Panos Kougias, MD, MSc, FACS

Panos Kougias, MD, MSc, FACS

Chair, Department of Surgery
Clarence and Mary Dennis Professor of Surgery
Chief, Division of Vascular Surgery

Dr. Kougias completed his general surgery training at the East Tennessee State University, Johnson City, TN; and his vascular surgery fellowship training at the Baylor College of Medicine in Houston, TX. He was subsequently retained in a faculty position at Baylor College of Medicine, where he served as an Associate Division Chief for Vascular Surgery and Chief for the VA Vascular Surgery service line.

During his 15-year tenure at Baylor, Dr. Kougias led or co-led multiple clinical and research initiatives that received regional and national recognition. Among those was the initiation of a fenestrated aortic aneurysm program. This minimally invasive procedure allows surgeons to repair aortic aneurysms through small incisions in the groin and/or arms while preserving blood flow to the critical branch arteries to the kidneys and other organs. It was the first program of its kind at Baylor.

Dr. Kougias has received more than $40 million of peer reviewed funding to either conduct large scale randomized trials, or manage and direct clinical trial supervision programs. He is the national principal investigator of TOP trial, a multicenter, multimillion randomized controlled trial that examines the effect of two different transfusion strategies on postoperative outcomes after major operative interventions in high cardiac risk patients. In addition, he is a national principal co-investigator for the IMPROVE-AD trial, which will compare TEVAR vs. medical management  in patients with uncomplicated type B aortic dissection.

Dr. Kougias has held numerous leadership positions in national scientific associations. In addition, he serves on multiple editorial boards, including associate and assistant editor positions. His scientific work has been featured in high-impact, peer-reviewed publications, such as the New England Journal of Medicine, JAMA Surgery, JAMA Cardiology and Annals of Surgery.

Dr. Kougias is passionate about providing personalized, high quality care. He is facile with all aspects of open vascular and minimally invasive endovascular surgery techniques, and has led numerous impactful clinical research initiatives that have influenced surgical practice. He has been included in America’s Top Doctors listing every year since 2009.

Dr. Kougias treats the full spectrum of vascular disorders. He is well familiar with all aspects of modern open vascular and minimally invasive endovascular procedures. His areas of expertise include the following:

  • Treatment of carotid artery occlusive disease using either open endarterectomy or stenting.
  • Procedures for peripheral arterial disease, either open or endovascular.
  • Treatment for abdominal aortic aneurysms, either open or endovascular. Dr. Kougias has unique expertise in managing juxtarenal, suprarenal, or thoracoabdominal aneurysms using custom-made, fenestrated endografts. 
  • Treatment of aneurysms in the arteries of the upper or lower extremities.

Dr. Kougias' research is focused in three areas; clinical trials, big data, and systems redesign.  He has functioned as PI or co-PI in multiple clinical trials funded from the NIH and the VA Office of Research and Development and has received more than $40 million in peer-reviewed funding. He has provided research mentorship to numerous trainees and faculty.

Dr. Kougias is currently the national principal investigator  of TOP trial (, a multicenter randomized study that examines the effect of transfusion strategies on postoperative outcomes in high cardiac risk patients. He is also a national principal co-investigator for the IMPROVE-AD trial, which will compare TEVAR vs. medical management in patients with uncomplicated type B aortic dissection. Furthermore, he has completed a randomized trial that demonstrated the value of a statistically-driven scheduling system in improving operating room efficiency.


Select Publications:

