Vascular Origin Stories: Bridging the Gap - The Fabric of Aortic Repair

Vascular Origin Stories is a podcast series that explores the fun and engaging stories that shaped vascular surgery. 

In today’s episode we will explore the different materials used to try and repair and bridge aortic gaps. We’ll discuss attempts to treat aortic aneurysms with ligation, banding and occlusion. We will hear how Albert Einstein’ abdominal aortic aneurysm was treated with cutting edge 1940s technology: cellophane!  And finally, we will hear how a young surgical research fellow, a stray suture, perseverance and fast sewing machine skills ushered in the modern era of  fabric grafts. 

First successful ligation of abdominal aortic aneurysm in 1923 by Rudolph Matas:

Matas, R. Aneurysm of the Abdominal Aorta at its Bifurcation Into the Common Iliac Arteries. Annals of Surgery. 1940 Nov.; 112(50: 909-922 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1387983/?page=4

Early Attempts at Gradual Aortic Occlusion 

Complete Occlusion of the Aorta with Cellophane in a Dog:

Pearse, HE. Experimental Studies in Gradual Occlusion of Large Arteries. Annals of Surgery 1940 Nov. 112 (5):923-937  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1387984/?page=2

1951 Dubost’s Aortic aneurysm repair as it appears below the renal arteries. First Successful Dubost, C. Resection of an Aneurysm of the Abdominal Aorta with Restoration of the Continuity by Human Arterial Graft. World Journal of Surgery. 6, 256-257, 1982

Dog No. 10 Retrograde Aortogram of cloth tube area prior to sacrifice. Survival time 56 days. Prosthesis completely patent. 

Voorhees, A.B. Jaretzki, A. Blakemore, A.H.The Use of Tubes Constructed From Vinyon “N” Cloth in Bridging Arterial Defects. Annals of Surgery. March 1952.

Sources for today's episode:

1. Guevara-Noriega, KA. Martinez Toiran, A. Alvarez-Conejo, B. Pomar, JL. Historical Overview of Vascular Allograft Transplantation. March 20, 2019. Vascular and Endovascular Review.  
2. Callow, AD. Arterial Homografts. European Journal of Vascular and Endovascular Surgery. Vol.12 272-281. 1996 
3. A History of Vascular Surgery. Steven G Friedman. Blackwell Publishing. 2005
4. Bergqvist, D. Historical Aspects on Aneurysmal Disease. Scandinavian Journal of Surgery 97: 90-99. 2008  
5. Thompson, JE. Early History of Aortic Surgery. Journal of Vascular Surgery. Vol 28. Iss. 4 October 01, 1998.
6. Lesney, M. Einstein’s Aneurysm: Of Cellophane and Rudolph Nissen. Vascular Specialists Online. January 24, 2012. 
7. Livesay, JJ. Messner, GN. Vaughn, WK. Milestones in Treatment of Aortic Aneurysm. Texas Heart Institute Journal. 2005 32(20: 130-134.
8. Cervantes, J. Reflections on the 50th Anniversary of the first abdominal aortic aneurysm resection. World Journal of Surgery. 2003 Feb; 27 (20: 246-8) 
9. Cooley, DA. A brief history of Aortic Aneurysms. AORTA. June 2013 V.1(1)
10. Siddique, Khawaar, Alvernia J. Fraser, K. Lanzino, G. Treatment of Aneurysms with wires and electricity, historical review. Journal of Neurosurgery. December 2003. 
11. Matas, R. Ligation of Aortic Anuerysism. Annals of Surgery. 1925. Feb; 81(20: 457-464)
12. Matas, R. Aneurysm of the Abdominal Aorta at its Bifurcation Into the Common Iliac Arteries. Annals of Surgery. 1940 Nov.; 112(50: 909-922)
13. Barr, J. Battle of the Bulge: Aortic Aneurysm Management From Early Modernity to the Present. Annals of Internal Medicine 2017 Feb, 21;166(4):291-296. 
14. Elkin, DC. Aneurysm of the Abdominal Aorta Treatment by Ligation. Annals of Surgery. 1940 Nov. 112(5) 895-908  
15. Pearse, HE. Experimental Studies in Gradual Occlusion of Large Arteries. Annals of Surgery 1940 Nov. 112 (5):923-937  
16. Keen, WW. A Case of Ligature of the Abdominal Aorta Just Below the Diaphragm, the Patient Surviving for 48 Days- American Journal of the Medical Sciences. September 1900.
17. Cohen, JR. Graver, LM. The Ruptured Aortic Aneurysm of Albert Einstein. Surgery Gynecology and Obstetrics. May 1990. 
18. Gross, RE. Hurwitt, ES. Bill, AH. Pierce, EC. Preliminary Observations on the Use of Human Arterial Grafts in the Treatment of Certain Cardiovascular Defects. New England Journal of Medicine. October 1948. 
19. Cohen, JR. Graver, LM. The Ruptured Abdominal Aortic Aneurysm of Albert Einstein. Surgery, Gynecology and Obstetrics. May 1990, Vol. 170. 455-458
20. Cervantes. J. Reflections on the 50th Anniversary of the First Abdominal Aortic Aneurysm Resection. World Journal of Surgery. 37, 246-248, 2003.
21. Friedman, S. The 50th Anniversary of Abdominal Aortic Reconstruction. Journal of Vascular Surgery. April, 2001. 
22. Dubost, C. Resection of an Aneurysm of the Abdominal Aorta with Restoration of the Continuity by Human Arterial Graft. World Journal of Surgery. 1982; 6, 256-257.
23. Levin, SM. Breakthrough: Arthur Blakemore and Arthur Voorhees. Journal of Vascular Surgery. 2012; 55:1829-31. 
24. Smith, R.B. Arthur B. Voorhees, Jr.: Pioneer vascular surgeon. Journal of Vascular Surgery. 1993; 18:341-8.
25. Voorhees, A.B. Jaretzki, A. Blakemore, A.H.The Use of Tubes Constructed From Vinyon “N” Cloth in Bridging Arterial Defects. Annals of Surgery. March 1952.
26. Levin, S.M. Reminiscences and Ruminations: Vascular Surgery Then and Now. Presidential Address. The American Journal of Surgery, August 1987, 154(2):158-162 
27. Debakey, M.E. Reflection: Clinical Application of a New Flexible Knitted Dacron Arterial Substitute. American Surgeon, May 2008.

Host:  

• Marlene (@GarciaNeuer) is a 4th year medical student at THE Ohio State College of Medicine.

Credits:

Author: Marlene Garcia-Neuer

Editor: Yasong Yu

Reviewers: Adam Johnson and Sharif Ellozy

Music from Kinemesis_Music , ArtSlop Flodur, Brolefilmer, Nesrality, JuliusH  from Pixabay