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Surgical Treatment of the Subclavian and Axillary Artery

Historical Background Although arterial compression represents the least common type of thoracic outlet syndrome, developmental anomalies of the thoracic outlet were probably first recognized in patients with arterial complications. As early as the second century Galen and Vesalius described arterial compression because of a cervical rib. Mayo is credited with the first description of subclavian artery abnormality associated with bony compression in the thoracic outlet. In…

Endovascular Treatment of Aortic Arch Vessels—Innominate, Carotid, and Subclavian Arteries

Historical Background Shimizu and Sano first described surgical repair of an atherosclerotic aortic arch branch vessel lesion in 1951. Initially, open surgical repair was performed via a transthoracic approach, but this was replaced by the more popular extraanatomic bypass after Crawford and associates’ report demonstrating a mortality rate of only 5.6% for extraanatomic repair compared with 22% for those patients treated using a transthoracic approach. Their…

Extraanatomic Repair of Aortic Arch Vessels

Historical Background Savory was the first to describe a patient with signs and symptoms suggesting occlusive disease involving the aortic arch vessels. Nearly 20 years later, in 1875, Broadbent chronicled a patient who while living had no radial pulses and at postmortem examination was found to have brachiocephalic and left subclavian artery occlusion. In 1908 Takayasu reported a patient with an ischemic retinopathy on ophthalmologic examination…

Direct Surgical Repair of Aortic Arch Vessels

Historical Background Surgical approaches to the aortic arch vessels had been described in the late nineteenth and early twentieth centuries. In 1958 DeBakey and associates described the first successful surgical reconstruction of an occluded symptomatic innominate artery using an nylon bifurcated graft from the ascending aortic arch to the left subclavian and common carotid arteries. This report was followed by a comprehensive 10-year review of the…

Surgical Treatment of the Vertebral Artery

Historical Background Reconstruction of the subclavian arteries via thromboendarterectomy was first described by Cate and Scott in 1957 and a year later, Crawford, DeBakey, and Fields described the technique of transsubclavian endarterectomy of the vertebral artery. In 1964 Parrott introduced the technique of transposition of the second portion of the subclavian artery to the common carotid artery. Transposition of the proximal vertebral artery to the common…

Carotid Body Tumor

Historical Background Reigner performed the first carotid body tumor (CBT) resection in 1880, though the patient did not survive. In 1889 Albert became the first to excise a CBT without cranial nerve or carotid artery injury, and Scudder was the first to do so in the United States in 1903. Though the days when “many of the contributions to the literature…are based upon a solitary case”…

Carotid Angioplasty and Stenting

Historical Background Balloon angioplasty of the carotid artery was first described in the late 1970s as an intervention for carotid artery stenosis. It was proposed as an alternative to carotid endarterectomy (CEA) in medically high-risk patients and those with hostile neck anatomy. Early trials demonstrated the feasibility of the technique but were not widely accepted because of small study size, high complication rates, and only occasional…

Eversion Endarterectomy and Special Problems in Carotid Surgery

Historical Background Conventional carotid endarterectomy (CEA) is an excellent and time-tested technique; however, eversion CEA is quicker to perform, avoids insertion of prosthetic material, and is associated with postoperative morbidity and restenosis rates that are comparable with those for conventional CEA. Because it is faster to perform, it is ideal for carotid surgery under regional anesthesia. Eversion CEA was first performed by Kieny and associates in…

Carotid Endarterectomy

Historical Background Although Carrea, Molins, and Murphy performed a successful carotid resection in 1951 and DeBakey completed a successful carotid endarterectomy (CEA) in 1953, the potential benefit of surgical treatment for symptomatic carotid occlusive disease was first highlighted by Eastcott, Pickering, and Rob in 1954. Use of a carotid shunt was then described by Al-Naaman, Carton, and Cooley in 1956. Two large multicenter randomized trials, the…

General Principles of Endovascular Therapy: Angioplasty, Stenting, Recanalization, and Embolization

Historical Background Angioplasty was first used by Dotter and Judkins in 1964 for the treatment of peripheral vascular lesions using rigid intravascular dilators. Although relatively unnoticed in the United States, this approach was used to treat large numbers of patients in Europe. Grüntzig substituted a balloon-tipped catheter for the rigid dilator and performed the first peripheral balloon angioplasty in 1974. Dotter also described the use of…

