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Placement of Vena Cava Filter

Historical Background Vena cava interruption for prevention of pulmonary embolism (PE) was introduced in the 1950s and 1960s. Femoral vein and inferior vena cava (IVC) ligation, as well as partial interruption of the IVC using plastic clips, plication, and mechanical staplers, were explored but because of lower extremity venous congestion, vena cava occlusion, incomplete protection from pulmonary emboli, and the need for direct surgical exposure of…

Upper and Lower Extremity Fasciotomy

Historical Background Fasciotomy is designed to prevent nerve injury and myonecrosis resulting from compartment syndrome characterized by elevated pressure within a fixed extremity compartment. Compartment syndrome is most often observed after reperfusion of an acutely ischemic extremity or among patients who present after severe limb trauma with associated soft-tissue and orthopedic injuries leading to elevated compartment pressures, compromised venous and arterial circulation, and direct barotrauma. In…

Amputations of the Forefoot

Historical Background In 1946 McKittrick described the use of the transmetatarsal amputation for the diabetic foot, along with specific indications including infection, ischemia, and neuropathic ulcerations of the toes and forefoot. He noted that forefoot amputation just proximal to the heads of the metatarsals, with primary closure, was practical only because of the introduction of penicillin for control of infection. The first transmetatarsal amputation was performed…

Above- and Below-Knee Amputation

Historical Background The first recorded instance of amputations and prosthetic replacement appears in the Rig-Veda, written in Sanskrit between 3500 and 1800 bc . The ancient Greek text, “On Joints,” written in the latter half of the fifth century bc , recommends amputation for gangrene below the “boundaries of blackening” as soon as it is “fairly dead and lost its sensibility.” In the first century, Celsus…

Endovascular Treatment of Popliteal Aneurysm

Historical Background Although open surgical treatment remains the gold standard for treatment of popliteal artery aneurysm, endovascular repair has become a viable alternative. In 1994 Marin and colleagues described the first endovascular approach to exclusion of a popliteal artery aneurysm, using an expanded polytetrafluoroethylene (ePTFE) graft supported by two Palmaz stents. Since that report, flexible, self-expanding endoprostheses, including the Wallgraft (Boston Scientific, Natick, Mass.) and the…

Endovascular Treatment of Tibial-Peroneal Arterial Occlusive Disease

Historical Background Initial series demonstrating the feasibility of infrapopliteal angioplasty were reported in the late 1980s and early 1990s concomitant with the development of increasingly small, strong, low-profile balloons; steerable hydrophilic guidewires; and improved road-mapping techniques. These reports, largely for the treatment of critical limb ischemia, described acceptable technical success rates and promising short-term patency and clinical outcomes. The technique of subintimal angioplasty, first reported in…

Endovascular Treatment of Femoral-Popliteal Arterial Occlusive Disease

Historical Background Dotter and Judkins first described percutaneous transluminal angioplasty (PTA) using a rigid catheter in 1964. By March 1977 approximately 1800 patients with femoral-popliteal arterial occlusions and stenoses had been treated using this technique, as reported in an international congress that included 12 European centers, to which Dotter contributed 322 cases. Grüntzig and Hopff introduced a high pressure balloon angioplasty catheter in 1974, and in…

Direct Surgical Repair of Popliteal Entrapment

Historical Background Popliteal artery entrapment is a congenital anomaly in which the popliteal artery passes medial to and beneath the medial head of the gastrocnemius muscle or a slip of that muscle, with consequent compression or functional occlusion of the artery. Popliteal artery entrapment was first noted in 1879 by Stuart, an Edinburgh medical student, who described an anatomic variant of the popliteal artery dissected from…

Direct Surgical Repair of Popliteal Artery Aneurysm

Historical Background In 1785 Hunter successfully ligated the popliteal artery of a coachman with a large popliteal aneurysm, relying on collateral circulation to maintain the viability of the limb. In 1916, while working at Johns Hopkins, Bertram Bernheim was the first to report the use of a saphenous vein interposition graft for treatment of a popliteal aneurysm. As a proponent of aneurysm ligation, Halsted did not…

Direct Surgical Repair of Tibial-Peroneal Arterial Occlusive Disease

Historical Background The feasibility of arterial reconstruction was first realized in the early 1900s through pioneering early studies performed by Carrell and Guthrie at the University of Chicago, as well as Bernheim at Johns Hopkins University. The availability of a safe heparin formulation, as developed by Best at the University of Toronto by the late 1940s, enabled arterial bypass grafting to be a practical intervention for…

