Sherene Shalhub (Oregon Health and Science University, Portland, USA) set out a new biologically informed framework that “captures the diverse spectrum of arterial fragility and repair outcomes across inherited and acquired aortic disease” during today’s Roy Greenberg Distinguished Lecture on Innovation at the 2025 Vascular Annual Meeting (VAM; 4–7 June, New Orleans, USA).
Shalhub introduced the Aortic and Arterial Vulnerability Spectrum (AAVS) in her talk ‘The aortic vulnerability spectrum: Reshaping the future of aortic surgery’.
Speaking to Vascular News ahead of the lecture, Shalhub noted that the AAVS was designed to address a gap between molecular and ultrastructural pathology and clinical decision-making and aims to “move beyond binary classifications” to better predict procedural durability, remodeling potential, and long-term risk.
“We always think about aortic disease in a binary manner,” Shalhub commented. “In reality, we should think of aortic disease as a spectrum, where you have some people who have extreme manifestations of the disease and then have other people with milder manifestations of the disease.”
Shalhub asserts that “everybody falls somewhere on that spectrum,” encouraging a shift in thinking to inform better patient care.
Homing in on some of the specifics of her work, Shalhub highlighted the use of ultrastructural skin biopsy analysis as a surrogate for aortic and arterial biology as “one of the most transformative innovations.” She explained: “In patients with aortic aneurysms and dissections, the skin provides a minimally invasive, accessible tissue that mirrors the extracellular matrix and connective tissue vulnerabilities found in the aorta, offering a unique window into the aorta.”
In addition, Shalhub considered how her work continues the legacy of Roy Greenberg ahead of delivering this year’s eponymously named lecture at VAM. “Dr Roy Greenberg pioneered customised endovascular solutions long before FDA [US Food and Drug Administration]-approved devices were widely available,” Shalhub says. “He understood that durable repair requires more than device deployment; it demands alignment between anatomy, haemodynamics, and biology. That philosophy resonates directly with AAVS, which seeks to individualise care based on biologic vulnerability, not just anatomy. AAVS can be seen as a biologic extension of Greenberg’s legacy: just as he matched devices to anatomy, we now aim to match interventions to underlying arterial biology.
“His legacy inspires today’s push toward precision vascular medicine where genotype, and substrate, guide care.”
SVS president Matthew Eagleton (Massachusetts General Hospital, Boston, USA) selected Shalhub to deliver this year’s Greenberg Lecture. Commenting on his choice of speaker, Eagleton told Vascular News: “The intent of the Greenberg Lecture was to highlight a physician who was interested in progressing the field of endovascular care through research. Dr Shalhub’s research on the genetic component of aortic disease would be very interesting to Roy. In particular, her focus on how that may affect what treatment options we offer our patients. He would love this year’s topic and to hear Dr Shalhub’s address.”
Shalhub’s introduction to the AAVS has also been published online in the Journal of Vascular Surgery (JVS).
