Physicians, engineers and firms work hard to find new and better solutions for patient's care. In this field, inventiveness is almost unlimited. However new devices, drugs or managements need a proper evaluation to assess the real benefit for the patient and the cost for the Health Care Provider and Public and Private insurance companies. The most striking example is the evolution of carotid angioplasty and stenting. Enthusiastic pioneers have embarked in the direction toward what appeared to be a less invasive thus safer treatment. Unfortunately several randomized controlled trials failed to prove a large scale benefit. Rapid changes also occur with rupture aneurysm, thoraco-abdominal aneurysms, dissection, aortic arch repair, renal stenosis, leg arteries treatment and veins diseases management.