[Pioneers of invasive cardiovascular medicine--Charles Theodore Dotter and colleagues: short historical review].

Within modern medicine at the beginning of 21st century, we are witnessing a revolutionary development of the invasive diagnostics and therapy of cardiovascular system diseases. With the discovery of X-rays at the end of 19th century by Wilhelm Roentgen, it is appropriate to reflect on the gifted individuals whose efforts drastically altered radiology and cardiology. The early techniques used in peripheral percutaneous transluminal angioplasty form the basis for subsequent percutaneous intervention both in the peripheral and coronary arteries and are largely the contribution of Charles Dotter. The main goal of his work was the use of catheters for diagnosis and treatment in an attempt to replace the scalpel. He was 20 years ahead of his time, especially with percutaneous transluminal angioplasty. The first percutaneous transluminal angioplasty marked a new era in the treatment of peripheral atherosclerotic lesions. This practical genius dedicated his considerable energy to the belief that there is always a better way to treat disease. His personal contributions to clinical medicine, research, and teaching have saved millions of limbs and lives all over the world. European physicians, who were more open to unproven techniques, almost immediately embraced percutaneous transluminal angioplasty. Without the contribution and help of his colleagues, Forssmann, Sones and Gruntzig, all of them pioneers, nothing would be done.They were all ahead of there time and opened completely new chapter in medicine.

Evolution in the techniques and outcomes of aortic arch surgery: a 22 year single centre experience.

BACKGROUND: Aortic arch replacement is a complicated and high risk procedure. There have been many advances over recent years. We review the changes in our unit's techniques and outcomes over the past 22 years. METHODS: Data were collated from databases and medical records for all patients who underwent aortic arch replacement surgery from January 1989 to December 2010. The patients were divided into two groups - Group A (1989-2005) and Group B (2006-2010). Data were analysed to compare early and late series patients' outcomes. Logistic regression was used to identify variables that predicted mortality. RESULTS: Seventy-five eligible patients (56 males; mean age: 57.5 years; Group A: 40, Group B 35) were identified. There were great changes in the technique and the methods of cerebral protection. The overall mortality rate was 30.7% - Group A: 50% and Group B: 8.6% (p<0.001). Overall permanent neurological dysfunction was 23.7% - Group A: 40% and Group B: 11.8% (p=0.012). Cardiovascular disease and circulatory arrest time were significant predictors of mortality. CONCLUSIONS: Increased experience and volume and advances in techniques over 22 years have resulted in major improvements in outcomes for patients having aortic arch replacement, allowing the procedure to be performed with greatly improved outcomes.

Upper extremity access for renal artery stenting: radial, brachial and axillary access: how to do them safely and pitfalls to avoid.

This manuscript traces the history of changes in preferred upper extremity puncture sites for renal artery stenting as our understanding of anatomy, techniques, technology and pharmacology, each separately and their confluence, has improved. A very detailed description of each technique is beyond the scope of this review; the references should allow the reader to readily access this information.

[Variants of reconstruction of carotid bifurcation in patients with atherosclerosis: history and current state of the art].

A historical review of reconstructive surgery for atherosclerotic lesions of carotid bifurcation is presented along with indications for the use of various methods of vascularization of internal carotid artery based on the experience gained at the Department of Vascular Surgery, A.V. Vishnevsky Institute of Surgery.

Current indications for carotid angioplasty and stenting.

Carotid angioplasty and stenting has been established as a minimally invasive alternative to endarterectomy for patients with significant extracranial carotid occlusive disease. Its indications, however, continue to evolve, as more controlled data from large clinical trials are being accumulated. The purpose of this article is to review the current evidence supporting the application of carotid angioplasty and stenting in certain subsets of patients and the relative contraindications for its use.

The vascular therapist.

My association with John Uther began when I was appointed as his Cardiology Research Fellow at Royal Prince Alfred Hospital in 1976. In 1983 John (then the Head of the Cardiology Unit at Westmead Hospital) appointed me as a cardiologist. John Uther and David Cody did the first coronary angioplasty at Westmead Hospital in 1983. By the end of the 1980s all of the cardiologists were fully trained in angioplasty. The first coronary stent was deployed at Westmead Hospital in 1993. In the mid to late 1990s coronary artery stenting led to a higher rate of procedural success with reduction in early complications and late restenosis. By the late 1990s stenting became routine treatment for any coronary artery where a stent could be technically placed. Drug eluting stents were developed to further reduce the risk of restenosis and the first stent was deployed at Westmead in 2002. We started primary coronary angioplasty in 1998 for patients presenting directly to Westmead Hospital with acute myocardial infarction. From November 1999 this was expanded as we began transferring patients from peripheral hospitals within the Area Health Service. In 1996 we began performing non-coronary artery angioplasty starting with carotid artery stenting followed by renal artery stenting in 1999. From early 2005 we have developed a collaboration with the vascular surgeons and we now perform a wide variety of non-coronary procedures as a team. In summary, vascular intervention has come a long way since John Uther did the first coronary procedure at Westmead Hospital 24 years ago.

Endovascular treatment of thoracoabdominal aortic aneurysms.

Open surgical repair of thoracoabdominal aortic aneurysms (TAAA) bridges the aneurysm with a large, conventional, unstented graft and restores flow to the visceral arteries through short grafts or direct sutured connections between the visceral arterial orifices and the primary conduit. The combination of retrograde visceral bypass and endovascular aneurysm exclusion substitutes an endovascular stent-graft for a standard graft, stented overlaps for sutured anastomoses, and transluminal insertion for direct aortic exposure. Compared to open surgery, the combination treatment requires less dissection, and causes less hemodynamic instability, and lower complication rates, particularly paraplegia. The multi-branched stent-graft substitutes endovascular visceral bypass through branches of the stent-graft for surgical visceral bypass through branches of a conventional extraluminal graft, which has the potential to further reduce surgical dissection, hemodynamic instability, and complication rates. We favor a modular approach in which short, axially oriented cuffs are extended into the visceral arteries, using self-expanding covered stents. In the past year, we have used this approach to implant multi-branched thoracoabdominal stent-graft in 16 patients. In our opinion, this approach will eventually assume a prominent role in the management of TAAA.