Janet Powell, the clinical trial investigator who played a pivotal role in several landmark abdominal aortic aneurysm (AAA) studies, has died at the age of 79. At the time of her death, Powell was professor of vascular biology and medicine at Imperial College London (London, UK).
Powell was born in Oxford on 1 August 1945. After obtaining a BSc in chemistry from the University of Oxford (1968) and a PhD in biophysics in London (1972), Powell moved to the USA to study medicine at the University of Miami School of Medicine, graduating in 1981. She then returned to the UK to complete clinical training in pathology, specialising in cardiovascular risk.
Initially interested in the pathophysiology of elastic tissues, Powell told Vascular News in a 2015 profile interview that her research interests turned to the aorta specifically through her work with Roger Greenhalgh, with whom she collaborated over many decades.
As part of the Imperial College Vascular Surgery Research Group, Powell was involved in numerous clinical trials in AAA management, including the UK Small Aneurysm Trial, EVAR-1, EVAR-2 and IMPROVE.
When asked in her 2015 Vascular News profile interview which piece of research she was most proud of, Powell highlighted a central focus of her work: the patient. “Anything that improves outcomes for patients,” she responded, “including all the randomised trials of abdominal aortic aneurysm management, as well as an early piece of pathology research which showed the importance of inflammation in the developing aneurysm… a theme still being investigated by vascular biologists and evaluated in randomised trials.”
Powell was the chief investigator of the IMPROVE randomised controlled trial, which compared open repair with an endovascular strategy for ruptured AAA. Initial trial results were published in the British Medical Journal (BMJ) in 2014, with one-year results presented at the 2015 Charing Cross (CX) Symposium and published in the European Heart Journal the same year. “We think that the results of this trial support the increasing use of endovascular repair and that it should always be available, so there’s equity of access to care for patients,” she told Vascular News in an interview on the one-year results.
Powell was actively involved in vascular disease research until her passing. Alongside Imperial College London colleagues Colin Bicknell and Anna Pouncey, she was co-chief investigator of the ongoing WARRIORS trial—her last research project—which aims to examine early endovascular aneurysm repair (EVAR) in women.
“The disadvantage of women with AAA can no longer be ignored, and we hope that you will support us, in what will hopefully be a major step towards readdressing the imbalance in AAA outcomes for women and men,” she urged Vascular News readers in an interview on the trial in 2022.
Powell has been recognised by several societies for her contributions to the vascular field. In 2012, she received a Lifetime Achievement Award from the Vascular Society of Great Britain and Ireland (VSGBI), while the European Society for Vascular Surgery (ESVS) hosts a named lecture at its annual meeting to honour Powell’s advocacy of evidence-based medicine.
Powell is survived by her son Duncan (46) and daughter Tamsin (48), as well as five grandchildren.
Colleagues have shared with Vascular News their memories of working and collaborating with Powell, as well as considered her legacy as a renowned clinical trial investigator.
Colin Bicknell, professor of vascular surgery at Imperial College London, said: “I think it is true to say that we are all in shock at the sudden announcement of Janet’s passing. Janet delivered numerous trials over the years and has unquestionably changed the way that every vascular surgeon in the world practises daily. Not many can claim that accolade.
“She has been a mentor to me and countless others, a role that she took so very seriously, building a cohort of researchers for the future. I and everyone will miss her every day, but I hope we can make her proud in delivering vascular trials in the future to practise evidence-based medicine in the way she taught us.”
Anna Pouncey, NIHR clinical lecturer in vascular surgery at St George’s, University of London (London, UK), remarked: “I could write for pages about the achievements of Janet Powell. No doubt others will do so, but she didn’t care for recognition. Rather, I will describe her as she was.
“The sight of Janet’s diminutive frame walking up to the microphone could send a grown vascular surgeon quaking in their boots, for they knew that, with a tilt of her bowed head and a characteristic stare, she would deliver a single line that cut through all their pomp and glamour—a line that went straight to the heart of the matter. Over the years, time and time again, she held the vascular community to account, reminding us all of what really mattered—not egos or career profiles, but rather scientific rigour, integrity, and, most of all, the patient.