  • Weissler EH, Osazuwa-Peters OL, Greiner MA, Hardy NC, Kougias P, O'Brien SM, Mark DB, Jones WS, Secemsky EA, Vekstein AM, Shalhub S, Mussa FF, Patel MR, Vemulapalli S. Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection. JAMA Cardiol. 2022 Nov 5. doi: 10.1001/jamacardio.2022.4187. Online ahead of print. PMID: 36334259
  • Kougias P, Kaji AH, Boermeester M. JAMA Surg. 2022 Oct 26. doi: 10.1001/ jamasurg.2022.4883. Online ahead of print. PMID: 36287556 Practical Guide to Designing a Clinical Trial in Surgery.
  • Eid MA, Barry MJ, Tang GL, Henke PK, Johanning JM, Tzeng E, Scali ST, Stone DH, Suckow BD, Lee ES, Arya S, Brooke BS, Nelson PR, Spangler EL, Murebee L, Dosluoglu HH, Raffetto JD, Kougias P, Brewster LP, Alabi OA, Dardik A, Halpern VJ, O’Connell JB, Ihnat DM, Zhou W, Sirovich BE, Metha K, Moore KO, Voorhees A, Goodney PP, for the Preferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) Study Team. Effect of a Decision Aid on Agreement Between Patient Preferences and Repair Type for Abdominal Aortic Aneurysm. A Randomized Clinical Trial. JAMA Surg. 2022;157(9):e222935. doi:10.1001/jamasurg.2022.2935
  • Kougias P, Sharath SE, Zamani N, Brunicardi FC, Berger DH, Wilson MA. Timing of a Major Operative Intervention After a Positive COVID-19 Test Affects Postoperative Mortality: Results From a Nationwide, Procedure-matched Analysis. Ann Surg. 2022 Sep 1;276(3):554-561. Epub 2022 Jul 15. PMID: 35837893
  • Hsu H, Lu T, Hansraj N, Russeau A, Kougias P, Barshes NR. Gender, racial and ethnic disparities in index hospitalization operations for symptomatic carotid stenosis in Texas hospitals. Ann Vasc Surg. 2022 Mar;80:152-157. doi: 10.1016/j.avsg.2021.08.039. Epub 2021 Oct 20. PMID: 34687890
  • Barshes NR, Bidare D, Kougias P, Mills JL Sr, LeMaire SA. Racial and ethnic disparities in abdominal aortic aneurysm evaluation and treatment rates in Texas. J Vasc Surg. 2022 Jan 19:S0741-5214(22)00041-6. doi: 10.1016/j.jvs.2021.12.072. Online ahead of print. PMID: 35063611
  • Sharath SE, Zamani N, DeSantis S, Kougias P. Treatment of Early Deep Wound Infections after Arterial Reconstructions: A Meta-Analysis and Survey. Ann Vasc Surg. 2021 Feb 4:S0890-5096(21)00122-9. doi: 10.1016/j.avsg.2020.12.058. Online ahead of print. PMID: 33549780
  • Anderson PB, Wanken ZJ, Perri JL, Columbo JA, Kang R, Spangler EL, Newhall K, Brooke BS, Dosluoglu H, Lee ES, Raffetto JD, Henke PK, Tang GL, Mureebe L, Kougias P, Johanning J, Arya S, Scali ST, Stone DH, Suckow BD, Orion K, Halpern V, O'Connell J, Inhat D, Nelson P, Tzeng E, Zhou W, Barry M, Sirovich B, Goodney PP; PROVE-AAA Study Team. Patient information sources when facing repair of abdominal aortic aneurysm. J Vasc Surg. 2020 Feb;71(2):497-504. doi: 10.1016/j.jvs.2019.04.460. Epub 2019 Jul 26. PMID: 31353272
  • Columbo JA, Kang R, Spangler EL, Newhall K, Brooke BS, Dosluoglu H, Lee ES, Raffetto JD, Henke PK, Tang GS, Mureebe L, Kougias P, Johanning J, Arya S, Scali ST, Stone DH, Suckow BD, Orion K, Halpern V, O'Connell J, Inhat D, Nelson P, Tzeng E, Zhou W, Barry M, Sirovich B, Goodney PP; PROVE-AAA Study Team. Design of the PReferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) Trial. Ann Vasc Surg. 2020 May;65:247-253. doi: 10.1016/j.avsg.2019.02.034. Epub 2019 May 8. PMID: 3107545
  • Kougias P. Delivering the promise of a minimally invasive thoracoabdominal aneurysm repair: The road less travelled. J Vasc Surg. 2020 Apr;71(4):1413-1414. doi: 10.1016/j.jvs.2019.09.015. PMID: 32204844
  • Zamani N, Sharath SE, Barshes NR, Braun JD, Kougias P. Long-term outcomes of lower extremity graft preservation using antibiotic beads in patients with early deep wound infections after major arterial reconstructions. J Vasc Surg. 2020 Apr;71(4):1315-1321. doi: 10.1016/j.jvs.2019.06.192. Epub 2019 Sep 10. PMID: 31519515
