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 U.S., and far beyond. It’s a journey being illuminated during the 2025 Charing Cross (CX) International Symposium in London, England (April 23–25), to honor EVAR’s founding fathers four decades on from their trail-blazing work, with some of the key figures among the assembled faculty at CX.
Marking four decades of development, the session will chart the course of EVAR with a historical perspective provided by interventional radiologist Krassi Ivancev, MD, of Lund, Sweden, who himself figures in EVAR development after he produced a stent graft system that incorporated the iliac arteries in early 1993.
The origins of EVAR in the aorta recalls two seminal figures: the late leading vascular surgeon in the Soviet Union, Nicolai L. Volodos, MD, of Kharkiv, Ukraine, and Argentinian vascular surgeon Juan C. Parodi, MD, of Buenos Aires. 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).
Founding father Parodi will be one of the faculty taking part in the panel discussion that follows Ivancev’s presentation. Interventional radiologist Michael Dake, MD, of Tucson, Arizona, who led the first aortic endograft placement for treatment of a thoracic aortic aneurysm in the U.S. in 1992, will also be present, and joined by former Society for Vascular Surgery (SVS) President Frank Veith, MD, of New York City, the surgeon behind the first stent graft placed for AAA in the U.S., also in 1992.
In a write-up of their European Society for Vascular Surgery (ESVS) 2019 Volodos Honorary Lecture in Hamburg, Germany, in the May 2020 issue of the European Journal for Vascular and Endovascular Surgery (EJVES), Ivancev and co-author Robert Vogelzang, MD, from Chicago, commented on how multiple centers and individuals spread out across the world had made independent contributions to the development of EVAR, pointing out that “the 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 the revolutionary period after the first U.S. AAA case he performed alongside Parodi, fellow vascular surgeon Michael Marin, MD, also of New York City, and interventional radiologist Claudio Schonholz, MD, of Charleston, South Carolina, on Nov. 22, 1992. “Remarkably his aneurysm was excluded, and his severe pain was totally relieved,” he recalls of the patient.
Veith says he realized 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 surgeon-made 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 his colleagues to become “endocompetent or they would become extinct as vascular doctors.”
The other assembled faculty will be vascular surgeon Rodney White, MD, of Torrance, California, who contributed to the early development of hand-made endoluminal stent grafts and worked to help spur adoption, and Christopher Zarins, MD, another former SVS president, of Stanford, California, who also made contributions to EVAR technology development and understanding of vascular mechanics. Themes the panel were set to discuss include some of the challenges faced during EVAR’s early stages, game-changing moments, key contributions, and where they feel the field may be headed next.
Zarins recalls arriving at Stanford shortly after Dake had completed the first U.S. 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.
