Evolution Of Peripheral Arterial Aneurysm Surgery: From Fatal Bleeding To Endovascular Interventions
A Darbari, S Tandon, A Kumar, M Bharadwaj, P Chauhan
aneurysm, history, vascular surgery
A Darbari, S Tandon, A Kumar, M Bharadwaj, P Chauhan. Evolution Of Peripheral Arterial Aneurysm Surgery: From Fatal Bleeding To Endovascular Interventions. The Internet Journal of Surgery. 2006 Volume 11 Number 1.
Arterial aneurysms have been recognized since ancient times and the term aneurysm is derived from the Greek word, meaning “a widening”. Surgery of aneurysm is peculiar because compressive force of an expanding aneurysm may cause adhesions and indurations to the surroundings, so that extensive dissection can pose a danger to adjacent structures. So complete dissection can be abandoned and in many cases, partial resection is sufficient and reconstruction may be performed by "inlay" techniques or bypass procedures. We are presenting an overview of the history of peripheral aneurysm surgery.
Our understanding of any disease advances as we gain new insights through continued experimental and clinical observations, which comes from past history and its developments. These new insights may enhance original conclusions and permit the emergence of new and noble principles of treatment. By current reporting standard, an aneurysm is defined as a permanent localized dilatation of an artery having at least a 50% increase in diameter compared with the expected normal diameter. Currently, surgical or endovascular intervention is the only accepted definitive therapy.
An aneurysm is the dilatation of an artery full of spiritous blood. –
Considerable attention has been given throughout ancient and modern history to the cause and treatment of aneurysms. One of the earliest texts known, by the
The first elective operation for treatment of an aneurysm was reported by the most famous surgeon in Greek antiquity,
In the seventh century, details of operative repair of an arterial aneurysm were rewritten by
Nearly after a century,
In medieval times, brachial artery aneurysms were frequent iatrogenic complications of blood letting during attempted puncture of the median cubital vein, a practice that was popular for more than 2000 years. In fact, the first successful direct arterial repair, by
Hunter had observed that the blood supply to the horns of deer changed under different conditions. A rich blood supply was present when the crest was full, but the blood vessels decreased in number and size when the horns shed. Hunter inferred that reserve vessels, now termed “collaterals”, might develop in humans if obstruction occurred in their arteries. In December 1785, a beer delivery man was admitted to St. George's Hospital with a pulsatile mass in the popliteal fossa, possibly secondary to repetitive trauma against the coachman's seat while driving on rough streets. The patient had been symptomatic for 3 years, he complained of leg pain on walking and rested frequently presumably owing to arterial occlusion distal to the aneurysm. Standard treatment at that time entailed above-knee amputation. Hunter's previous experiments, however, suggested that collateral vessels have formed around the obstruction or the leg would have developed gangrene. Thus, he incised above the knee at a location now known as “Hunter's canal” and tied four ligatures around the artery. Four sutures were used to avoid sawing through the vessel. After a bout of local infection, the patient survived and was discharged fully ambulatory. Later, Hunter performed four similar operations and three were successful; the fourth patient died 26 days postoperatively [5,6,7,8].
A better method of treatment of peripheral aneurysm had been developed in 1888 by the
Modern techniques of aneurysm repair were made possible by
In 1890, Alexis Carrel was admitted to the Medical School of Lyon, where he developed interest in blood vessel repair and did intensive research on vascular surgery. This interest was precipitated by an unsuccessful portal vein injury repair of the French president M. F. S. Carnot in 1894. With
On June 12, 1906,
The first clinical transplantation of a homologus artery from one human to another was performed by
The introduction of anticoagulants, especially heparin (discovered in 1916 by
A technique of wrapping abdominal and peripheral aneurysms in cellophane was introduced by
The Present & Future
One of the major developments in vascular surgery over the past years has been the introduction of endovascular repair of aneurysms. In 1967,
Direct compression therapy as reported by
The history of vascular surgery is very extensive. Many other advances in asepsis, anaesthesiology, blood transfusion, coagulation, angiography, radiology, improved instrumentation and simplification of flow and pressure measurements helped to achieve the current status. Regardless of aetiology and site, the principle for aneurysm repair is still the same. The life threatening lesions should be addressed first, followed by the limb threatening lesions. The aneurysm must be excluded from the circulation and arterial circulation restored.
Dr Anshuman Darbari THORACIC & CARDIO-VASCULAR SURGERY DEPARTMENT K. G. M. University, Lucknow-226003 Uttar Pradesh, INDIA Phone number – 091-0522-3241778 Fax no. – 091-0522-2255394 E mail – firstname.lastname@example.org