Patients Come First · Virginia Hospital & Healthcare Association

Patients Come First Podcast - Dr. Joshua Adams

June 9, 2025·19 min·1 clip

Dr. Adams breaks down the 60,000-mile vascular system using a simple high-pressure vs. low-pressure analogy for patients.

This episode features Dr. Joshua Adams, the Medical Director of the Carilion Clinic Aortic Center and an Associate Professor of Surgery. Host Julian engages Dr. Adams in a conversation about vascular health, his career path, and the specialized aortic center he helps lead. Dr. Adams is a vascular and endovascular surgeon who adopted a unique training pathway to focus on minimally invasive procedures. Dr. Adams initially planned to become a cardiac surgeon but shifted to vascular surgery and interventional radiology during his residency at the University of Virginia. He explains the vascular system by differentiating high-pressure arteries from low-pressure veins that return blood to the heart. Tobacco smoking is identified as the most significant modifiable risk factor for vascular disease, followed by hypertension, high cholesterol, and diabetes. He treats conditions like aortic aneurysms, blockages, and dissections, primarily focusing on the arterial system. He uses a "pipe in the wall" analogy to describe aortic disease, comparing traditional open surgery to a major wall repair and his endovascular approach to relining the pipe from the inside. Through fenestrated and branched stent grafts, he can repair complex aneurysms involving arteries to organs like the kidneys. He states that 95% of his patients undergoing these endovascular procedures go home the next day, whereas traditional surgery required lengthy ICU and hospital stays. Since 2017, Dr. Adams has performed over 400 complex aortic repairs at the Carilion Clinic. The Carilion Clinic Aortic Center is expanding its catchment area across multiple states and will move into a new cardiovascular institute in July. The new facility will feature state-of-the-art operating rooms with Philips imaging systems and LumaGuide technology to reduce radiation exposure during procedures. Dr. Adams emphasizes that his guiding principle in training future physicians is to always ask, "What's best for the patient?" He believes this focus helps navigate conflicts and tough decisions in medical practice. When asked surprise questions, Dr. Adams selects the book "Start With Why" by Simon Sinek and the movie "Hoosiers." For a superpower, he chooses the ability to fly, and for a skill to master, he selects making people feel heard and special. The episode is educational and conversational, blending medical explanations with personal insights and career anecdotes. Listeners interested in medical innovation, vascular health, or surgical careers would appreciate this episode. Those seeking a highly narrative or debate-driven podcast might find it less engaging.

As heard by us

Practical, calm discussion of vascular risk, aortic repair, and the value of prevention.

Patients Come First spends this hour on aortic disease, and it works best when it stays concrete. Dr. Joshua Adams, the Medical Director of the Carilion Clinic Aortic Center, explains the topic in plain language and keeps circling back to what patients actually face: lowering…

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A calm way to understand aortic disease, vascular health, and minimally invasive treatment options.

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