In the arterial space, VIVA 2018 focused on the fact that there is an increasing awareness of limb threatening ischaemia coupled with an increase in interventional tools, but no clear defined pathway for treatment. There is also uncertainty about the metrics that matter to patients. In the venous world, there is still a need to define the appropriateness and timing of intervention. So said John Kaufman(Portland, USA; and president of VIVA) and Raghu Kolluri (Columbus, USA; chairman of the VEINS at VIVA meeting) who outlined the critical issues facing vascular specialists. They also looked forward to the trial data that they hope to see in 2019.