Lower Extremity Bypass for Occlusive Disease: A Brief History.

BACKGROUND: This is a narrative review that aims to highlight key advancements that led to the current state of lower extremity bypass surgery. It focuses on key contributors during the last century who have driven the standardization of surgical treatment of peripheral arterial occlusive disease. METHODS: A narrative review was conducted utilizing available resources in the scientific and historical literature to track landmark achievements in the development of modern lower extremity bypass surgery for occlusive disease, focusing primarily on the last century of advancement. RESULTS: Several critical conceptual, technological, and technical landmarks were identified as critical components of modern lower extremity bypass surgery. This includes fundamental developments in the techniques of vascular anastomosis led by Carrel and others, a developing understanding of vascular occlusive disease as a localized and segmental process with broad implementation of the techniques of arteriography, and the development of safe thromboendarterectomy aided by the development and utilization of heparin for anticoagulation. These factors led to the first femoral-to-popliteal artery bypass by Jean Kunlin in 1948. From here, advances in vascular prosthetic material pioneered by Voorhees and others, alternative vascular conduits, increasing acceptance of tibial revascularization, and dispelling the myth of diabetic "small vessel" disease broadened revascularization options for patients with complex patterns of occlusive disease and those who have limited conduit availability. CONCLUSIONS: Modern lower extremity bypass surgery for occlusive disease arose steadily over a course of a century, driven by complex problem-solving in the pathophysiological understanding of atherosclerosis, technical developments in vascular anastomosis and arteriography, and evolution of conduit materials and pharmacologic therapy. Future advancements in bypass surgery are targeted at solving the complex problems of anastomotic intimal hyperplasia, expanding technology for alternative vascular conduits, ongoing optimization of risk factors, and scrutinizing of outcomes to make patient-centered, evidence-based decisions regarding revascularization strategy.

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.

Treatment of infected thoracic aortic prosthetic grafts with the in situ preservation strategy: a review of its history, surgical technique, and results.

For cardiothoracic surgeons prosthetic graft infection still represents a difficult diagnostic and treatment problem to manage. An aggressive surgical strategy involving removal and in situ replacement of all the prosthetic material combined with extensive removal of the surrounding mediastinal tissue remains technically challenging in any case. Mortality and morbidity rates following such a major and risky surgical procedure are high due to the nature of the aggressive surgical approach and multi-organ failure typically caused by sepsis. However, removal of the infected prosthetic graft in patients who had an operation to reconstruct the ascending aorta and/or the aortic arch is not always possible or necessary for selected patients according to current alternative treatment options. Rather than following the traditional surgical concept of aggressive graft replacement nowadays a more conservative surgical approach with in situ preservation and coverage of the prosthetic graft by vascular tissue flaps can result in a good outcome. In this article, we review the relevant literature on this specific topic, particularly in terms of graft-sparing surgery for infected ascending/arch prosthetic grafts with special emphasis on staged treatment and the use of omentum transposition.

[Professor Iosif Khaimovich Rabkin and his priorities in roentgenoendovascular surgery].

The article is dedicated to outstanding Soviet and Russian interventional radiologist, Professor I. Kh. Rabkin and his priorities in the development of roentgenoendovascular methods of diagnosis and treatment of arterial and venous diseases. Virtually simultaneously with American surgeons, I. Kh. Rabkin not only worked out anew method of intravascular stenting of arteries with spirals made of shape-memory metal ( nitinol) but was the first in the world who in 1984 successfully stented the external iliac artery in a 56-year-old male patient with stage IV limb ischaemia.

Historical overview of venous valve prostheses for the treatment of deep venous valve insufficiency.

Almost 3% of people in the Western world will suffer from a venous disease at some time in their lives, but as yet there are very few effective treatments for the venous system. When the valves become incompetent, they allow backflow and subsequent pooling of blood in the lower extremities. Current clinical therapies for the elimination of deep reflux are very invasive and provide short-lasting results. Thus, there is an urgent need for technological evolution of implantable valves and, if possible, with minimally invasive techniques. This review provides a basic history of the discovery of deep vein valves and various designs of prosthetic vein valves that have been evaluated in animal models and clinical studies.

Champ Lyons, Holt McDowell, and the evolution of vascular surgery at the University of Alabama at Birmingham: a personal perspective.