  • Kougias P, Sharath SE, Mi Z, Biswas K, Mills JL. Effect of postoperative permissive anemia and cardiovascular risk status on outcomes after major general and vascular surgery operative interventions. Ann Surg. 2019 Oct;270(4):602-611. PMID: 3147897
  • Sharath SE, Zamani N, Kougias P, Kim S. Missing Data in Surgical Data Sets: A Review of Pertinent Issues and Solutions.. J Surg Res. 2018 Dec;232:240-246. doi: 10.1016/j.jss.2018.06.034. Epub 2018 Jul 13. Review. PMID: 30463724
  • Kougias P, Branco BC, Braun J, Sharath S, Younes H, Barshes NR, Mills JL Sr. Ischemia-induced lower extremity neurologic impairment after fenestrated endovascular aneurysm repair. J Vasc Surg. 2019;70:23-30.PMID: 30626551
  • Kougias P, Tiwari V, Sharath SE, Garcia A, Pathak A, Chen M, Ramsey D, Barshes NR, Berger DH. A Statistical Model-driven Surgical Case Scheduling System Improves Multiple Measures of Operative Suite Efficiency: Findings From a Single-center, Randomized Controlled Trial. Ann Surg. 2019 Dec;270(6):1000-1004. PMID: 29697450
  • Kougias P, Sharath S, Barshes NR, Chen M, Mills JL, Sr. Effect of postoperative anemia and baseline cardiac risk on serious adverse outcomes after major vascular interventions. J Vasc Surg. 10.1016/j.jvs.2017.05.113 2017. PubMed PMID: 28947229.
  • Massarweh NN, Anaya DA, Kougias P, Bakaeen FG, Awad SS, Berger DH. Variation and Impact of Multiple Complications on Failure to Rescue After Inpatient Surgery. Ann Surg. 2017;266(1):59-65. PubMed PMID: 27429030.
  • Kougias P, Tiwari V and Berger DH. Use of simulation to assess a statistically driven surgical scheduling system. J Surg Res. 2016;201:306-12. PubMed PMID: 27020812.
  • Massarweh NN, Kougias P, Wilson MA. Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System. JAMA surgery. 2016;151:1157-1165. PubMed PMID: 27653498.
  • Kougias P, Collins R, Pastorek N, Sharath SE, Barshes NR, McCulloch K, Pisimisis G, Berger DH. Comparison of domain-specific cognitive function after carotid endarterectomy and stenting. J Vasc Surg. 2015;62(2):355-362. PubMed PMID: 26211378.
  • Bakaeen FG, Reda DJ, Gelijns AC, Cornwell L, Omer S, Al Jurdi R, Kougias P, Anaya D, Berger DH, Huang GD. Department of veterans affairs cooperative studies program network of dedicated enrollment sites: Implications for surgical trials. JAMA surgery. 2014 March 19. PubMed PMID: 24647851.
  • Pisimisis GT, Kougias P, Barshes NR, Bechara CF. Surgeon-modified fenestrated endograft to treat ruptured juxtarenal aneurysm. JAMA surgery. 2014;149:447-449. PubMed PMID: 24671448
  • Kougias P, Sharath S, Barshes NR, Lowery B, Garcia A, Pak T, Bechara CF, Pisimisis G. Impact of cumulative intravascular contrast exposure on renal function in patients with occlusive and aneurysmal vascular disease. J Vasc Surg. 2014;59:1644-1650. PubMed PMID: 24560864.
  • Matos JM, Barshes NR, McCoy S, Pisimisis G, Felkai D, Kougias P, Lin PH, Bechara CF. Validating common carotid stenosis by duplex ultrasound with carotid angiogram or computed tomography scan. J Vasc Surg. 2014;59:435-439. PubMed PMID: 24080127.
  • Barshes NR, Bechara CF, Pisimisis G, Kougias P. Preliminary experiences with early primary closure of foot wounds after lower extremity revascularization. Ann Vasc Surg. 2014;28:48-52. PubMed PMID: 24189006.
  • Barshes NR, Kougias P, Ozaki CK, Pisimisis G, Bechara CF, Henson HK, Belkin M. Cost-effectiveness of revascularization for limb preservation in patients with marginal functional status. Ann Vasc Surg. 2014;28:10-17. PubMed PMID: 24332257.
  • Omer S, Kar B, Cornwell LD, Blaustein A, Levine GN, Ali N, Jneid H, Paniagua D, Atluri PV, Bechara CF, Kougias P, Ruma M, Preventza O, Bozkurt B, Carabello BA, Bakaeen FG. Early experience of a transcatheter aortic valve program at a veterans affairs facility. JAMA Surgery. 2013;148:1087-1093. PubMed PMID: 24048246.
