European Society for Vascular Surgery

In this episode of the ESVS Podcast, we explore air pollution as an often-overlooked risk factor for peripheral arterial disease (PAD).
We are joined by Professor Alberto Maria Settembrini. Professor Settembrini is a vascular surgeon in Milan in MultiMedica and Professor of vascular surgery at Unicamillus University in Rome. He is a co-author of a large Rome-based longitudinal study involving over 1.7 million individuals. The study shows that long-term exposure to PM2.5, NO₂, and black carbon is associated with increased PAD incidence, with stronger effects in males and people aged 55–69.
Professor Settembrini discusses the links between different pollutants and PAD, how pollution interacts with traditional risk factors (obesity, diabetes, smoking, hypertension), the underlying mechanisms, and practical advice for vascular specialists in daily practice.
During the episode, we also hear from Porto’s City Councillor for the Mobility and Transportation, Engineer Hugo Beirão, who shares the city’s efforts to improve urban health.
References:
1- Ravalli S, Musumeci G, et al. Chelation therapy in patients with cardiovascular disease: a systematic review. Journal of Clinical Medicine. 2022;11(4):1033. doi:10.3390/jcm11041033
2- Serra R, Abramo A, Ielapi N, Procopio S, Marino P. Environmental pollution and peripheral artery disease. Risk Manag Healthc Policy. 2021;14:2181–2190.
3- Liao SH, Chiu CS, Jang LH, Hu SY, How CK, Hsieh VCR, et al. Long-term exposures to air pollutants and risk of peripheral arterial occlusive disease: a nationwide cohort study in Taiwan. Front Cardiovasc Med. 2022;9:796423.
4- Gwon JG, Park JH, Kim JS, Seo HM. Exposure to long-term air pollution and incidence of peripheral arterial disease in the general population: a national population-based retrospective cohort study. [Preprint]. 2021.
5- Deng Z, Duan L, Wang K. Revisiting the association between air pollution and peripheral artery disease: evidence from Mendelian randomization analysis. Eur J Intern Med. 2025;132:164–166.
6- Di Blasi C, Nobile F, Settembrini AM, Stafoggia M, Davoli M, Michelozzi P, et al. Association between long-term exposure to air pollution and incidence of peripheral artery disease: evidence from a longitudinal study. Eur J Intern Med. 2025;132:113–117.

In this episode, we’ll focus on the final sections of the guideline, which deal with rupture, trauma, and post-operative complications. These are scenarios where decisions are often made under time pressure, evidence is limited, and outcomes can be profoundly affected by organisation of care, experience, and judgement.
Guests:
Prof. Anders Wanhainen
Dr. Carlota Fernández-Prendes
Prof. Athanasios Katsargyris

Welcome back to the ESVS Podcasts. This is Suzanne Stokmans, and you are listening to part 2 of the Q&A series on the ESVS 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases.
In this episode, we move from the general principles discussed in part 1 to disease-specific management. We’ll focus on acute thoracic aortic syndromes, chronic type B aortic dissection, and degenerative descending thoracic and thoraco-abdominal aortic aneurysms, conditions that make up a large part of daily aortic practice, where decision-making is often nuanced and time-critical.

Full names of guests:
Prof. Anders Wanhainen
Dr. Carlota Fernández Prendes
Prof. Athanasios Katsargyris.

In today’s episode, the first of this three-part series, we will discuss the opening section of the guideline: service standards and general considerations. Before moving to specific disease entities or operative strategies, the guideline deliberately starts with the fundamentals — how care should be organised, how patients should be assessed, and which general principles should guide our decision making.
Full names of guests:
Prof. Anders Wanhainen
Dr. Carlota Fernández Prendes
Prof. Athanasios Katsargyris.

In this episode of the ESVS Podcast, supported by Servier, we explore the importance of therapy adherence in chronic venous disease (CVD). The episode opens with short patient testimonies, highlighting real-world reasons for non-adherence.
To explore this further, we are joined by Professor Denisa Celovska and Professor Atul Pathak. Professor Celovska is an Associate Professor of Angiology and Internal Medicine at the University Hospital and Comenius University in Bratislava, Slovakia. She is currently the President of the Slovak Angiology Society. Professor Pathak is the Head of the National Institute of Cardiology, Cardiac Surgery and Interventional Cardiology in Luxembourg.
In this episode, they share their clinical perspective on why patients frequently disengage from treatment, the most common barriers to adherence in daily practice, and practical strategies to improve long-term treatment persistence.
The episode also includes insights from a community pharmacist, offering a complementary view on what happens between prescription and real-life use, particularly regarding venoactive drugs. We conclude by emphasising that effective CVD management extends beyond prescribing treatment. Patient education, shared decision-making, follow-up, and human connection are essential to improve adherence and long-term outcomes in CVD.
References:
Kim H, Cho S, Lee K, Lee SH, Joh JH. A nationwide study of compliance of venoactive drugs in chronic venous disease patients. Ann Surg Treat Res. 2023 May;104(5):288-295. doi: 10.4174/astr.2023.104.5.288. Epub 2023 Apr 28. PMID: 37179697; PMCID: PMC10172027.
Burnier M. The role of adherence in patients with chronic diseases. Eur J Intern Med. 2024 Jan;119:1-5. doi: 10.1016/j.ejim.2023.07.008. Epub 2023 Jul 20. PMID: 37479633.
Mezalek ZT, Feodor T, Chernukha L, Chen Z, Rueda A, Sánchez IE, Ochoa AJG, Chirol J, Blanc-Guillemaud V, Lohier-Durel C, Ulloa JH. VEIN STEP: A Prospective, Observational, International Study to Assess Effectiveness of Conservative Treatments in Chronic Venous Disease. Adv Ther. 2023 Nov;40(11):5016-5036. doi: 10.1007/s12325-023-02643-6. Epub 2023 Sep 20. Erratum in: Adv Ther. 2024 Jan;41(1):464-465. doi: 10.1007/s12325-023-02722-8. Erratum in: Adv Ther. 2024 Jun;41(6):2540-2541. doi: 10.1007/s12325-024-02857-2. PMID: 37728696; PMCID: PMC10567827.
Bogachev, V., Arribas, J.M.J., Baila, S. et al. Management and evaluation of treatment adherence and effectiveness in chronic venous disorders: results of the international study VEIN Act Program. Drugs Ther Perspect 35, 396–404 (2019). https://doi.org/10.1007/s40267-019-00637-5
Golna C, Poimenidou C, Giannoukari EE, Saridi M, Liberopoulos E, Souliotis K. Assessing a pharmacist-enabled intervention to improve adherence to medication for hypertension, dyslipidemia, and chronic venous circulation disorders in Greece. Patient Prefer Adherence. 2023;17:3341–3352. doi:10.2147/PPA.S420811
6. Branisteanu DE, Munteanu AE, Dolofan BM, Popescu EG, Vittos O. Adherence to pharmacological treatment in chronic venous disease: results of a real-world, prospective, observational cohort study. Life (Basel). 2025;15(3):377. doi:10.3390/life15030377.
7. Ulloa JH, Guerra D, Cadavid LG, Fajardo D, Villarreal R, Bayona G, Hoyos AS, Garcia G. Nonoperative approach for symptomatic patients with chronic venous disease: results from the VEIN Act program. Phlebolymphology. 2018;25(2):123
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