The first resection of an aortic aneurysm.

In 1951 the report from Paris that an abdominal aortic aneurysm had been successfully resected greatly influenced surgeons throughout the world who, until then, had regarded such an operation as being outside the bounds of surgery. Indeed, as a young surgeon I could hardly believe such a procedure would be possible, having seen an unsuccessful attempt at producing thrombosis of the aneurysm by introducing coils of wire into the sac, (Colt's operation) and, in other cases, merely standing by helplessly as the patient exsanguinated from rupture of the aneurysm.

Early endovascular grafts at Montefiore Hospital and their effect on vascular surgery.

Vascular surgery is very fortunate. It recognized the transition from open surgery to endovascular procedures as treatments for vascular disease early enough to adapt as a specialty. As a result, most vascular surgeons in North America became competent with endovascular techniques, and the survival of the specialty was assured. The endovascular graft program at Montefiore Hospital played a major role in vascular surgery's early recognition of the importance of the endovascular revolution. This article will review the history of this early endovascular graft program and how it influenced the specialty.

Moving into the paravisceral aorta using fenestrated and branched endografts.

When one compares the potential advantages of endovascular aortic repair with respect to traditional open repair, it would seem logical that extension into the paravisceral aorta would be easily justified, given the complexity of open aortic repair and its associated complications. Eight years have transpired between trial initiation and Food and Drug Administration approval of the first fenestrated device in the United States for the treatment of juxtarenal aneurysms. While there are only a few centers in the United States with substantial experience performing fenestrated and branched endovascular aortic repair, there is a diverse experience outside the United States that has been gained over the past decade. It is through the experience of these centers that the technical and procedural complexities of complex endovascular aortic repair has been solved and provide the foundation that has allowed aortic specialists to move endovascular therapy into the paravisceral aorta with fenestrated and branched endovascular aortic repairs.

The retroperitoneal approach to the abdominal aorta in the endovascular era.

The aim of this review was to assess the place of retroperitoneal (RP) aortic surgery for abdominal aortic aneurysms (AAAs) in the endovascular era and evaluate the evidence supporting it in preference to the more traditional transperitoneal approach. As endovascular graft technology improves, open aortic surgery is declining. AAAs unsuitable for endovascular aneurysm repair are, by definition, anatomically challenging. The RP approach is especially suited to anatomic challenges such as those posed by contemporary open AAA because it facilitates access to the suprarenal aorta. There is evidence that the RP approach reduces postoperative morbidity and length of stay compared with transperitoneal approaches. The evidence available indicates that the RP approach should be the first considered for any AAA unsuitable for endovascular aneurysm repair; however, the technique is more difficult to learn and less commonly practiced than the transperitoneal approach. Combined with a decrease in training hours in the United Kingdom, there is a real threat that the RP technique will only be performed by an ever-decreasing number of enthusiasts.

Open versus endovascular stent graft repair for abdominal aortic aneurysms: an historical view.

Development of endovascular abdominal aortic aneurysms repair (EVAR), now in its 4th decade, has involved at least 16 different devices, not counting major modifications of some, only 4 of which have emerged from clinical trials and gained US Food and Drug Administration approval. The main impetus behind EVAR has been its potential for significantly reducing procedural mortality and morbidity, but it was also expected to speed recovery and reduce costs through decreased use of hospital resources. At the outset, EVAR was touted as a better alternative to OPEN in high-risk patients with large abdominal aortic aneurysms, and to "watchful waiting" (periodic ultrasound surveillance) for those with small abdominal aortic aneurysms. This new technology has evoked a mixed response with enthusiasts and detractors debating its pros and cons. Bias and conflict of interest exist on both sides. This review will attempt to present a balanced review of the development and current status of this controversial competition between EVAR and OPEN, comparing them in terms of the following key considerations: mortality and morbidity, complications, failure modes and durability, and costs.

The early days of surgery for abdominal aortic aneurysm.

Aneurysms of the abdominal aorta, usually due to arteriosclerosis, have been long recognised as presenting a formidable challenge to the surgeon. At first symptomless, the aneurysm then presents as a pulsatile swelling. Once it reaches about 6 cm in diameter, it is at risk of rupture, and this danger increases as the mass gets larger. Untreated, of course, rupture means death from massive haemorrhage.

1992: Parodi, Montefiore, and the first abdominal aortic aneurysm stent graft in the United States.

In 1990 Juan C. Parodi performed the first endovascular abdominal aortic aneurysm (AAA) repair in Buenos Aires. Two years later, in 1992, Parodi and Claudio Schonholz visited Montefiore Medical Center in New York to perform with us the first endovascular AAA repair to be done in the United States. Since then the Montefiore/Einstein vascular group has performed 1522 endovascular grafts in 674 patients for many types of vascular lesions using a variety of both surgeon-made and industry-made devices. The purpose of the present article is to describe the events that surrounded the performance of the first seminal endovascular AAA repair at our institution on November 23, 1992.

Reflections on the 50th anniversary of the first abdominal aortic aneurysm resection.

Fifty years ago, on March 29, 1951, Charles Dubost in France performed the first successful resection of an abdominal aortic aneurysm and replaced it with a cadaver homograft, thereby initiating the modern era of surgical correction of a common entity. This article offers a summary of the events leading to that milestone in vascular surgery.

[Aneurysms from the viewpoint of medical history]. / Das Aneurysma aus medizinhistorischer Sicht.

The history of arterial aneurysms dates back to the old Egypts, Byzantines and Greeks. Vesal 1557 and Harvey 1628 introduced the disease into modern medicine. They diagnosed a pulsating tumor intra vitam and confirmed the aneurysm at autopsy. Further corner stones during the 18th and beginning of the 19th century were the monographs of Lancisi and Scarpa, the latter beautifully illustrated. The first effectful therapy was external compression, the second ligature of the artery proximal to the aneurysm, which was pioneered by John Hunter in 1785. Endoaneurysmoraphy (Matas) and wrapping by cellophane were performed, before diagnostic ultrasound and bypass surgery became routine procedures and improved dramatically the survival of the patients. The diagnostic and therapeutic problems in the middle of the 20th century are illustrated by the fate of two prominent patients, Albert Einstein and Thomas Mann, who died both of a ruptured aneurysm in 1955.