Weekly vascular bulletin — September 28, 2026

Week of September 21–28, 2026. A week of moderate volume: the heaviest item is the three-paper clinical Series on peripheral artery disease published by The Lancet, accompanied by an open debate in Europe over the ESVS guideline update that advises against routine paclitaxel in claudication. On the venous side, a Danish nationwide study in The BMJ on hormone therapy and venous thromboembolism, and the first insights from the European Venous Registry. The English-language trade press had little news because VIVA, The VEINS and the ESVS annual meeting take place next week; the October issue of the Journal of Vascular Surgery is now available and supplies several items. Searches in Chinese, Japanese, Korean, Russian, Arabic, Turkish and Portuguese found no verifiable publications or approvals dated this week; the only item from outside North America and Western Europe is the Japanese multicenter study of stents in calcified femoropopliteal disease.

Peripheral arterial disease, calcium and CLTI

1. The Lancet publishes a three-paper Series on peripheral arterial disease

[Publication] [International; coordinated from Germany and Sweden]
On September 22 The Lancet posted the first paper of a three-part clinical Series on PAD (Behrendt, Norgren, Nicolajsen, Powell, Chuter, Gupta, Woo and Nordanstig), open access. The figures it sets: more than 113 million people aged 40 and older with PAD in 2019 (prevalence 1.52%) and more than 316 million aged 25 and older in the 2023 GBD analysis; when diagnosed at an advanced stage, five-year mortality is between 30% and 50%, higher than acute myocardial infarction and several serious cancers. Of the 7% of asymptomatic patients who develop claudication, 21% progress to chronic limb-threatening ischemia within five years; between 50% and 90% of CLTI patients die or lose the limb within that period. The other two papers (Tulamo et al. on medical, endovascular and surgical treatment; Golledge et al. on disparities and global burden) appeared on September 23.
Why it matters: it is a narrative review and generates no new evidence, but it sets the epidemiological frame that guidelines and payers will cite for years and reinforces ankle-brachial index detection in risk groups; all three papers are worth reading in full, especially the second, which summarizes the state of the drug-device debate.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00846-9/fulltext
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00845-7/abstract
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00847-0/fulltext

2. Paclitaxel in claudication: the ESVS update and the interventionalists' reply

[Guideline] [Europe]
Vascular News published two opposing pieces on September 23. The first summarizes the focused update of the ESVS 2024 guideline (Nordanstig et al., EJVES June 2026;71:923-927), driven mainly by SWEDEPAD 2 (1,136 claudicants; no improvement in quality of life or reintervention at 12 months with paclitaxel-coated versus uncoated devices, and a signal of excess mortality at five years): supervised exercise and best medical therapy as first line, endovascular revascularization only for persistent lifestyle-limiting symptoms, and "the routine adjunctive use of paclitaxel-coated balloons or paclitaxel-eluting stents is not recommended" in the femoropopliteal segment, reserving them for selected restenosis cases. The second is a comment by Schneider, Zeller, van den Berg, Gouëffic and Steiner objecting that the guideline rests on a single trial from a single country, with 40.4% Rutherford 1-2 patients, a subjective primary endpoint, no core lab or patency assessment, and a mortality signal visible only at year five; they cite the French administrative cohort of 259,137 adults (Wargny, JACC 2024) with no association between paclitaxel and mortality. The same debate was staged at CIRSE 2026 (Copenhagen, September 5-9).
Why it matters: the European recommendation is already published and will change practice and reimbursement in several countries; four of the five comment authors report manufacturer ties, but their methodological objections are legitimate and Nordanstig himself acknowledges the need for limus trials, with SirPAD (NEJM 2026) as the reference; for those treating claudicants, the practical message is to document failure of conservative therapy before intervening.
https://vascularnews.com/swedepad-2-sparks-guideline-update-for-asymptomatic-pad-and-intermittent-claudication/
https://vascularnews.com/comment-how-should-the-new-claudication-guideline-be-interpreted/

3. German Society for Vascular Surgery annual congress: PAD screening and frailty

[Meeting] [Germany]
The DGG held its 42nd annual congress in Frankfurt on September 23-26. At its pre-congress press conference it called for targeted ankle-brachial index screening in risk groups, citing Hamburg City Health Study data in which nearly a quarter (23.6%) of participants aged 45-74 had an index below 0.9, and presented a joint position paper with the German societies of geriatrics and angiology (Gefässchirurgie 31:432-434) calling for systematic frailty screening, structured vascular-geriatric cooperation and a research registry. A third release addressed artificial intelligence and robotics in aortic planning, with the caveat that clinical decisions remain the physician's.
Why it matters: these are society positions, not new data, but the formal incorporation of frailty into vascular decision-making is a trend the SVS guidelines also reflect and should be kept in mind in elderly patients with aneurysm or CLTI. (Source in German.)
https://www.gefaesschirurgie.de/fileadmin/dgg/news/pressemitteilungen/Pressemappe_DGG_Online-PK_September_2026.pdf

