17th Congress of the European Chapter of the International Union of Angiology
April 25-28, 2007 - Nicosia, Cyprus




N. Angelides: The ever Changing Face of Vascular Surgery in Europe
Nicosia General Hospital, Nicosia, Cyprus)

The core of vascular surgery has undergone several transformations throughout the years. These transformations occurred step-by-step through out the centuries.

– The first interventions on blood vessels are lost in the depth of history.

– However, all classical physicians such as Hippocrates described methods of treating varicose veins even by stripping!

– Also, the Greek Antyllus described an operation for aneurysms by the application of two ligatures to the artery, cutting in between them.

There have been long stagnant periods during which little progress could be seen.

– William Harvey, at the beginning of the 16th century, went to Padova and studied anatomy under Hieronymus Fabricius. Later on in London, he proved that blood is circulating in a circuit system of arteries, including the heart.

– John Hunter, at the mid of the 17th century, described the exposition of the arteries in the human body and transformed vascular surgery from a terrifying art to a positive scientific profession.

At the end of the 19th century and the beginning of the 20th, a great experimentation was carried out all over the world on vascular suturing.

– The French School had the greatest success in the research.

– Alexis Carrel and Rene Leriche in Lyon were the first to evolve modern techniques of vascular anastomoses.

– Alexis Carrel could not find satisfactory work in Europe and immigrated first to Canada and then to Chicago.

– In 1912 he was awarded the Nobel Prize for medicine for his work on vascular suturing and anastomoses.

Rene Leriche created the first School of vascular Surgery in Strasbourg.

– This School has been the nursery of angiologists and vascular surgeons in Europe and USA.

Angiography was developed in Portugal.

Moniz, performed the 1st cerebral angiogram in Lisbon in 1927.

– Reynaldo Cid dos Santos performed the 1st aortogram in the same city in 1929.

– J. Kinmonth, in London invented peripheral lymphangiography.

Heparin was discovered in America by William Howell and Jay McLean in 1925. It was manufactured in crystalline form by Fischer and Schmitzin in Copenhagen, in 1933.

– Finally, heparin was used by Crafood in Stockholm in 1937, to treat patients with DVT.

1st endarterectomy

– The first endarterectomy of the brachial artery was carried out under local anaesthesia in Lisbon, in 1946, by Jean Cid dos Santos.

1st FemPop by pass.

– The 1st fem-pop by-pass graft was performed by Jean Kunlin in Paris in 1948.

– Rene Leriche was sceptical about the idea of a venous by-pass graft. He believed that arterial pressure could rupture the vein. Kunlin waited until Leriche was out of town before operating upon his 1st patient, with critical limb ischaemia and impending gangrene!

1st aorta replacement

– Jacques Oudot in France performed the first aorta replacement in 1950, using an aortic allograft from a victim of an accident. He also experimented with intraarterial injection of vasodilating drugs.

– At the age of 40, he crashed his powerful sport car and sustained fatal injuries.

1st open repair of AAA

– The first operation to repair an abdominal aortic aneurysm was carried out in 1952 by another Frenchman, Charles Dubost. He performed the operation using a thoracic aortic allograft from a young accident victim.

– The patient lived another 8 years before dying from MI.

1st carotid endarterectomy

– Felix Eastcott is credited with the first reported carotid reconstruction for recurrent TIA’s in London, in 1954.

– However, it has been claimed that Michael DeBakey carried out a similar operation just before Eastcott in Huston.

The well known Hippocrates aphorism "ocosa farmaca uk iite, sidiros iite" = "When drugs do not help then surgery helps", which was an axiom for centuries, seems suddenly to loose its real value, as we move into the era of endovascular methods!

It is beyond any doubt that since the development of prosthetic graft material, the treatment of peripheral arterial occlusive disease has not undergone such great change as that evoked by the advent percutaneous interventions.

1st peripheral and 1st coronary angioplasty.

– Andreas Gruntzing has opened the gates for endovascular surgery by the invention of an effective balloon catheter for arterial dilatation.

– He carried out the first femoral and iliac angioplasties in 1972, and the first coronary angioplasty in 1977, in Zurich.

1st endovascular repair of an AAA.

– Juan Parodi performed an endovascular repair of an AAA in Buenos Aires, in 1990, using a straight graft, stented at the proximal end.

1st modular endovascular repair of an AAA.

– However, the first modular intra-aortic stent/graft was introduced by Claude Mialhe.

Edwards Diethrich, the world wide pioneer in endovascular surgery perceived that: "Without any doubt endovascular surgery will by the tern of the 20th century be the preferred therapeutic approach to peripheral vascular disease in almost any vascular bed".