The history of medical centers, hospitals, clinics, and their evolution are important contributions and resources to medical history. Likewise, evolution of specialties within these healthcare centers frequently parallels their growth and development. This contribution depicts the evolution of a specialty, vascular surgery, within a major medical center, the University of Alabama at Birmingham. It recounts the major participants involved and their contributions and pioneering efforts, some of which have received little attention or were overshadowed by other events. Perspectives from participants--a patient and a trainee--provide insight into this process that has supported the growth and development of a major world-class medical center.

[Vascular prostheses: 50 years of advancement from synthetic towards tissue engineering and cell therapy]. / Cévní protézy: 50 let vývoje od syntetických k tkánovému inzenýrství a bunecné terapii.

Since more than 50 years, the gold standard in synthetic vascular prostheses has been represented by polyethylene terephtalate (PET, Dacron) and expanded polytetrafluoroethylene (ePTFE). These polymers perform well as sustitutes of large-caliber vessels, however, their long-term patencies are disappointing in small-caliber applications (< 6 mm). Thus, patient's own artery or vein remains the material of choice in coronary, crural or microvessel bypass surgery. Synthetic materials fail due to thrombosis and insufficient healing process that consists in highly incomplete endothelial cells coverage and intimal hyperplasia caused by compliance mismatch and hemodynamic imbalance. To find better small-caliber vascular graft, surgical techniques have been modified, novel biomaterials have been investigated and cell and tissue culture technologies have been adopted. Partly or fully tissue-engineered vascular grafts have been produced and experimentally and clinically evaluated with some promising result. The aim of this review is to briefly list currently used and examined vascular graft materials with special attention to cell/biomaterial ineractions, tissue engineering and authors' own experience.

The early days of vascular and heart valve prostheses: a historical review.

This surgical heritage article provides a historical overview of the most important early advances of vascular- and valvular surgery, that lead to the development of currently used vascular- and valvular prostheses and materials. The first writings describing techniques in vascular surgery mainly focussed on hemorrhage control and date from around 1600 B.C. The strategy of vessel ligation was first mentioned in Western literature around 200 B.C. In the 18th century, techniques of ligation were expanded towards attempts of vessel restoration. The first artificial vascular prosthesis was made in 1894. From this time on, vascular prostheses were used in animal experiments and around 1900 for the first time in humans. More than 60 years later, in 1952, the first mechanical heart valve prosthesis was implanted. Four years later, the first successful biological heart valve implantation followed. In 2000, a transcatheter heart valve was successfully implanted in a human for the first time. Over time, procedures and techniques became more efficient and effective. This led to new developments, such as the manufacturing of a tissue engineered blood vessel in 1986. Nowadays, dozens of different valve prostheses have been devised, both mechanical and biological. Still, no ideal model of vascular and heart valve prosthesis exists.

Blood vessel replacement: 50 years of development and tissue engineering paradigms in vascular surgery.

The gold standard material in bypass surgery of blood vessels remains the patient's own artery or vein. However, this material may be unavailable, or may suffer vein graft disease. Currently available vascular prostheses, namely polyethylene terephthalate (PET, Dacron) and expanded polytetrafluoroethylene (ePTFE), perform well as large-caliber replacements, but their long-term patency is discouraging in small-caliber applications (<6 mm), such as in coronary, crural or microvessel surgery. This failure is mainly a result of an unfavorable healing process with surface thrombogenicity, due to lack of endothelial cells and anastomotic intimal hyperplasia caused by hemodynamic disturbances. An ideal small-diameter vascular graft has become a major focus of research. Novel biomaterials have been manufactured, and tissue-biomaterial interactions have been optimized. Tissue engineering technology has proven that the concept of partially or totally living blood vessels is feasible. The purpose of this review is to outline the vascular graft materials that are currently being implanted, taking into account cell-biomaterial physiology, tissue engineering approaches and the collective achievements of the authors.

Forty years of vascular access.

March 9, 1960, was a milestone marker in end stage renal disease history - the date when a patient received the very first arteriovenous Scribner shunt. This began the era of maintenance or chronic hemodialysis. With long-term dialysis a reality, various new types of vascular access were developed. As the American Nephrology Nurses' Association celebrates its 40th anniversary, this article looks back to see just how far vascular access has come and what might be in store for the future.

In memoriam of Michael Ellis DeBakey. Alternative reconstructions of carotid bifurcation for atherosclerosis: the history and the latest advances.

The paper overviews the history of reconstructive surgery for atherosclerotic lesions of carotid bifurcation, as well as indications for various revascularization procedures for internal carotid artery, based on the experience of the Vascular Surgery Department, A. V. Vishnevsky Institute of Surgery, and in particular, on 205 interventions that were carried out in 2006.