ESVS 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases - Part 2

Prof. Christian Behrendt (head of the German research association) and Prof. Joy Roy (Karolinska Institute) take us on a look back chronologically at the journey Paclitaxel has taken us on, from the original mortality scare to landmark trials, we follow the twists and turns of the evidence. We ask if safety is only half the story and whether it makes sense to judge every drug-coated balloon and stent as one big, paclitaxel-coated family, what the emerging Limus technologies might bring to the table, and whether industry influence has helped shape a debate in which the stakes are anything but theoretical. Because ultimately, a beautiful angiogram is lovely. But if our patients aren't walking further, living longer, or feeling better, what exactly are we celebrating? Join us as we separate the signal from the noise and ask all the uncomfortable questions at the heart of it all. This episode is supported by Cook Medical PAPERS MENTIONED 1. Katsanos et al. (2018) — Risk of Death Following Application of Paclitaxel- Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Read the paper — Journal of the American Heart Association 2. IMPERIAL trial (2018) — Gray et al. A polymer-coated, paclitaxel-eluting stent (Eluvia) versus a polymer-free, paclitaxel-coated stent (Zilver PTX) for endovascular femoropopliteal intervention: a randomised, non-inferiority trial. Read the paper — The Lancet 3. Katsanos et al. (2026) — Dynamic Risk of Death following Application of Paclitaxel Coated Devices in the Femoropopliteal Artery: A Contemporary Meta- analysis of Randomised Controlled Trials. Read the paper — European Journal of Vascular and Endovascular Surgery 4. SWEDEPAD 1 (2025) — Paclitaxel-coated versus uncoated devices for infrainguinal endovascular revascularisation in chronic limb-threatening ischaemia: a multicentre, participant-masked, registry-based, randomised controlled trial. Read the paper — The Lancet 5. SWEDEPAD 2 (2025) — Paclitaxel-coated versus uncoated devices for infrainguinal endovascular revascularisation in patients with intermittent claudication: a multicentre, participant-masked, registry-based, randomised controlled trial. Read the paper — The Lancet 6. REALDES — 3-year outcomes (2025) — Shibata et al. Comparative Analysis of Three Year Results of Two Paclitaxel Related Stents for the Management of Femoropopliteal Disease in a Real World Setting. Read the paper — European Journal of Vascular and Endovascular Surgery 7. REALDES — 1-year outcomes — Shibata et al. One Year Outcomes of Zilver PTX Versus Eluvia for Femoropopliteal Disease in Real-World Practice: REALDES Study. Read the paper — Journal of Endovascular Therapy 8. Behrendt et al. (2020) — Long Term Survival after Femoropopliteal Artery Revascularisation with Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis. A large German health-insurance database study comparing long-term outcomes after paclitaxel-coated and uncoated devices. 9.Read the paper — European Journal of Vascular and Endovascular Surgery 10. Nordanstig et al. (2026) — Editor's Choice – Focused Update on Paclitaxel Coated Technologies, from the 2024 ESVS Guidelines on the Management of Asymptomatic Peripheral Arterial Disease and Intermittent Claudication. The updated recommendations reconsider the role of paclitaxel-coated devices in intermittent claudication in light of SWEDEPAD 2 and the emerging evidence on clinical benefit and long-term safety. Read the paper — European Journal of Vascular and Endovascular Surgery

Three trials walk into an aorta and ask what the house recommends. The bartender shrugs: “Sorry, we’re randomising tonight.” Three trials. Three leading investigators. One of the biggest unresolved questions in aortic surgery: should patients with uncomplicated type B aortic dissection undergo thoracic endovascular aortic repair (TEVAR), or is best medical therapy the better strategy? In this episode of the ESVS Podcast, Safa Riahi brings together Professor Jacob Budtz-Lilly (SUNDAY), Professor Firas Mussa (IMPROVE-AD) and Professor Colin Bicknell (EARNEST), for an in-depth roundtable exploring the rationale, design, and challenges behind three major randomised controlled trials. From differences in patient selection and timing of intervention to aortic remodelling, procedural safety, long-term outcomes, and cost-effectiveness, we examine what each trial hopes to establish and why their results could reshape the management of uncomplicated type B aortic dissection. We also discuss the meaning of “uncomplicated,” the limitations of our current evidence, the importance of best medical therapy, and the challenge of communicating genuine clinical uncertainty to patients. Will these trials finally help us identify who benefits from early TEVAR, when to intervene, and whether improved aortic remodelling translates into better outcomes for patients? Three trials walk into an aorta. The answers, for now, remain anything but straightforward. With: Professor Firas Mussa, Professor Colin Bicknell, and Professor Jacob Budtz-Lilly. Trials discussed: IMPROVE-AD: https://clinicaltrials.gov/study/NCT06087029 EARNEST: https://www.isrctn.com/ISRCTN30838068 SUNDAY: https://clinicaltrials.gov/study/NCT05215587

In this special episode of the ESVS Podcast, we sit down with Professor Kak Khee Yeung as she begins her term as President of the European Society for Vascular Surgery. Professor Yeung talks openly about her journey as a vascular surgeon and researcher, her passion for aneurysm biology and personalised vascular care, and the curiosity that has driven her throughout her career. From her Chinese heritage and the calligraphy featured in her inaugural lecture to artificial intelligence, teamwork and the future of vascular surgery, the conversation goes beyond the CV to explore the person behind the surgeon and scientist. Professor Yeung also shares her thoughts on leadership, diversity, the next generation of vascular surgeons and her ambitions for the ESVS. Her passion for vascular surgery is contagious, and this conversation offers a personal glimpse into the ideas and energy she brings to her presidency. Links: Inaugural lecture: https://pure.amsterdamumc.nl/ws/portalfiles/portal/143254652/oratie_final_KKY.pdf

Recorded live from Belgrade at the ESVS course on complex aortic surgery. In this episode, Joanna Halman is joined by Professors Marko Dragaš, Igor Končar and Nikola Ilić for a practical discussion on complex aortic surgery. They discuss how to choose between open and endovascular repair, whether aortic surgery should become further subspecialised, and their approaches to aortic clamping, visceral perfusion and organ protection during open repair. At the end of the episode, special guest Professor Germano Melissano joins the discussion to share his perspective on training and education in complex aortic surgery.

In this episode of the ESVS Podcast, we discuss one of the oldest yet most effective treatments in vascular medicine: compression therapy. Our guest is Professor Melina Vega de Ceniga, Head of the Department of Angiology and Vascular Surgery at Galdakao-Usansolo University Hospital, Spain, and an internationally recognised expert in chronic venous disease. She is an active member of the European Society for Vascular Surgery (ESVS), she has been involved in the creation and development of the ESVS Podcast programme. Together, we explore the physiological basis of compression therapy, its indications across a wide range of vascular conditions, the different compression systems available, and practical aspects of their application. We also discuss pressure selection, contraindications, compression therapy in patients with peripheral arterial disease and heart failure, and the management of venous leg ulcers. Finally, Professor Vega de Ceniga shares practical strategies to improve patient adherence, prevent ulcer recurrence, and optimise long-term outcomes. This episode provides practical guidance for vascular specialists, trainees, wound-care professionals, and all clinicians involved in the management of patients with chronic venous disease and lower-limb oedema.