Vascular surgery in Sweden

Abstract

Vascular surgery in Sweden is still a part of general surgery an important part as we vascular surgeons tend to claim. Right now there are no plans or indications from the health care authorities to create another speciality. None the less there are surgeons with full time dedication to vascular surgery and the Swedish Society for Vascular Surgery (SSVS, established in 1991 as a development of the more informal Swedish Vascular Club, which held its first meeting in 1979) has 175 paying members, out of some 1000 general surgeons in Sweden (8.7 million inhabitants). Many of these are also performing other types of general surgery and in the European Society for Vascular Surgery there are 85 Swedish members. Swedish vascular surgeons have taken an active part in the European Society. Sven-Erik Bergentz from Malm6 was the chairman during the inauguration meeting in London in 1987, and the author of this article is the second and present editor of the European Journal of Vascular and Endovascular Surgery. At the present time there are two professors of vascular surgery in the countr~ one in Uppsala and one in Malm6, both established in 1993. As already stated there is no formal specialist training in vascular surgery but within the SSVS there is a group dealing with educational problems with the aim of establishing requirements to create a vascular surgery profile within general surgery. In the Swedish Society there are two more subgroups a vascular graft reference group dealing with new grafts coming into the market and one working with scientific problems meeting programmes and design of studies. Before looking at the situation for vascular surgery in Sweden toda~ I will focus on some historical snapshots in vascular surgery but also in neighbouring fields, which have had impact on the development of vascular surgery. Examples of early Swedish surgeons with an interest in vascular problems were Fritz Bauer and Einar Key. Bauer 1 successfully operated on a patient with an acute aortic occlusion and Key 2-4 was one of the first to publish a large series of arterial embolectomies an operation which was sometimes referred to as the Key operation. Clarence Crawford was one of the world pioneers in thoracic and cardiovascular surgery and an important piece of knowledge, also for peripheral vascular surger~ was his report on surgical treatment for aortic coarctation in 1945. Early vascular surgery was performed by thoracic surgeons. One of the pioneers in Swedish vascular surgery was actually an orthopaedic surgeon by the name of Tor Hierton, who prophetically regarded vascular surgery as a method to prevent amputation. Moreover, he described cystic degeneration of the popliteal artery as a cause of claudication in young male patients who could successfully be treated with vein bypass grafting. 5 This interest also led him into experimental research on arterial homografts, the topic for his PhD thesis in 1952. 6 One major innovation of great influence for vascular surgery, although not by a vascular surgeon, was the introduction of the catheter techni7que for angiography in 1953 by SvenIvar Seldinger. This short publication is one of the classics within medical literature and today angiography ad modum Seldinger is often referred to without knowledge of the original publication. Seldinger soon left an academic career to become head of the X-ray department in a district hospital (Mora in Dalecarlia). Another development of importance for vascular surgery has been the possibility to prevent thrombotic occlusion. Suffice to mention Erik Jorpes and his