Development Of Vascular Surgery Research Articles

The development of vascular surgery

The development of vascular surgery

Recent developments in vascular surgery: With particular reference to orthopedics

An intimate relationship between orthopedic and vascular surgery has existed throughout recorded medical history. Rapid developments in vascular surgery during the past decade have allowed application of numerous vascular technics to specific problems encountered in patients with musculoskeletal trauma. A thorough understanding of these vascular injuries and methods available for their surgical management should prove useful to the orthopedic surgeon as he is often the surgeon responsible for the care of patients with multiple-system injuries. Arterial injuries are frequently associated with fractures and dislocations. Numerous technics of arterial repair are available, and their applications are based on the location and type of injury. Aneurysms may occur in association with certain types of musculoskeletal trauma and successful surgical correction of these aneurysms is now well established. Rapid deceleration injuries are occurring with increasing frequency and are responsible not only for numerous orthopedic problems but also for a significant variety of cardiovascular lesions. A close working relationship between the orthopedic surgeon and the vascular surgeon is necessary for maximal salvage of life and restoration of functional continuity. An intimate relationship between orthopedic and vascular surgery has existed throughout recorded medical history. Rapid developments in vascular surgery during the past decade have allowed application of numerous vascular technics to specific problems encountered in patients with musculoskeletal trauma. A thorough understanding of these vascular injuries and methods available for their surgical management should prove useful to the orthopedic surgeon as he is often the surgeon responsible for the care of patients with multiple-system injuries. Arterial injuries are frequently associated with fractures and dislocations. Numerous technics of arterial repair are available, and their applications are based on the location and type of injury. Aneurysms may occur in association with certain types of musculoskeletal trauma and successful surgical correction of these aneurysms is now well established. Rapid deceleration injuries are occurring with increasing frequency and are responsible not only for numerous orthopedic problems but also for a significant variety of cardiovascular lesions. A close working relationship between the orthopedic surgeon and the vascular surgeon is necessary for maximal salvage of life and restoration of functional continuity.

A patient propulsion procedure for aorto-arteriography.

The development of vascular surgery has required that suitable radiographic procedures be available to illustrate the pathologic or congenital abnormalities present, as well as to give further information relating to altered hemodynamics. The proper planning of a surgical approach is partially dependent on knowledge gained in these areas by radiologic methods. Such procedures are of great use, also, in separating abnormalities not yet amenable to surgical correction. Many methods have been designed for peripheral arteriography and for abdominal aortography since Dos Santos (1) introduced this as a clinical procedure in 1929. Reviews and discussions of the methods have been numerous; briefly, the technics consist of single long-film exposures or serial long-film exposures, multiple combinations of 14 × 17-inch films, or scanography (2–6). In plans for new x-ray departments or revisions of existing areas, consideration is generally given to the purchase of apparatus for cardiac angiography, but infrequently to the acquisition of specific equipment for peripheral arteriography. This situation arose in our own institution. The procedure that we have selected and have developed consists essentially of moving the patient over a serialographic film changer, the rate of movement and the intervals of exposure being known. Earlier efforts in this direction have been made by Christmann (7) and Ellzey (8). The selection was not dictated solely because of possible superiority over other existing methods. The object was to determine whether or not the versatility of previously installed, expensive, specialized equipment (angiocardiographic) could be increased, as well as to reduce the costs that would be necessitated by employing still further “special equipment” such built by Eyler (2) or manufactured for this purpose. The interrelationship of this project with other developments utilizing the same basic equipment is described elsewhere (9). Many radiological departments now have serialographic film changers with a suitable width of coverage to expose both femoral areas simultaneously. These might be used, as will be illustrated, for aorto-arteriography in continuity. The additional expense is small. Equipment The general equipment is illustrated in Figure 1. Its major component is the horizontal plane of a biplane roll film changer; this is placed at the foot of a radiographic table. A Formica-covered plywood platform, measuring 8×2 feet, and 1 inch thick, is suspended over the changer with one end resting on the x-ray table and the other on a simple metal stand. An aperture, the size of the film exposure area, has been cut in this platform in the appropriate place. Two wooden guide-bars run the length of the table; they are separated by 20.5 inches.

Nonsuture Blood-Vessel Anastomosis

The techniques of vascular anastomosis and blood vessel grafting are undergoing constant revision and improvement. Developments in vascular surgery have been recently hastened by the widening scope of therapeutic applications. Almost no segment of the human aorta is immune from surgical attack at present, encompassing such various pathologic entities as coarctation, thrombosis, aneurysm, and arteriosclerosis. In many of these conditions after the diseased segment has been resected it is impossible to restore vascular continuity without the interposition of a graft. The present-day surgeon has his choice of fresh, frozen, and freeze-dried arterial homografts, or he may prefer one of the recently introduced plastic cloths for a grafting material. Grafts in the venous system are less frequently indicated than in the arterial, but they have found recent application in the performance of portacaval shunts and in treatment of the superior vena cava syndrome. Venous autografts are usually used for grafts in

ARTERIAL EMBOLISM AND EMBOLECTOMY

An embolus occluding one of the main arterial stems of the extremities is an uncommon occurrence. Bull¹demonstrated embolism of the extremities fifteen times in 6,140 postmortem examinations. Such an accident frequently results in gangrene of the affected limb, and amputation becomes necessary. With the development of vascular surgery, operative removal of obstructing emboli naturally was tried. The first attempt was made by Ssabanejew²in 1895 but was unsuccessful. Following him several other surgeons performed arteriotomy for the removal of emboli, but none of these succeeded in reestablishing the circulation. In 1911 Labey²of France performed the first successful embolectomy and in the following year Key³performed the second successful one. Mainly as a result of the work of Key, this operation has had great vogue and success in Sweden. Up to the latter part of 1928, Petitpierre⁴collected 118 reports of embolectomy from the