Behind The Knife: The Surgery Podcast1 Jan

Journal Review in Vascular Surgery: Beef to Biologics - The Cutting Edge of Medical Management for Peripheral Arterial Disease

Peripheral artery disease has been called the ‘silent circulatory crisis’—affecting millions, limiting mobility, and quietly raising the risk of heart attack, stroke, and limb loss. For decades, treatment focused on walking programs, aspirin, and sometimes a stent or bypass. But today, the landscape is changing. From PCSK9 inhibitors that drive cholesterol to record lows, to GLP-1 agonists like semaglutide improving walking distance, to novel antithrombotic strategies that balance bleeding and clotting—PAD care is entering a new era. In this episode, we’ll explore the breakthroughs, the evidence behind them, and what they mean for patients who just want to keep moving forward.

Hosted by the University of Michigan Department of Vascular Surgery:
- Robert Beaulieu, Program Director
- Frank Davis, Assistant Professor of Surgery
- Luciano Delbono, PGY-5 House Officer
- Andrew Huang, PGY-4 House Officer
- Carolyn Judge, PGY-2 House Officer

Learning objectives:
1. Describe the current evidence-based recommendations for multifactorial medical management of peripheral artery disease (PAD), including lipid, glycemic, and antithrombotic strategies per 2024 SVS/AHA guidelines.

2. Interpret the clinical implications of the FOURIER trial regarding the role of PCSK9 inhibition in reducing cardiovascular events in patients with atherosclerotic disease, including PAD.

3. Evaluate the emerging role of GLP-1 receptor agonists, such as semaglutide, in improving walking performance and quality of life among patients with diabetic PAD based on findings from the STRIDE trial.

Sponsor URL: https://www.goremedical.com/

References:
H. L. Gornik et al., “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease,” JACC, vol. 83, no. 24, pp. 2497–2604, June 2024, doi: 10.1016/j.jacc.2024.02.013.

L. Mazzolai et al., “2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM),” Eur Heart J, vol. 45, no. 36, pp. 3538–3700, Sept. 2024, doi: 10.1093/eurheartj/ehae179.
https://pubmed.ncbi.nlm.nih.gov/40169145/

M. S. Sabatine et al., “Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease,” N Engl J Med, vol. 376, no. 18, pp. 1713–1722, May 2017, doi: 10.1056/NEJMoa1615664.
https://pubmed.ncbi.nlm.nih.gov/28304224/

M. P. Bonaca et al., “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial,” Lancet, vol. 405, no. 10489, pp. 1580–1593, May 2025, doi: 10.1016/S0140-6736(25)00509-4.
https://pubmed.ncbi.nlm.nih.gov/40169145/

N. E. Hubbard, D. Lim, and K. L. Erickson, “Beef tallow increases the potency of conjugated linoleic acid in the reduction of mouse mammary tumor metastasis,” J Nutr, vol. 136, no. 1, pp. 88–93, Jan. 2006, doi: 10.1093/jn/136.1.88.
https://pubmed.ncbi.nlm.nih.gov/16365064/

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