Future Paradigms

in Future Directions in Vascular Surgery

Applied

Type

Addition

Confidence

95%

Created

Mar 19, 2026

Evidence

2 sources

Rationale

The 2022 ACC/AHA Aortic Guidelines (Isselbacher et al.) represent a significant paradigm shift by formalizing the role of Multidisciplinary Aortic Teams (MAT) and Shared Decision-Making (SDM) in clinical practice. These concepts are integrated into the 'Future Paradigms' section to reflect the evolving standard of care. The guideline also reinforces the trend toward endovascular-first strategies for aortic disease. Article 2 is a duplicate publication of the same guideline and is included under the primary citation key already established in the chapter.

Evidence

Isselbacher EM, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022. PMID: 36322642.
Verified source
PubMedDOI
PMID: 37389507
Verified source
PubMedDOI

Content Changes

* **Total endovascular aortic surgery** as default [@wanhainen2019].[@wanhainen2019] [@aha2022-isselbacher-isselbacher].
* **[[endovascular trauma management (EVTM)]] fully integrated into trauma care worldwide** [@horer2016] [@bulger2019].
* **Hybrid**Multidisciplinary aortic teams (MAT)** and the **hybrid vascular surgeon** (open + endovascular + AIartificial intelligence (AI) skills) as the new standard [@mills2008].for complex aortic care [@mills2008] [@aha2022-isselbacher-isselbacher].
* **Predictive vascular medicine** using AI + genomics [@eur2020].
* **Expanded use of minimally invasive devices** even in emergency/field conditions [@morrison2014] [@bulger2019].
* **Shared decision-making (SDM)** as a fundamental requirement in the management of aortic disease to optimize patient-centered outcomes [@aha2022-isselbacher-isselbacher].

**References**

1. Patel VI, et al. Evolution of vascular surgery into an endovascular specialty. *J Vasc Surg*. 2017. PubMed
2. Powell JT, et al. Endovascular vs open repair of [[abdominal aortic aneurysm (AAA)]] – long-term results. *NEJM*. 2010. PubMed [@powell2010]
3. Wanhainen A, et al. ESVS Guidelines on [[AAA]]. *Eur J Vasc Endovasc Surg*. 2019. PubMed [@wanhainen2019]
4. Björck M, et al. ESVS 2025 Guidelines on Mesenteric and Renal Arteries. *Eur J Vasc Endovasc Surg*. 2025. [PubMed](https://pubmed.ncbi.nlm.nih.gov/40513642/) [@esvs2025]
5. Hörer TM, et al. [[EVTM]] paradigm in trauma and resuscitation. *J Trauma Acute Care Surg*. 2016. PubMed [@horer2016]
6. Mouawad NJ, et al. The role of robotics in vascular surgery. *Vascular*. 2020. PubMed [@mouawad2020]
7. Conte MS, et al. Global vascular guidelines on chronic limb-threatening ischemia. *J Vasc Surg*. 2019. PubMed [@conte2019-gvg]
8. Mani K, et al. The role of registries in vascular surgery (Swedvasc, Vascunet). *Eur J Vasc Endovasc Surg*. 2020. PubMed [@mani2020]
9. Daye D, Walker TG. Novel endovascular devices for peripheral interventions. *Tech Vasc Interv Radiol*. 2018. PubMed [@daye2018]
10. Loftus IM, et al. Future challenges in vascular surgery: global and societal perspectives. *Br J Surg*. 2021. PubMed
11. Isselbacher EM, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. *Circulation*. 2022. [PubMed](https://pubmed.ncbi.nlm.nih.gov/36322642/) [@aha2022-isselbacher-isselbacher]
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