[Hans von Haberer--the beginnings of reconstructive carotid surgery]

Hans von Haberer (1875-1958) gained wide experience in the reconstructive surgery of vascular aneurysms at the universities of Innsbruck, Graz, Düsseldorf and Cologne. In this period he operated on 421 vascular aneurysms--including 30 carotid aneurysms--mainly by means of direct circular vascular suture. In 1914 von Haberer described the first repair of a carotid aneurysm. Therefore he is the pioneer of reconstructive carotid surgery. Based on detailed clinical and operation reports on approximately 16,000 cases, written by Hans von Haberer between 1904 and 1949, and on the contemporary literature, we describe his experience in vascular surgery.

The pulmonary autograft: history and basic techniques

The pulmonary autograft introduced in 1967 evolved from the homograft aortic valve, which had been in place 5 years by the time it showed structural deterioration. The strength of the autograft cusps was an initial anxiety, but clinical and experimental studies have shown that they are well able to withstand aortic pressures. The right side reconstruction has been with homografts, first aortic and later pulmonary. Other forms of reconstruction, including autogenous fascia lata and pericardium, have not been satisfactory. Clinical results have been rewarding and suggest a permanent valve replacement. Additionally, there is accumulating evidence that the autograft will grow in young patients. Most surgeons favor root replacement, but there is some anxiety about possible dilatation of the root. This probably relates to technical inadequacies, but subcoronary and inclusion or cylinder insertion remain valid options. There are few contraindications to the use of an autograft, and it has an increasing application in infective and post prosthetic endocarditis.

[History of surgical instruments: 5. The development of tangentially closing vascular clamps]

We demonstrate the historical development of tangential occlusion clamps, which by partially clamping the vessels and by partially maintaining the blood flow, allow to reconstruct or to anastomose large vessels in the side-by-side-technique. The first tangential occlusion clamp was developed by Friedrich Trendelenburg (1844-1924) in 1908, when he performed the operative treatment of embolism of the pulmonary artery. This clamp was modified later by A.W. Meyer [1927] and V.P. Satinsky [ca. 1950].

Remembering Alexis Carrel and Charles A. Lindbergh

Images

The history of vascular surgery in Canada

The clinical specialty of vascular surgery in Canada began before the Second World War with the introduction of heparin into clinical practice by Gordon Murray of Toronto. He showed that heparin could prevent thrombosis during the repair of blood vessels and was useful in the treatment of spontaneous arterial and venous occlusion. The unfavourable war experience with arterial ligation for trauma led to an interest in the direct repair of vascular injuries by surgeons returning to civilian practice. Embolectomy, first performed in the late 1940s, was the other early vascular operation. Aortic surgery initially depended upon the use of cadaver homografts, and a number of programs were started in the early 1950s, only to be abandoned as synthetic grafts became available. Infrainguinal bypass grafting with saphenous vein evolved in clinics set up to treat varicose veins and varicose ulcers. The first in-situ grafts were done by Paul Cartier of Montreal in 1960. By this time, reconstruction for aneurysmal and occlusive disease was well established throughout Canada. Specific fellowships in vascular surgery were first offered in the 1970s, as clinical units were set up in teaching hospitals. Surgeons concentrating on vascular disease founded the Canadian Society for Vascular Surgery (CSVS) in 1978 and approached the Royal College of Physicians and Surgeons of Canada to establish training requirements in their specialty. The first qualifying examination was held in 1983, and by 1994 certificates of special competence had been awarded to 178 candidates. The pioneers in Canadian vascular surgery are acknowledged and their contributions summarized.

The history of endovascular therapy

The roots of endovascular therapy in both the United States and Russia are explored. Developments in selected areas of endovascular neurosurgery are recounted.