The 40-year history of endovascular aneurysm repair (EVAR) of the aorta wends a circuitous route, from behind the Iron Curtain in Soviet Ukraine, to Buenos Aires, Argentina, points east and west in the United States, and far beyond.
It’s a journey that will be illuminated this morning at 09:40 in Theatre 2 during a special CX 2025 session to honour EVAR’s founding fathers, some of whom will form its assembled faculty.
Marking four decades of development, the session will chart the course of EVAR with a historical perspective provided by Krassi Ivancev (Lund, Sweden), who himself produced a stent graft system that incorporated the iliac arteries in 1993.
The origins of EVAR in the aorta recalls two seminal figures: the late Nicolai L Volodos (Kharkiv, Ukraine) and Juan C Parodi (Buenos Aires, Argentina). The former was the first to treat a thoracic aortic aneurysm with a stent graft and the latter performed the first EVAR on an abdominal aortic aneurysm (AAA).
Parodi will be taking part in the panel discussion that follows Ivancev’s presentation. Michael Dake (Tucson, United States), who led the first aortic endograft placement for treatment of a thoracic aortic aneurysm in 1992, will also be present, as will Frank Veith (New York, United States), the surgeon behind the first stent graft placed for AAA in the United States.
In a write-up of their European Society for Vascular Surgery (ESVS) 2019 Volodos Honorary Lecture in the May 2020 issue of the European Journal for Vascular and Endovascular Surgery (EJVES), Ivancev and Robert Vogelzang (Chicago, United States), noted centres and individuals spread out across the world had made independent contributions to the development of EVAR, pointing out that “contributors to this concept came from different areas of subspecialties such as interventional radiologists and cardiovascular surgeons, thus underlining the critical step of repurposing knowledge from one area, interventional radiology, to another area, vascular surgery.”
Veith remembers a revolutionary period after the first US AAA case he performed alongside Parodi, Michael Marin (New York, United States) and Claudio Schonholz (Charleston, United States) on 22 November 1992. “Remarkably his aneurysm was excluded, and his severe pain was totally relieved,” he recalls of the patient to CX Daily News.
Veith says he realised vascular surgeons had to carry out these procedures in patients who could not undergo open surgery. “Our treatment was surprisingly successful in these patients, and by 1994 we had used our surgeonmade endografts to treat more than 150 patients,” he says.
At the helm of the Eastern Vascular Society (EVS) in 1994, then the Society for Vascular Surgery (SVS) in 1996, he used his presidential addresses to compel colleagues to become “endocompetent or they would become extinct as vascular doctors.”
The other assembled faculty will be Rodney White (Torrance, United States), who contributed to the early development of hand-made endoluminal stent grafts and worked to help spur adoption, and Christopher Zarins (Stanford, United States), another contributor to EVAR technology development as well as the understanding of vascular mechanics.
Themes the panel will discuss include some of the challenges faced during EVAR’s early stages, gamechanging comments, key contributions, and where they feel the field may be headed next.
Speaking to CX Daily News, Zarins recalls arriving at Stanford shortly after Dake had completed the first US aortic endograft in 1992, describing a time of great innovation. “I worked with Tom Fogarty who was developing a stent graft—later to become the AneuRx device—and we were all together in the Stanford Vascular Center where collaboration and innovation was the name of the game,” he says.
This session has been generously supported by Gore.
