The Nursery of Vascular Surgery in Europe in the 1930s was the Ren Leriche School in Strasburg France

The identity of vascular surgery as a specialty in the major field of surgery, not only in Europe but also internationally, started emerging in the 1930s in the famous School of René Leriche in Strasburg. In this Clinic many young European surgeons and the American Michael E. De-Bakey had their training and were indoctrinated with the impressive ideas and experience of Leriche concerning the pathophysiology and treatment of arterial diseases. Among Leriche's pupils were Michael E. DeBakey (USA), Nicolas Christeas (Greece) (both were my teachers), Joao Cid dos Santos (Portugal) and the French René Fontaine, Jean Kunlin and others (Fig. 1.1.4).

René Leriche, from Lyon, became director of a surgical clinic in Strasburg and later in Paris. He described the occlusion of the terminal aorta, a condition which was coined Leriche syndrome [38]. For the treatment of occlusion of the abdominal aorta he performed lumbar sympathectomies with or without excision of the occluded aortic segment. Certainly he thought that the proper treatment should be resection of the occluded aorta and its replacement with an arterial substitute, as Carrel has done experimentally, but no arterial substitute for Man was available at the time [37]. He performed with R. Fontaine, his successor in Strasburg, stellate ganglion block for the release of arterial spasm in pulmonary embolism, in angina pectoris and in vasospastic conditions, such as Raynaud's syndrome (Fig. 1.1.5). These methods were used for many years in our angiological practice [46]. In 1947 René Leriche proposed the establishment of the specialty of vascular surgery by stating "Arterial surgery is a special discipline of general surgery. The diagnostic investigation and the operations exist and the material is

Rene Leriche

Fig. 1.1.4 An historic picture of Leriche and his pupils in Strasburg in 1938. First row from left to right: (starting third from left) M. E. DeBakey (USA), René Leriche, N. Christeas (Greece), C. Eliades (Greece), J. Kunlin (France). Second row: from left to right: Joao Cid dos Santos (Portugal). (Picture from author's personal collection)

Fig. 1.1.4 An historic picture of Leriche and his pupils in Strasburg in 1938. First row from left to right: (starting third from left) M. E. DeBakey (USA), René Leriche, N. Christeas (Greece), C. Eliades (Greece), J. Kunlin (France). Second row: from left to right: Joao Cid dos Santos (Portugal). (Picture from author's personal collection)

abundant" [38]. His proposal was realized in the European Union countries after 57 years, in 2004 [42].

It is important to mention that many prominent American vascular surgeons had obtained their "portions" of training in Europe before the Second World War, e.g. Michael E. DeBakey, or after the war, e.g. Denton A. Cooley. The author owes a personal debt of gratitude to their two cardiovascular centres for the training he received. They are the Methodist Hospital-Texas Medical Center of Michael E. DeBakey and the St. Luke's Hospital-Texas Heart Institute of Denton A. Cooley. A very large series of European surgeons was trained and many hundreds of European cardiovascular surgeons have visited these centres, obtaining experience in vascular and/or cardiac surgery, bringing it back to their home institutions. Most of these trainees and many other cardiovascular surgeons from all over the world became members of the M. E. DeBakey International Cardiovascular Society which I established in

Fig. 1.1.5 Leriche performing operation with Christeas on his left. Strasburg 1938. (Picture from author's personal collection)
Fig. 1.1.6 Audience to the President of the Hellenic Republic, Professor Constantinos Tsatsos. From left to right : H. Eascott (UK), E. Malan (Italy), The President, M. E. DeBakey (USA), A. Senning (Switzerland), P. Balas (Greece)

Athens, Greece in 1976 (Fig. 1.1.6). Also, a similar Society of Denton A. Cooley was established.

Many prominent American vascular surgeons were born in Europe and, after immigrating to the USA, developed leading vascular centres. Among them are the following: R. Linton born in Scotland, who was Director of Vascular Service in the Massachusetts General Hospital in Boston; Emeriick Szilagyi, born in Hungary, who was Director of Vascular Service in the Henry Ford Hospital, in Detroit; and Gega de Takats, also born in Hungary, who was Director of the Vascular Service in the University of Illinois, Chicago. Henry Haimovici from Tulcea Romania grew up and went to Medical School in Marseille, France. He moved to New York and became Head of Vascular Surgical Service Montefiore Hospital and Medical Center. It is very interesting that after his donation in 1976 the Rumanian Vascular Surgical Society was established. John Dormandy, born in Hungary, was Consultant Vascular Surgeon at St. George Hospital, London, UK. Peter Gloviczki, born in Hungary, is Professor and Chairman of the Department of Vascular Surgery, Mayo Clinic, Rochester, Minnesota, USA. Christopher K. Zarins, born in Latvia, is Director of Vascular Service in Stanford University Medical Center, Stanford, California. C. Rob moved from St. Mary's Hospital in London, UK to the USA and became Chairman of the Department of Surgery at the Rochester University Medical School in Rochester, New York. In these centres many European surgeons were trained in vascular surgery, bringing about a reciprocal exchange of knowledge and experience among the surgeons and vascular surgical centres of Europe and the USA, starting from the old continent.

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