Stanford Aortic Festgraft
Remarks Given by Dr. Ron Dalman, Chief Vascular Surgery
Humbling experience to be asked to give an overview of this event, to summarize the significant of the events of the day as well as the last 25 years.
As we have been discussing in the lead-up to this meeting, the opportunity is rare indeed that the “pioneers” in any area of consequential endeavor can convene to review and take historical measure of the extent of their contribution – in the case of EVAR alone, more than 80% of AAAs repaired in this fashion – approaching 50,000 procedures annually in the US alone, >$600M market, more than 3 fold reduction in operative mortality, dramatic improvements in peri-operative outcomes, world-wide decline in aneurysm-related mortality as a leading cause of death – the list goes on.
EVAR/TEVAR are the “great equalizers” of aortic surgery and aortic disease management – allow what used to be recognized as extraordinary outcomes in ordinary hospitals. ICU services, blood-banking, advanced anesthesia skills – all the accouterments of major aortic and cardiac surgery, no longer needed to obtain world-class outcomes.
We all owe Mike a great debt of gratitude for recognizing and memorializing the significance of this moment.
As a specialty, Vascular Surgery has a history of overcoming the “received wisdom” of any specific period in time. In the Second World War, arterial reconstruction procedures were forbidden in the British Army - too dangerous, unpredictable, risk of death vs. life-long disability. Yet it was during this exact same moment, in other field and evacuations hospitals in the same theater of war, that Drs. DeBakey and many others were exploring options beyond ligation and limb amputation to manage vascular injuries.
Vascular surgery as a specialty was dedicated, right from the start, to making the extraordinary ordinary - hence the name “Society for Vascular Surgery” - surgeons committed to making vascular reconstruction mainstream and predictably successful. That’s why there is so much emphasis on outcomes in our specialty - results do matter, as Norm Hertzer emphasized in his SVS Presidential Address in 1994, and the adoption and refinement of EVAR stands as a defining validation of that foundational principle.
Aortic endografting represents the biggest single innovation in vascular disease management in our professional lifetimes. Much of the endovascular “revolution” for traditional vascular surgeons, started with the recognition the EVAR, and subsequently TEVAR, would become the dominant paradigm of aortic aneurysm repair. In the mid-1990s, we had a hands-on course at Stanford, using animal modeling - remember Kim Hodgson grumbling that most of the attendees that he was mentoring, in his session, were interested only in learning - didn’t want to learn about renal angioplasty and stenting, or venous interventions, or use of thrombolytic therapy - just wanted to learn EVAR. From there it was only a matter of time before the entire armamentarium of endovascular techniques would become essential tools for the well-trained vascular specialist.
The scale of the contribution represented by aortic endografting is on par with the greatest technical surgical achievements of the 20th century that enabled the development of vascular surgery as we know it today:
McClean and Howell
Role of commercialization of EVAR – sustainability, rapid prototyping and iterative design improvements, large-scale engineering and manufacturing prowess, planning and procedural support: John Stevens & Wes Sterman, Tom Fogarty, Chris Zarins, Rod White and Ted Detrich – with industrial partners, made the modern practice of EVAR possible.
We aren’t here tonight celebrate ourselves, but rather celebrate the spirit of a pioneering era and the innovative energy of that period that resonates across the years, inspiring legions of capable, curious, and emphatic young physicians to pursue careers as vascular specialists. If we have learned nothing else today, it is that when it comes to changing the world, there are plenty of seats at the table.
So join me in a toast to the pioneers, living and dead, who made today and all of our tomorrows possible. Long live the spirit of innovation.