Medical and Interventional Vascular Contributions to the Development of Vascular Surgery in Europe and Worldwide

Christian Doppler was a mathematician born in Salzburg, Austria. In 1842 he wrote a paper entitled "Concerning the colored light of double stars", the substance of which is now known as the Doppler effect. He hypothesized that the pitch of a sound would change if the source of the sound was moving. This hypothesis was tested in 1845. The Japanese Shige and Satomiga applied the Doppler effect to the diagnostic investigation of the cardiovascular system using ultrasound techniques. The resulting valuable tools for the study of the cardiovascular system include Doppler ultrasonography, which uses audio and graphic measurements to hear and measure blood flow, and duplex ultrasonography, with or without colour imaging.

In the early 1950s, Swedish physicians, following the work of the Swede Gunnar Bauer in 1940, developed both ascending and descending phlebography and they also started the use of heparin for the treatment of venous thrombosis [4].

Sven Ivar Seldinger, a radiologist at the Karolinska Hospital in Stockholm, applied in 1952 a technique for peripheral arteriography; the procedure is now coined with his name [56] and is used at present for all endovas-cular procedures. In the 1960s the Swedes Carl Arnodi, Knut Haeger, Goran Nylander and others contributed to the study of venous disorders of the lower extremities (G. Hagmueller, communication by correspondence 2004).

James S. T. Yao, working as research fellow at the vascular laboratory W.T. Irving at St. Mary's Hospital in London in 1968, did pioneering work in the study of peripheral arterial circulation by using strain gauge plethysmography and ultrasound Doppler and developed the an-kle/brachial blood pressure index (ABI), which has been and still is used extensively [62]. In the 1960s I. Boerema, father of modern hyperbaric medicine, applied hyper-baric oxygen therapy in cases of critical limb ischaemia and gangrene and in anaerobic infections of the extremities, and he also performed minor procedures in the hy-perbaric facility in the University Hospital in Amsterdam [7] (Fig. 1.1.10). However, the largest and very impressive hyperbaric medical facility in Europe, and probably the world, was established in AURCS in Moscow in 1975, where Victor Krylov performed carotid endarterectomy and B. A. Konstantinov and others performed cardiac operations in 1998. In 1998 I visited this centre, which was under the direction of a senior professor specializing in hyperbaric medicine and included many sections such as surgical, obstetrics, gynaecology and others [2] (Fig. 1.1.11).

In the early 1970s in London V. V. Kakkar made a breakthrough in the prevention of venous thrombo-embolism by introducing the subcutaneous injection of a low dose of heparin for the prophylaxis of deep vein thrombosis (DVT) [34].

Fig. 1.1.10 Hyperbaric Chamber, University Hospital of Amsterdam

A. Nikolaides contributed through original works to the study of venous diseases [6].

S. I. Seldinger, a radiologist at the Karolinska hospital in Stockholm, applied in 1952 a technique for periph eral arteriography; the procedure is now coined with his name [58].

In 1971 E. Zeitler, a German radiologist, started popularizing in Europe the American Charles Dotter's technique of transcutaneous arterial disoblitaration. Andreas Gruntzig of the Angiological Clinic of Alfred Bollinger in Zurich, Switzerland, after his work with Zeitler, developed in 1974 the monumental method of arterial dilatation by using a balloon catheter for dilatation of the peripheral and coronary arteries, introducing percutaneous transluminal angioplasty (PTA) [28]. In 1976 Gruntzig performed the first PTA on the coronary arteries with the back-up of cardiac surgeons [28]. In 1977 Felix Mahler from the Department of Angiology of the University of Berne was the first to perform PTA of the renal arteries, for renovascular hypertension, with the back-up of vascular surgeons. The application of Gruntzigs method (PTA) was one of the greatest breakthroughs in the treatment of cardiovascular diseases in the twentieth century. The radiologist I. K. Rabkin at AURCS in Moscow performed the first transcatheter intravascular procedure in

Fig. 1.1.11 Performance of minor surgery in the chamber

the USSR and was the first in the world to perform, in 1984, dilatation and endovascular prosthetic grafting of an external iliac artery [54]. N. L. Volodos was the world pioneer in devising and clinically applying endoprostheses in the aorta and iliac arteries in the Ukraine in 1985, before J. Parodi [54]. Claude Mialhe from France was a world pioneer, performing in 1995 endovascular abdominal aortic aneurysm repair by using a modular stent graft [47], followed immediately by Wolf J. Stelter in Frankfurt, Germany (personal communication, 1964). The Leicester group under Sir Peter Bell and the radiologist A. Bolia contributed to the advancement of endoluminal treatment by applying subintimal angioplasty to the lower extremities [8]. In the 1970s Herbert Ehringer in Vienna introduced intravenous thrombolysis for arterial occlusions. The German angiologist Hans Hess in Munich in the early 1980s introduced intra-arterial thrombolysis in peripheral arterial occlusive disease, followed by the Swede D.D. Do (1987).

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