Vascular Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped vascular surgery practice.

AAA Repair: Open vs Endovascular

EVAR's early benefit fades

Open only → EVAR 1 (2004) → EVAR 2 → long-term open catches up → reintervention → selection

Surgery vs stenting vs medical therapy

CEA gold standard (NASCET/ECST) → CAS (CREST 2010) → ACST-2 asymptomatic (2021) → optimal medical

Anatomy guides the choice

Bypass → PTA → drug-coated balloons → DES → BEST-CLI (2022) → anatomy-guided

From warfarin to DOACs

Heparin/warfarin → DOACs (RE-COVER/EINSTEIN) → CDT → ATTRACT (2017) → risk-selected CDT

Non-thermal takes over

Stripping → endovenous laser/RF → CLASS (2019) → cyanoacrylate glue → mechanochemical → NTNT