As Nicholay Volodos, who developed a self-fixing synthetic endoprosthesis in the former Soviet Union in 1984, was unable to make CX 34, Krassi Ivancev, London, UK, spoke about the early history of endovascular repair on his behalf. Commenting on Volodos’ work, Ivancev said he was the “pioneer who started the endovascular stent graft revolution.” 

Roger Greenhalgh, London, UK and CX programme chairman, also praised the work of Volodos and asked people to stand if they thought it was worthwhile sending a message, via Ukranian delegates, to Volodos about how much everyone appreciated Volodos’ achievements – the entire audience stood up to celebrate his work. Volodos used the self-fixing synthetic endoprosthesis to perform his first transfemoral remote endosprothesis implantation in an iliac artery. This was in May 1985.

Two years later, he performed an endovascular repair for an aneurysm in the descending section of the thoracic aorta. “The world’s first EVAR was performed in 1987 by professor Nicholay Volodos in Kharkov, Soviet Union, and introduced in an article written in 1988,” Ivancev said at CX.

The first EVAR procedure reported in the literature took place on 7 September 1990, when Juan Parodi, Julio Palmaz and HD Barone at the Instituto Cardiovascular de Buenos Aires, Argentina, treated an abdominal aortic aneurysm patient. The aneurysm was excluded endoluminally with a Dacron graft that was anchored at the proximal infrarenal neck with a stainless steel balloon-expandable stent. Ivancev said, “Volodos realised the mechanical properties required of a stent graft. He designed, manufactured and implemented the first stent graft and his principles are still valid and exploited by us today.”

Volodos’ early experience was recorded in a paper titled “Experience with endovascular stent grafts for arterial disease from 1985 to present”, which was presented at the 21st Annual Symposium on Current Critical Problems – New Horizons and Techniques in Vascular Surgery in 1994. He wrote: “Trying to realise more effectively Charles Dotter’s attractive idea of implanting a prosthesis in not easily approached vessels through a superficially lying vessel, we developed a self-fixing synthetic endoprosthesis in 1984. This endoprosthesis received the national patent of the former USSR on 22 May 1984. At that initial stage we called the method a remote endoprosthesis.” “The design feature of the endoprosthesis was a fixing element in the form of a radial zigzag shaped cylindrical spring. The spring was made from stainless steel wire 0.4–0.5mm in the diameter. 

The height of the fixing element was about 18mm. As a rule, the number of rings was six or seven,” Volodos reported. The first animal studies with the endoprosthesis were conducted in dogs, with the transfemoral prosthesis implanted in the thoracic aorta. “The results of the study showed good function of the endoprosthesis six months after the operation,” Volodos said. 

Volodos and colleagues used these results as the basis to perform endoprosthesis implantation in patients. “The first operation of transfemoral remote endoprosthesis implantation in the iliac artery in the clinic was performed on 4 May 1985. 

It was done in combination with a simultaneous femorotibial bypass,” he wrote. In the first report, Volodos said that 19 patients had been treated for stenosis and occlusions of the iliac arteries. “Positive results were achieved in 17 patients immediately after operation and in 15 patients in the late period (from one to eight years).” “Transfemoral remote endoprosthesis implantation with the self-fixing synthetic endoprosthesis in case of the traumatic aneurysm of the descending section of the thoracic aorta was performed on 24 March 1987. It was performed in four patients, with positive results in all of them. At 7.5 years of follow-up, it has shown good function of the endoprosthesis.” After that, Volodos performed endoprosthesis implantation of the abdominal aorta in five patients – two of them received a bifurcated synthetic endoprosthesis. “The accumulated experience with the self-fixing synthetic endoprosthesis permits us to consider that remote endoprosthetics should have a place in the treatment of patients with lesions of the aorta and main arteries,” Volodos concluded in the paper.