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 EuropeNicosia General Hospital, Nicosia,
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
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
At the end of the 19th century and the beginning of
the 20th, a great experimentation was carried out all over the world on
The French School had the greatest success in
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
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.
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
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
Felix Eastcott is credited with the first
reported carotid reconstruction for recurrent TIAs in London, in
However, it has been claimed that Michael
DeBakey carried out a similar operation just before Eastcott in
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
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,
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
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
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
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
Dysplasias of the Thoracic Duct and Related Syndromes
The Modern Surgical Management of Peripheral
Role of Low Molecular Weight Heparins in the
Management of VTE
Sequential Pneumatic Compression Device. Haemodynamic
and Clinical Studies on Venous Ulcers
Surgical Training for the Vascular Specialist
E.A. Kaperonis, E.D. Avgerinos and C.D. Liapis
Erectile Function: A Window to the Heart
Markers of Preclinical Atherosclerosis
Secondary Prevention of Peripheral Arterial Disease
Carotid Artery Kinking: A Particularly Interesting
P.N. Antoniadis, S. Goulas, D. Kardoulas, C. Mathas, D. Staramos and
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
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
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
V. Triponis, N. Markevicius, G. Drasutiene, D. Triponiene, M.
Dumciuviene and V. Kazlauskas