Uncomplicated type B dissection: are there any indications for early intervention?

Currently thoracic endovascular repair (TEVAR) has a limited role in uncomplicated type B aortic dissection. Aggressive medical therapy is deemed appropriate for most of these patients allowing one-year survival rate of 80-90%. Outcomes are less than optimal in the long term, however, since aorta related complications (disease progression, rapid deterioration, acute rupture and elevated mortality) may occur in up to 50% of patients at five years. Subgroups of patients with uncomplicated type B dissection may benefit from early stent-graft placement, but identification of these remains difficult. Only future studies, especially randomized trials, will clarify the utility of early TEVAR in the setting of uncomplicated acute type B dissection.

Alexis Carrel: innovator extraordinaire

Alexis Carrel was awarded the 1912 Nobel Prize for Physiology or Medicine for pioneering surgical techniques in vascular surgery. His triangulation technique enabled successful anastomosis of blood vessels and subsequently led to advances in blood vessel and organ transplantation. However, Alexis Carrel did not limit his research to the vascular speciality. During the First World War he developed the Carrel-Dakin method of wound irrigation and later his interests lay in aging cells.

Aortic dissection: a 250-year perspective

Two hundred fifty years have passed since Frank Nicholls' history-making, accurate observations on the anatomic findings and cause of death of King George II were published. Several decades later, the disease was named, using--for the first time--the terms dissection and dissecting attached to an aortic disease process. Another century went by before effective surgical treatment was developed. In sharp contrast, the evolution of the last 20 years has been nothing short of amazing. Our understanding of AD, while not yet complete, has improved dramatically. In addition, the introduction of nonsurgical endovascular therapy has had a profoundly transformative impact--and we are just at the beginning! It would not be unreasonable to predict that stent-graft repair will likely replace (or nearly replace) open surgery in the treatment of complicated type B dissection in the near future, especially as technologies continue to improve and indication-specific designs are developed and tested in the clinical setting. Moreover, it is predictable that endovascular solutions for some patients with type A aortic dissection will become available in the years to come as surgical results continue to be suboptimal. Finally, and amidst this plethora of “good news,” it is appropriate to reflect on the formidable challenge that endovascular therapies face as they gear to “compete” with optimal medical therapy in the management of patients with acute uncomplicated type B dissection, because it will obviously be difficult (if not impossible) to improve on the already-achieved 30-day mortality rate of less than 10%. Long-term gains may well become the winning card when and if the late results of TEVAR can be shown to improve on the rather compromised outlook of medically treated dissection patients. Stay tuned.

Champ Lyons, Holt McDowell, and the evolution of vascular surgery at the University of Alabama at Birmingham: a personal perspective

The history of medical centers, hospitals, clinics, and their evolution are important contributions and resources to medical history. Likewise, evolution of specialties within these healthcare centers frequently parallels their growth and development. This contribution depicts the evolution of a specialty, vascular surgery, within a major medical center, the University of Alabama at Birmingham. It recounts the major participants involved and their contributions and pioneering efforts, some of which have received little attention or were overshadowed by other events. Perspectives from participants--a patient and a trainee--provide insight into this process that has supported the growth and development of a major world-class medical center.

[Origins and development of the Vascular Surgery Department of Hospital de São João]

The authors report the history of the Vascular Surgery Department of Hospital de São João since its origin to the actual reality, mentioning the most relevant steps of its foundation, development and major contributors.

[Delivery of the surgical services to the wounded with injuries of major vessels]

According to consolidated data the frequency of injuries of blood vessels during the Great Patriotic war 1941-1945 was 2.3-4.9%. In the first and the second period of the war the temporary hemostasia on the battlefield was delivered via surgical tubing, tamponade or compressing bandage; the final--via deligation of the arteries in the wound or overlap of hemostatic clamp or the amputation was performed. In the process of delivering of the knowledgeable medical assistance garrot was removed, traumatonesis was performed and the final hemostasia was performed via vasoligation in the wound or along it, than transfused. In some hospitals were organized special units for patients with injuries of vessels. In the third period of the war the main method of primary and secondary hemostasia was vasoligation in the wound or along it. The vessel suture was performed rarer than in the first and the second period. The methods of treatment and prophylaxis of complication of vessel's injury were examined.

[Jaboulay, vascular surgeon at Lyon]

Mathieu Jaboulay was an excellent surgeon. He was the first to come up with the principles of vascular surgery as he made a surgical anastomosis between two arteries of a dog by an eversion circular suture. In 1902, he implemented a suture between an artery and a vein in an arteritis by obliteration. Jaboulay also tried the graft of an animal kidney on the crease of a human elbow in 1906. Jaboulay was an initiator for Alexis Carrel.

[Contribution of Russian surgeons-participants of the First World War in development of vascular surgery]

During the First World War wounds of vessels took 0,3-1,5% of all wounds, and lethality - 10-22%. Experience of vascular treatment, get by military-field surgeons during this war, was great. They have demonstrated advantage of vascular seam of bandage of vessels in conditions of their damages. Russian surgeons-participants of the First World War have formed the base, on which russian vascular surgery was advancing not only during wars, but also during peace-time.

The arterial switch operation before Jatene

Attempts at the arterial switch operation predated the Senning and the Mustard venous switch procedures. No patients survived the earlier arterial switch methods. Therefore, from the 1960s to the 1980s, venous switch surgeries became the dominant treatment method for transposition of the great arteries. The Brazilian cardiac surgeon, Adib Jatene, reported the first successful arterial switch in 1975. The history of the earlier arterial switches performed in the 1950s and 1960s is not well known. This article discusses that early history.

[To centenary of Takayasu's presentation of nonspecific aortoarteritis case]

Literature review is dedicated to the 100th anniversary of the first case presentation for nonspecific aortoarteritis. The review covers the history of the disease concept development, current knowledge on its etiology and pathogenesis, unresolved problems of management strategy for patients with this pathology.