You can call VBA function from vsto and pass parameters. But keep in mind that this call is also a subject to interop. So it would not make sense to create wrappers for Visio functions. Anyways, I think it worth trying first in pure VBA, maybe you don't need VSTO.
You can also expose your .net object for VBA, VSTO supports this as well, performance is the same.
The security is controlled by user's admins. They can disable or enable your extension regardless of the signature actually (although with signature it is easier of course). Simply signing you stencil with EV certificate will not guarantee the absence of security warnings,.
EV is only relevant now if you want to sign device drivers, as far as I know. You get certificate on USB token (means that you need it to physically present every time you sign), and it's more expensive. Even the "green browser bar" and "instant reputation" are now gone, as far as I know.