Open Surgical Bypass of Femoral-Popliteal Arterial Occlusive Disease

Historical Background Vascular reconstruction of peripheral arterial disease (PAD) using venous autografts dates back to the early twentieth century. Carrel and Guthrie described the technique of vascular anastomosis after developing the model in canines. In 1906 they published their experience of early bypass grafting using “venous transplantation.” Carrel was subsequently awarded the Nobel Prize in Physiology and Medicine in 1912. While Bernheim reported the use of…

Endovascular Treatment of Hepatic, Gastroduodenal, Pancreaticoduodenal, and Splenic Artery Aneurysms

Historical Background Hepatic artery aneurysms are the second most common type of visceral aneurysms after those of the splenic artery. In 1809 Wilson first described a hepatic artery aneurysm as the “size and shape of a heart involving the left hepatic artery,” and in 1903 Kehr reported the first successful ligation of a hepatic artery aneurysm. Hepatic artery aneurysms comprise 20% of visceral artery aneurysms, and…

Direct Surgical Repair of Visceral Artery Aneurysms

Historical Background Visceral artery aneurysms are a rare but clinically important vascular condition and have been recognized for more than 200 years. As of 2002, there were about 3000 cases reported in the literature, and the incidence of visceral artery aneurysms in the general population has been estimated at 0.1% to 2%. The first successful surgical repair of a visceral aneurysm, the repair of a mycotic…

Endovascular Treatment of Occlusive Superior Mesenteric Artery Disease

Historical Background Traditionally, the preferred treatment to restore adequate blood flow to the visceral organs was open surgical bypass. This treatment resulted in significant morbidity and mortality rates, ranging from 12% to 33% and 2% to 15%, respectively. In 1980 Furrer and colleagues were the first to report a successful angioplasty of a superior mesenteric artery stenosis. The role of percutaneous mesenteric revascularization has since expanded…

Direct Surgical Repair for Celiac Axis and Superior Mesenteric Artery Occlusive Disease

Historical Background Embolectomy of the superior mesenteric artery for acute mesenteric ischemia was suggested by Ryvlin in 1943 and Klass in 1951, with the first successful embolectomy reported by Shaw and Rutledge in 1957. The feasibility of performing synchronous superior mesenteric artery embolectomy and small bowel resection was described a year later. The manifestation of occlusive disease of the superior mesenteric artery and celiac axis as…

Endovascular Treatment of Renal Artery Aneurysms

Historical Background Although renal artery aneurysms located in a distal branch can be sacrificed with little consequence to renal function, centrally located aneurysms posed an initial challenge for the development of successful endovascular treatment options. In 1995 Bui and colleagues described the treatment of a renal artery aneurysm with a stent graft. Although a useful strategy in carefully selected patients, covered stents could not be used…

Endovascular Treatment of Renal Artery Stenosis

Historical Background In 1978 Grüntzig and colleagues were the first to describe angioplasty for the treatment of atherosclerotic renal artery disease, and in 1991 early experience with balloon-expandable and self-expanding stents for treatment of renal artery stenosis was reported. Stent placement was subsequently demonstrated to be superior to primary angioplasty and has lead to a marked increase in the number of patients treated for renal artery…

Extraanatomic Repair for Renovascular Disease

Historical Background Extraanatomic revascularization of the renal arteries using the splenic or hepatic branches of the celiac trunk for inflow generally yields inferior results when compared with traditional aortorenal bypass. These procedures are usually reserved for patients in whom exposure of the aorta is considered difficult or dangerous. Splenorenal revascularization was initially described by Thompson and Smithwick in 1952 as a splenic artery transposition in a…

Direct Surgical Repair of Renovascular Disease

Historical Background In 1937 Goldblatt demonstrated that renal artery constriction produced atrophy of the kidney and systemic hypertension in a canine model. His elegant experiments defined a causal relationship between renovascular disease and hypertension. Leadbetter and Burkland are credited with the first successful treatment of renovascular hypertension. A 5-year-old child was cured of severe hypertension after removal of an ischemic kidney. After Leadbetter and Burkland’s 1938…

Surgical Treatment of Pseudoaneurysm of the Femoral Artery

Historical Background The development of prosthetic grafts has extended the vascular surgeon’s ability to replace or bypass diseased arterial segments. However, the risk of infection, although small, constantly looms over a patient with an indwelling prosthetic graft, and preventive measures remain the most effective means of infection control. When infection occurs, subsequent degeneration of the anastomosis with arterial bleeding is potentially both limb and life threatening.…