“When Janet moved, she moved quietly. Like pebbles dropped into a pond, the ripples of her actions were often only noticed much later. Now, as we look back, we realise that she helped shape vast swathes of our discipline. She was kind and loyal to those she cared for, rescuing and defending many a vascular surgeon in times of need. By doing so, she built not only a wealth of scientific evidence but also a living legacy within the vascular community.
“I suppose some might say I came to know Janet in her ‘twilight years’. But in working with her on her last project, the WARRIORS trial, she burned brighter than ever. Inspired and enthusiastic, she led by example, working so relentlessly that it was difficult to keep up! Through WARRIORS, she hoped to bring greater equity to the treatment of women and to build a model of international collaboration for the vascular world to follow. She was tremendously excited for what was to come, and I hope those she inspired will see it brought to life. RIP JTP.”
Ian Loftus, consultant and professor in vascular and endovascular surgery at St George’s University Hospitals NHS Foundation Trust (London, UK), immediate past president of the ESVS and Vascular News editorial board member, commented: “Professor Janet Powell was unsurpassed in her achievements, to promote evidence-based vascular practice. Her work has changed the way we work, through numerous ‘landmark’ clinical trials, but also a rigorous interpretation of scientific and clinical research, contributions to a number of ESVS Clinical Guidelines, and other international collaborations. She was chair of the ESVS Board of Directors for many years, and her contributions to the Society and its Journal, were immense. It is right that these will be honoured formally at the forthcoming annual meeting in Istanbul in September.
“One of her great contributions was to ask the questions of research that others sometimes feared to ask. More often however, others just didn’t think of these questions. She always saw others’ work through a different and often probing eye, but always with an inquisitive perspective.
“Vascular surgeons have always loved a good debate, with some especially legendary duels taking place at the CX symposia over the years. These debates deliberately take the ‘one therapy is better than the other’ mantra, to challenge the evidence and the audience to decide. But of course, the real world is very different to this mantra. On a shared journey back from the Milan meeting last December, where her contributions were as sharp as ever, I asked her if she ever found this frustrating. With the usual glint in her eye and wry smile, she said ‘better to debate, than not debate at all!’
And of course, she was a master at debating along with all aspects of her professional life, because no one knew the literature as well as she did. But for someone who spent her life in full time research, she never forgot that the patient should be at the heart of everything we do. That should, and I am sure will be, her legacy.”
Pinar Ulug, a clinical trial manager at Imperial College London who worked with Powell for 15 years, told Vascular News: “A superb scientist and outstanding researcher, Professor Powell was extremely dedicated to improving outcomes for patients through collaborative research and high-quality randomised clinical trials. She was integral to landmark UK trials on the management of abdominal aortic aneurysms and made unparalleled contributions to vascular surgery with lasting impact not only in the UK, but throughout the world. Janet was committed to creating consensus and she never shied away from speaking out about difficult or unpopular issues. Her intellectual rigour, dedication to scientific excellence, and ability to foresee and resolve complex challenges in the trials she led set her apart as a brilliant leader and hugely inspirational mentor.
“She leaves behind a lasting legacy, both professionally and personally, and her influence on surgical practice is immeasurable. Janet’s passing is a tremendous loss to the vascular surgery community, but her remarkable career and extraordinary contributions will continue to inspire for years to come. She will be deeply missed by all of us who had the privilege of working with her.”
Frank Veith, chair of the VEITHsymposium and professor of surgery at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (Cleveland, USA) and New York University Medical Center (New York, USA), said: “Janet was a superstar scientist and researcher and a good friend. She was a superb critical thinker with an uncanny knack to be correct on most issues. She was a major star contributor to our annual VEITHsymposium for decades. Janet was a genuinely good person and a great doctor/scientist who will be sorely missed on both sides of the Atlantic.”
Alun Davies, professor of vascular surgery at Imperial College London, shared: “Janet was a delightful colleague with an international reputation, with whom I had worked for 30 years. She was adored by all her colleagues and students. She also had a unique long-term research collaboration with Roger Greenhalgh. Janet will be sadly missed.”
Photos courtesy of Janet Powell’s son, Duncan.