4. Interwoven nitinol stent versus drug-eluting stent in severely calcified femoropopliteal disease: three years

[Publication] [Japan]
In the October issue of the Journal of Vascular Surgery, now available, the LEADers PAD group (Yanagiuchi et al., eight Japanese centers, 2018-2021) compares Supera (interwoven nitinol) with Eluvia (paclitaxel-eluting stent) in 257 lesions with PACSS grade 3-4 calcification, with 69 propensity-matched pairs and a mean lesion length of about 165 mm. Three-year freedom from target lesion revascularization was 80.2% with Supera versus 78.2% with Eluvia (P = .87); primary patency 69.6% versus 78.8% (P = .56). First-year restenoses were occlusive or thrombotic in 50% of Eluvia cases versus 13% with Supera (P = .059), and Eluvia was associated with more reintervention in patients under 75 and in lesions of 200 mm or longer.
Why it matters: retrospective, without specific funding, with one author consulting for several manufacturers; it does not change practice, but it suggests that in severe calcium mechanical scaffolding performs as well as drug at three years and that the failure mode differs, which matters for anyone planning reinterventions.
https://www.sciencedirect.com/science/article/pii/S0741521426013078

5. A failed endovascular attempt before bypass does not worsen CLTI outcomes

[Publication] [USA]
Also in the October JVS, the Johns Hopkins team (Kawaji, Abularrage et al.) analyzes 94 bypasses in 81 patients from a multidisciplinary diabetic limb preservation program (2012-2024), comparing upfront bypass with bypass after failed endovascular intervention under a strict protocol of not intervening on the future distal target vessel. At four years, limb salvage was 89% versus 91% (P = .92), amputation-free survival 55% versus 55% (P = .92) and freedom from major adverse limb events 69% versus 86% (P = .20).
Why it matters: a single-center series of modest size in a predominantly diabetic and Black population; it qualifies the BEST-CLI message favoring initial surgery, provided the endovascular strategy spares the outflow of the future bypass.
https://www.sciencedirect.com/science/article/pii/S0741521426012103

Venous disease

6. Oral hormone therapy and venous thromboembolism: Danish nationwide study in The BMJ

[Publication] [Denmark]
The BMJ published on September 23 a nested case-control study using Danish national registries (Berggreen et al., BMJ 2026;394:e100688) in women aged 50-69 between 2003 and 2021: 9,807 venous thromboembolism cases versus 49,035 controls, plus 18,460 ischemic strokes and 11,974 myocardial infarctions. Oral hormone therapy was associated with higher VTE risk regardless of dose and duration; the absolute excess was 0.09% per year, one additional case per 1,055 women treated per year on a background rate of 15.8 per 10,000 person-years. Stroke and infarction increased only with high-dose oral estradiol (more than 1 mg/day) for more than one year. Transdermal therapy was not associated with excess thrombosis in any regimen.
Why it matters: observational, without smoking or body mass index data, but its size and adjustment confirm with contemporary data that the route of administration is the modifiable factor; in the venous clinic, for patients with prior DVT or high risk who need hormone therapy, transdermal is the reasonable option.
https://www.bmj.com/content/394/bmj-2026-100688
https://bmjgroup.com/oral-menopausal-hormone-therapy-linked-to-higher-blood-clot-risk-in-legs-or-lungs-regardless-of-dose-or-duration/

7. European Venous Registry: "huge variation in practice" in deep venous treatment

[Registry] [Europe; ESVS]
Venous News and Vascular News published on September 24 an interview with Baris Ozdemir (Bristol) and Khadija Inam (ESVS) on the European Venous Registry (EVeR), a pragmatic prospective registry of deep venous disease launched two years ago: more than 50 sites, more than 550 patients and ethics approval in 20 countries; a core outcome set and the first annual report have been published, and objective performance goals for deep venous interventions are in development. The early insights are qualitative: wide variation in procedure setting, anesthesia, adjuncts and above all intravascular ultrasound use, and a meaningful share of patients without a good outcome at three months under both conservative and interventional management.
Why it matters: no outcome figures yet and the registry depends on follow-up completeness, but it is the first European initiative that can generate industry-independent performance goals for venous stenting and thrombectomy, something currently missing.
https://venousnews.com/early-insights-from-the-european-venous-registry/

