The EVAR Dilemma
EVAR changed the paradigm of aortic repair — but not its nature. What if the most elegant procedure in vascular surgery still lives inside its own paradox: a seal built on a moving wall, a success that must be watched forever?
Why the most elegant procedure in modern vascular surgery still lives inside its own paradox.
There is no doubt that endovascular therapy has changed the history of vascular disease.
In both peripheral and coronary experience it has proved its potential where vessels were occluded.
In that setting the technique offered all its logic: reopen & restore.
It is the triumph of efficacy applied to obstruction.
But when that same logic was extended to the dilatative disease something changed.
The problem is not the technique itself, but its philosophical foundation.
Here, we are not reopening a lumen: we are trying to exclude a fragile wall from the circulation, asking the same wall to firmly hold a device for the rest of the patient’s life.
And this is where the paradox begins.