  • Barshes NR, Ozaki CK, Kougias P, Belkin M. A cost-effectiveness analysis of infrainguinal bypass in the absence of great saphenous vein conduit. Journal of Vascular Surgery. 2013;57:1466-1470. PubMed PMID: 23395205.
  • Bechara CF, Barshes NR, Pisimisis G, Chen H, Pak T, Lin PH, Kougias P. Predicting the learning curve and failures of total percutaneous endovascular aortic aneurysm repair. Journal of Vascular Surgery. 2013;57:72-76 . PubMed PMID: 23127982.
  • Jneid H, Kar B, Paniagua D, Blaustein A, Cornwell L, Levine GN, Ali N, Bechara CF, Kougias P, Atluri PV, Pawlak C, Carabello B, Bozkurt B, Bakaeen FG. Transcatheter aortic valve replacement as a treatment for late apicoaortic conduit obstruction in a patient with severe aortic stenosis. Circulation. 2013;127:e491-494. PubMed PMID: 23509034.
  • Kougias P, Orcutt S, Pak T, Pisimisis G, Barshes NR, Lin PH, Bechara CF. Impact of postoperative nadir hemoglobin and blood transfusion on outcomes after operations for atherosclerotic vascular disease. Journal of Vascular Surgery. 2013;57:1331-1337; discussion. PubMed PMID: 23384496
  • Kougias P, Tiwari V, Barshes NR, Bechara CF, Lowery B, Pisimisis G, Berger DH. Modeling anesthetic times. Predictors and implications for short-term outcomes. The Journal of Surgical Research. 2013;180:1-7. PubMed PMID: 23158406.
  • Poi MJ, Pisimisis G, Barshes NR, Darouiche RO, Lin PH, Kougias P, Bechara CF. Evaluating effectiveness of antibiotic polymethylmethacrylate beads in achieving wound sterilization and graft preservation in patients with early and late vascular graft infections. Surgery. 2013;153:673-682. PubMed PMID: 23270968.
  • Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS, Padberg FT, Jr., Kohler TR, Kougias P, Jean-Claude JM, Cikrit DF, Swanson KM. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. The New England Journal of Medicine. 2012;367:1988-1997. PubMed PMID: 23171095
  • Kougias P, Tiwari V, Orcutt S, Chen A, Pisimisis G, Barshes NR, Bechara CF, Berger DH. Derivation and out of sample validation of a modeling system to predict surgical case duration. Am J Surg. (2012) 204, 563–568. PubMed PMID: 23140826.
  • Lin PH, Kougias P, Bechara CF, Weakley SM, Bakaeen FG, Lemaire SA, Coselli JS. Clinical outcome of staged versus combined treatment approach of hybrid repair of thoracoabdominal aortic aneurysm with visceral vessel debranching and aortic endograft exclusion. Perspectives in vascular surgery and endovascular therapy. 2012;24:5-13. PubMed PMID: 22316552
  • Kougias P, Weakly SM, Yao Q, Chen C, Lin PH. Arterial baroreceptors in the management of systemic hypertension. Med Sci Monit. 2010 Jan;16(1):RA1-8.
  • Kougias P, Chen A, Cagiannos C, Bechara CF, Huynh TT, Lin PH. Subintimal placement of covered stent versus subintimal balloon angioplasty in the treatment of long-segment superficial femoral artery occlusion. Am J Surg Nov 2009;198(5):645-649
  • Kougias P, Hyunh TT, Lin PH. Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mesenteric ischemia. Int Angiol, 2009. 28(2): p. 132-7
  • Kougias P, Lau D, El Sayed HF, et al. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007, 46(3): 467-74.
  • Kougias P, Zhou , El Sayed HF, Lin PH. Chronic mesenteric ischemia. The role of endovascular therapy - J Endovasc Ther Jul 2007 14(3): p. 395-406
  • Kougias P, Lin PH, Dardik A, Lee A, El Sayed HF, Zhou W. Successful treatment of endotension and aneurysm sac enlargement with endovascular stent graft reinforcement. J Vasc Surg, Jul 2007. 46(1):124-7.
  • Kougias P, Kappa JR, Sewell DH, Feit RA, Michalik RE, Imam M, Greenfield TD. Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Grafting: Results in Specific Patient Groups. Ann Vasc Surg, May 12 2007.
  • Kougias P, Peden EK, Lumsden AB. Endovascular management of thoracic aortic aneurysms. Preoperative imaging and device sizing. J Vasc Surg. Feb 2006;43 Suppl A:48A-52A.

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Department of Surgery