Artificial intelligence-based decision support systems and their role in vascular surgery and clinical practice

Artificial intelligence-based decision support systems (AI-DSS) are gaining attention in medicine as tools for diagnosis, risk assessment, and treatment planning. By processing large, heterogeneous datasets, these systems can recognize patterns and generate predictions that complement clinical expertise. Vascular surgery is a relevant case, given its reliance on imaging, patient-specific risk stratification, and complex perioperative choices. Applications in vascular surgery span imaging, intraoperative guidance, and predictive modeling. Deep learning methods support segmentation of aneurysms and peripheral arteries, detection of plaques, and classification of stenoses, achieving accuracy comparable to expert analysis. Intraoperative models aid endoleak detection and graft visualization during endovascular repair. Predictive approaches refine management of abdominal aortic aneurysms by combining imaging, biomechanical modeling, and biomarkers to improve on diameter-based thresholds. Postoperative models forecast complications, survival, and reintervention, while emerging concepts such as digital twins and wearable monitoring suggest more continuous, personalized vascular care. Despite promise, adoption faces barriers. Many models remain "black boxes," raising concerns about interpretability, generalizability, and integration with electronic records. Ethical and legal issues - including accountability, fairness, informed consent, and patient autonomy - are central, with frameworks such as the EU AI Act and FDA guidance beginning to set standards. High development costs and uncertain reimbursement further limit implementation. Building trust will require transparency, reliability, and assurance that AI supports rather than replaces human judgment. Future progress depends on rigorous external validation, workflow integration, and co-design with clinicians. Meeting these conditions could allow AI-DSS to evolve into reliable tools that enhance precision, safety, and personalization in vascular surgery while preserving human values in care.