General Principles of Endovascular Therapy: Guidewire and Catheter Manipulation

Historical Background The age of endovascular therapy began with Dr. Sven Seldinger’s publication in 1953 of his technique for vascular access over a wire. The field expanded rapidly with subsequent seminal publications, including those by Dr. Charles Dotter, an American radiologist, in 1964 that demonstrated a technique to cross an atherosclerotic lesion. Indeed, Dotter was the first to describe flow-directed balloon catheterization, the double-lumen balloon catheter,…

General Principles of Endovascular Therapy: Access Site Management

Historical Background Throughout the 1940s and early 1950s, angiographic procedures required surgical exposure with placement of a blunt metal trocar and were often cumbersome and dangerous. A percutaneous approach was first described by Jönsson in 1949 with passage of a blunt trocar into the thoracic aorta via the common carotid artery. Seldinger’s report in 1953 was the first description of a soft, polyethylene catheter rather than…

General Principles of Sedation, Angiography, and Intravascular Ultrasound

Historical Background In 1927 Moniz at the University of Lisbon was the first to demonstrate the clinical utility of angiography by performing the first cerebral angiogram using sodium iodide. In 1929 dos Santos performed the first aortogram. Swick in 1928 reported the initial experience with water-soluble iodinated organic compounds as intravenous contrast agents for urography. By 1956 a less toxic, triiodinated, fully substituted benzene derivative, diatrizoic…

General Principles of Vascular Surgery

As most vascular surgeons will attest, among the many attractions to our discipline are the vast array of instruments and procedures available to address some of the most severe medical problems known to mankind and the opportunity to apply our surgical skills to virtually every portion of the human body. Because of the many presentations of vascular disease, the vascular surgeon must have extensive knowledge, sound…

Robotic adrenalectomy – transabdominal approach

Indications Minimally invasive adrenalectomy is the gold standard of care for functional and nonfunctional adrenal masses. Laparoscopic adrenalectomy has been popularized over the last three decades and has been demonstrated to be a safe and effective method of adrenalectomy. Laparoscopic adrenalectomy has been shown to be superior to open adrenalectomy with respect to postoperative pain, blood loss, length of stay, return to activity, and transfusion requirements.…

Robotic pylorus-preserving pancreaticoduodenectomy and cholecystectomy

Introduction The application of minimally invasive techniques in hepatopancreaticobiliary (HPB) surgery has lagged behind other surgical specialties, such as bariatric and colorectal surgery. This is a testament to the unique and complex nature of HPB operations, particularly pancreaticoduodenectomies. The application of laparoscopic techniques has demonstrated limited efficacy due to the inherent difficulty to perform fine motor tasks, such as reconstruction of a pancreaticojejunostomy. The meticulous surgical…

Robotic whipple procedure

Introduction The first minimally invasive pancreaticoduodenectomy (PD) was reported in 1994, followed by the first published description of a robot-assisted PD in 2003. , The robot-assisted approach to PD offers surgeons many advantages compared with standard laparoscopy, and its use has led to increased rates of minimally invasive PD. Multi-institutional studies have since confirmed the safety and efficacy of robot-assisted PD. Robot-assisted PD has been consistently…

Robotic distal pancreatectomy

Indications The indications for robotic distal pancreatectomy are similar to those for traditional laparoscopic approaches, ranging from cystic neoplasms to malignant diseases of the distal pancreas. However, robotics appears to have several important advantages over laparoscopy, which has been shown to provide short- and long-term oncologic outcomes comparable to open distal pancreatectomy, with a shorter hospital stay and less intraoperative blood loss. , Although the long-term…

Robotic hepatectomy

Introduction The evolution of minimally invasive techniques, starting from laparoscopy to the more recent robotic platform, have allowed for greater consistency in the applicability of advanced surgical techniques. The widespread adoption of robotic surgery has stimulated expansion of the robotic platform into complex hepatobiliary procedures. The goal of any new technique is to improve outcomes, and robotic hepatectomies have shown promise in that regard. In 2018,…

Robotic splenectomy

Introduction Minimally invasive splenectomy is now established as the standard of care in general surgery for almost all conditions requiring an elective splenectomy. It was first reported in 1991 by Delaitre and Maignien, who performed a laparoscopic splenectomy. Subsequent literature has shown that minimally invasive splenectomy improves patient morbidity, reduces length of stay in hospital, reduces perioperative pain, and provides enhanced cosmesis. , With the advent…