information from abdominal imaging reports in a large, real-world, multicentre database in San Francisco, USA. Robert Chang (Kaiser Permanente Northern California, Oakland, USA) and Colleen Flanagan (University of California, San Francisco, San Francisco, USA) led the research, which found that an opensource, foundational, or “off-the-shelf” large language model was able to extract critical information about the aorta from the imaging reports. “We did not train this model ourselves at all; we crafted and refined a prompt to extract information of interest,” Chang and Flanagan detail, speaking to Vascular News about the research. The team then used this prompt on over 16,000 imaging reports in their real-world arterial aneurysm
registry. The researchers found that the accuracy of the model, LLaMa 3.3, was over 90% overall. “We think this could support our ability to closely track AAAs [abdominal aortic aneurysms], including those found on screening and those found incidentally on non-aortic imaging studies, by automating the flagging of these patients for appropriate referral and follow-up,” Chang and Flanagan remark. Elsewhere at VAM 2025, Justin Bader (Yale School of Medicine, New Haven, USA) presented a paper outlining the creation of a prediction model for safe contrast volume thresholds to prevent post-contrast acute kidney injury (PCAKI) after endovascular aneurysm repair (EVAR). The research team is now using AI to harness the model’s future potential. Bader explains that the team—led by Cassius Iyad Ochoa Chaar (Yale School of Medicine, New Haven, USA)—used VQI data to create a “calculator” that allows physicians to generate a recommended contrast volume to minimise PC-AKI risk by inputting 13 patient-specific variables. “It serves as a guideline for surgeons when they’re operating,” he says. The model, Bader tells Vascular News, is “working extremely well” and the team is presently collaborating with statistics experts at Yale on advanced AI and machine learning techniques to make the calculator “even more accurate”. VAM 2025 also saw data from Prem Chand Gupta (CARE Hospitals, Hyderabad, India) and colleagues that looked at the correlation of imaging characteristics of carotid plaque with clinical and histopathological features, and the application of AI. “We found that routinely performed ultrasound by us was
AGAINST THE BACKDROP OF an ageing population and increasing demand for complex endovascular aortic solutions, Santi Trimarchi (Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy) and a global team of experts recently authored a consensus statement on ascending thoracic endovascular aortic repair (aTEVAR). The statement has been published as part of the new European Society for Vascular Surgery (ESVS) consensus statement programme, which aims to standardise and strengthen the process for publishing expert opinion-based recommendations in areas of clinical practice where evidence is lacking. The framework was recently formalised by Chris Twine (University of Bristol, Bristol, UK) and Anders Wanhainen (Uppsala University, Uppsala, Sweden) in the European Journal of Vascular and Endovascular Surgery (EJVES). The aTEVAR statement includes recommendations on patient selection, procedural strategies, and postoperative management among other areas. “By addressing key topics such as landing zones, stent graft sizing, risk assessment, and adjunctive procedures, this document aims to guide clinical practice, improve patient outcomes, and enhance procedural safety,” Trimarchi and colleagues write in the paper. Highlighting one of the key reasons why aTEVAR was selected as a topic for the first official ESVS consensus statement, Trimarchi, Continued on page 5
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