To-day, the focus of therapy is moving towards maximal revascularization with minimal invasive techniques.

– Few years ago, the focus of endovascular interventions was the treatment of peripheral occlusive disease, located in the lower extremities.

– Nowadays, aneurismal disease and carotid artery stenosis as well as visceral artery stenosis have joined the target list for percutaneous intraluminal therapy.

– With the use of endoluminal grafts, large and small aneurysms in the thoracoabdominal aorta and the ilio-femoral arteries can be treated without major surgery.

– The same intraluminal prosthetic concept has been applied to long-segment occlusive disease in which the simple intraluminal techniques do not produce satisfactory results.

– In all these cases the endoluminal devise acts as an internal by-pass which behaves as neointimal lining and does not allow smooth muscle cell proliferation to produce restenosis.

– Endoluminal repair of carotid artery stenosis by means of angioplasty and stenting, with the use of cerebral protection, seems to provide to-day equally good results as surgical endarterectomy.

As these new technologies are unfolding, the field of endovascular surgery is in an exciting phase of development.

– This field is multidisciplinary in character, but remains to the vascular surgeon to select and combine the best and more efficient therapies from the classical and catheter-based armamentarium, in order to achieve optimum revascularization with a minimum of invasiveness.

– To-day, vascular surgeons are no-longer confined to a step-by-step progressive treatment of peripheral arterial disease, including exercise, medication and by-pass surgery.

– The options have expanded to include thrombolysis, laser angioplasty, atherectomy, balloon dilatation, intravascular stents, endovascular grafts with protection of the target organ.

This sequence was further assisted by the development of intravascular ultrasound (IVUS) and angioscopy.

To-day, vascular surgeons can evaluate atherosclerotic disease with accuracy, deriving more information about an obstruction than was ever required for classical vascular reconstruction.

Throughout the years, while contributions from other continents merit recognition, Europe can claim to have been the cradle of Vascular Surgery.

– Fundamental principles were established throughout the twentieth century and vascular practice has evolved into a well defined speciality.

– Today, advances in the management of vascular diseases continue to progress at an accelerating pace.

– Now it is depended upon vascular surgeons to appreciate the strategies for selecting endovascular interventions which could provide results equal to those methods used in the past but with less invasiveness.

To conclude everything could always be a matter of team work!





Invited Lectures


Dysplasias of the Thoracic Duct and Related Syndromes

C. Campisi


The Modern Surgical Management of Peripheral Lymhoedema

C. Campisi


Role of Low Molecular Weight Heparins in the Management of VTE

E. Kalodiki


Sequential Pneumatic Compression Device. Haemodynamic and Clinical Studies on Venous Ulcers

E. Kalodiki


Surgical Training for the Vascular Specialist

E.A. Kaperonis, E.D. Avgerinos and C.D. Liapis


Erectile Function: A Window to the Heart

P. Poredoš


Markers of Preclinical Atherosclerosis

P. Poredos


Secondary Prevention of Peripheral Arterial Disease with Drugs

P. Poredoš




Free Papers


Carotid Artery Kinking: A Particularly Interesting Clinical Entity

P.N. Antoniadis, S. Goulas, D. Kardoulas, C. Mathas, D. Staramos and A. Kalamaras


Short and Midterm Follow-up of Endovascular Repair of Abdominal Aortic Aneurysms: A Single Centre Experience

C. Bekos, M. Mantelas, D. Kaitzis, A. Mpalitas, A. Hatzibaloglou and I. Moros


Usefulness of the Hardman Index in Predicting Outcome After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

T. Gerassimidis, C. Karkos, D. Karamanos, A. Kantas, E. Theochari, K. Papazoglou and A. Kamparoudis


Idiopathic Inflammatoty Bowel Disease and Venous Thrombosis: A Treacherous Relation

S. Goulas, P.N. Antoniadis, K. Kounougeri, D. Kardoulas, E. Papageorgiou and G. Geropapas


How Should We Build Operating Rooms for Treatment of Vascular Diseases?

H.O. Myhre, A. Ψdegεrd, K.R. Heide and J.G. Skogεs


Aortic Aneurysm Due to Giant Cell Arteritis

V. Stvrtinova, S. Stvrtina and J. Rovensky


Treatment of Proximal Deep Vein Thrombosis in Pregnancy

V. Triponis, N. Markevicius, G. Drasutiene, D. Triponiene, M. Dumciuviene and V. Kazlauskas

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