5 Questions with Juan Carlos Parodi, MD
A true pioneer, Dr. Parodi surmounted adversity to develop revolutionary aneurysm endograft technology.
How did you come to invent the endograft? The idea for an endograft came to me while I was a vascular surgery resident at the Cleveland Clinic in 1975. I had learned that even the best care, in terms of technical skills, good clinical judgment, and careful postoperative control, did not always result in a favorable outcome. I remember saying to Edwin Bevin, “I foresee a day in which a patient harboring an aneurysm enters a room, and after 10 minutes, walks out with a bandage on his or her groin and the aneurysm excluded from the circulation.” In my attempts to design a less-aggressive treatment, I determined that a vascular graft could be implanted in a retrograde or antegrade fashiothrough the wide arterial lumens of AAA patients.
What were some of the initial difficulties you encountered in its development? Many people considered the endograft an unrealistic fantasy and therefore disregarded it. To implement innovations in Argentina, you must rely solely on your own resources. Support from the government or private institutions is virtually nonexistent. The lack of recognition from my Argentinean colleagues, who denied me access to academic positions despite my collaborative attempts and willingness to share with them everything I knew, was probably the biggest disappointment of my career. My friends from the US and Europe were the people who opened the doors of their societies and universities to my innovations.
How will endograft technology progress in the future? Despite the lack of long-term results, the lay public’s acceptance of endografting due to its minimally invasive nature and rapid recovery times, has been very encouraging. Systems are improving to correct many of the initial pitfalls. The use of growth factors, the combination of endovascular and laparoscopic or thoracoscopic approaches, and the development of endosutures, are some of the new concepts being incorporated into the field. Fatigue-free material and systems that are adaptable to changing geometries are in development, and models with high versatility that can cover all or most of the anatomical variations will expand the use of endografts. Nonmetallic components will soon appear, making the devices less costly and more reliable, and endografts with side branches will be applied in the aortic arch and in thoracoabdominal aneurysms.
Tell us more about practicing in Argentina. Being a doctor in Argentina is not an easy task. Fewer resources from the government and a lack of support from the universities and state-owned institutions forced us to develop our own clinic and hospital. Because the cost of living is lower than that of the US, reimbursements in Argentina are less than one-third of those in the US for any given procedure. Also, most of the materials utilized are imported, increasing the cost of each procedure.
What would you like to accomplish over the next 5 years? First, I must finish what I started and provide patients with a reliable endoluminal treatment for aneurysms, dissections, trauma, and occlusive disease using endografts. Second, I aim to design a new treatment for selected stroke cases using the reversal-of-flow system that I designed as a protection device for carotid stenting. Finally, I am planning to utilize the same principle for failing aorto-coronary vein bypasses and acute myocardial infarctions. Apart from my medical endeavors, however, the most demanding and challenging desire I have is to become a good golfer.