8. Spectrum trial: cyanoacrylate versus endothermal ablation, 12-month safety results

[Clinical trial] [International; 17 sites in 8 countries]
The October issue of JVS carries the abstract of the randomized Spectrum trial (Kiguchi, Gibson and Gohel), presented at the Vascular Annual Meeting, comparing cyanoacrylate closure (136 patients) with endothermal ablation (139) for C2-C5 saphenous reflux, with an independent clinical events committee. At 12 months there were no new adjudicable events between months six and twelve; hypersensitivity to the adhesive in 5.9% (8 of 136), one exit-site granuloma resolved with local excision, phlebitis 8.8% versus 2.9%, and ablation-related thrombus extension 0.7% versus 3.6%; anatomic closure was comparable. Secondary 24-month outcomes in C6 disease will be presented at The VEINS on October 3-4.
Why it matters: this is a meeting abstract, not the full paper, and all three authors report Medtronic honoraria; the 5.9% hypersensitivity figure is the most useful number for informed consent, and the lower thrombus extension with adhesive is consistent with earlier series.
https://www.sciencedirect.com/science/article/pii/S0741521426012607

Rest of the specialty

9. PERFORMANCE III: transcarotid revascularization with integrated embolic protection, 30-day results

[Clinical trial] [USA]
The October JVS publishes, open access, the pivotal PERFORMANCE III study (Lyden, Metzger et al.; 26 US centers and one in France): a prospective single-arm study of the Neuroguard IEP Direct system from Contego Medical (closed-cell stent, post-dilation balloon and integrated 40-micron filter) used with transcarotid flow reversal. In 146 intention-to-treat patients (21% symptomatic, 98.6% with moderate or severe calcification), the 30-day rate of stroke, myocardial infarction or death was 0.7% (one cardiac death on day 18, unrelated to the device), with zero strokes, against a performance goal of 11% (P < .001); technical success 99.3%, no cranial nerve injuries.
Why it matters: manufacturer-sponsored, no comparator and a selected population, but zero strokes in 145 patients with an independent core lab is notable and supports the device's regulatory path; the one-year data will be the ones that count.
https://www.sciencedirect.com/science/article/pii/S0741521426011705

10. First-in-human implant of a silk and polyurethane graft for hemodialysis access

[Industry] [Italy]
Dialybrid announced on September 22 the start of an open-label, single-arm first-in-human trial of its Silkothane arteriovenous graft (silk fibroin plus polyurethane) in 18 adults at four Italian centers, with planned follow-up of 60 months and interim analyses at 6, 12 and 24 months; the first implant was performed by Matteo Tozzi (Varese). The company also closed a 15 million euro financing round.
Why it matters: a press release without results; the interest lies in the material, which aims to improve integration and infection resistance compared with polytetrafluoroethylene, and 12-month patency will have to be seen before drawing conclusions.
https://evtoday.com/news/dialybrid-commences-fih-trial-for-silkothane-av-graft-for-vascular-access-in-hemodialysis

Upcoming meetings and dates

• October 1-3: European Venous Forum hands-on workshop (EVF HOW), Krakow, Poland.
• October 3-4: The VEINS, Las Vegas, with Spectrum 24-month C6 results, BOLT (mechanical thrombectomy for DVT), C-TRACT (iliac stenting in post-thrombotic syndrome), RAPID-PE, the Abre registry at 30 days and the Recana thrombectomy system.
• October 4-7: VIVA 2026, Las Vegas, with SELUTION4SFA at 12 months, DISRUPT PAD BTK II at two years, POWER PAD II (pulsatile lithotripsy), PROMISE III (transcatheter venous arterialization), TRUST (Laguna system), STORM-PE and ELEGANCE at 12 months.
• October 6-9: 40th ESVS annual meeting, Belgrade, Serbia.
• October 14-16: SITE Santiago 2026, Santiago de Compostela, Spain.
• November 17-21: VEITHsymposium, New York.

Weekly vascular bulletin — September 28, 2026
Ten verified items this week: The Lancet, The BMJ, Journal of Vascular Surgery (October issue), EJVES, Vascular News and Venous News.
Three worth your time:
• The Lancet publishes a three-paper Series on peripheral artery disease: more than 113 million people aged 40+ affected and 30-50% five-year mortality when diagnosed late. Narrative review, no new evidence, but it will be the reference for guidelines and payers.
• The ESVS advises against routine paclitaxel in claudication (SWEDEPAD 2, n = 1,136) and five interventionalists reply that a single trial, with 40% Rutherford 1-2 patients and no core lab, is not enough. Four of the five report industry ties.
• The BMJ, Danish study with 9,807 VTE cases: oral hormone therapy raises risk (one extra case per 1,055 women-years); transdermal does not. Observational, no adjustment for smoking or BMI.
Full bulletin, with a critical reading of each study and links to the primary sources:
https://boletinesmedicos.com/en/vascular/2026-09-28.html
#VascularSurgery #Endovascular #VenousDisease #PAD #Paclitaxel

Lancet: 3-paper PAD Series, >113 M affected, 30-50% five-year mortality when diagnosed late. BMJ: oral hormone therapy raises VTE risk (1 extra case per 1,055 women-years); transdermal does not. Weekly vascular bulletin: https://boletinesmedicos.com/en/vascular/2026-09-28.html