Subject(s)
Biomedical Research/history , Cardiology/history , Committee Membership , Peripheral Arterial Disease/history , Societies, Medical , Career Choice , History, 20th Century , History, 21st Century , Humans , Mentors/history , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/therapyABSTRACT
BACKGROUND: The purpose of this study is to recognize those investigators responsible for initiating progress in limb salvage where runoff beyond the arterial blockage was limited to the crural vasculature and to also describe how crural bypass has evolved into the contemporary setting where endovascular options have become increasingly prominent. METHODS: An extensive literature review of articles published from 1960 to 1979 was the basis for selecting and recognizing surgeons who pioneered infrageniculate revascularization. Documentation of patency and amputation rates were tabulated for these early series of distal limb bypass. Cases performed in the decade of interest, but not published until the 1980s, are also recognized and recorded separately. RESULTS: Subsequent to the first tibial bypass performed in 1961 by McCaughan, a total of 746 crural bypasses were defined in the decades of interest, where possible, with overall 6-, 12-, and 36-month patencies of 76%, 59%, and 48%, respectively. There was an overall amputation rate of 17%. Life table analysis and other statistical methods were also adopted during this time. CONCLUSIONS: Performance of crural bypass from 1960 to 1979 was analyzed in groups according to the distal anastomosis site. These results confirm the satisfactory early progress leading to further refinement in subsequent decades. It is essential that the current generation of vascular surgeons recognize the value of these early open procedures as a stable force for securing limb salvage in conjunction with evolving endovascular techniques.
Subject(s)
Limb Salvage , Lower Extremity/blood supply , Peripheral Arterial Disease/surgery , Vascular Grafting/methods , Amputation, Surgical , Diffusion of Innovation , History, 20th Century , Humans , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/history , Peripheral Arterial Disease/physiopathology , Risk Factors , Time Factors , Treatment Outcome , Vascular Grafting/adverse effects , Vascular Grafting/history , Vascular PatencyABSTRACT
The history of the recognition and surgical treatment of lower limb ischemia dates back to the Middle Ages. The twin Saints Comas and Damian were ascribed to have saved a gangrenous limb in the 13th century and became patrons of future surgeons. The physicians that followed developed the theories of blood flow, anatomy of the arterial circulation, and recognition that occlusive disease was the cause of limb ischemia and gangrene. Innovative physicians developed the techniques of arterial surgery and bypass grafting to restore limb blood flow and allow healing of lesions. In the 1960s, the era of endovascular intervention by the pioneering work of Charles Dotter, who developed techniques to image diseased arteries during a recanalization procedure. The development of guide wires, angioplasty balloons, and stents quickly followed. Management of lower limb ischemia and the diabetic foot will continue to evolve, building on the history and passion of preceding physicians and surgeons.
Subject(s)
Diabetic Foot/history , Diagnostic Techniques, Cardiovascular/history , Foot/blood supply , Ischemia/history , Peripheral Arterial Disease/history , Vascular Surgical Procedures/history , Critical Illness , Diabetic Foot/diagnosis , Diabetic Foot/surgery , Endovascular Procedures/history , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , History, Ancient , History, Medieval , Humans , Ischemia/diagnosis , Ischemia/surgery , Paintings/history , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/surgery , Predictive Value of Tests , Regional Blood Flow , Treatment Outcome , Wound HealingABSTRACT
No disponible
Subject(s)
Humans , Peripheral Arterial Disease/history , Vascular Surgical Procedures/history , Peripheral Vascular Diseases/historyABSTRACT
Anecdote is defined as "a usually short narrative of an interesting, amusing, or biographical incident" and are not often deemed scientifically valuable (www.merriam-webster.com). Anecdotes can be analyzed, however, and those observations can become the initiation of important and groundbreaking work. In this article, we describe aecdotes of several cases which by themselves had seemingly little value. The value was added later, when these concepts were extrapolated to important projects, which expanded into series of experiences, which were reproducible and able to be analyzed and judged as valuable devices and/or methods. The authors recognize that some of the images are old and not of great quality but the information provided is as complete as possible and reliable.
Subject(s)
Anecdotes as Topic , Aortic Aneurysm/history , Evidence-Based Medicine , Peripheral Arterial Disease/history , Vascular Surgical Procedures/history , Vascular System Injuries/history , Aged , Aortic Aneurysm/diagnosis , Aortic Aneurysm/surgery , Aortography , Blood Vessel Prosthesis Implantation/history , Diffusion of Innovation , Echocardiography, Transesophageal , Endovascular Procedures/history , History, 20th Century , Humans , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/surgery , Tomography, X-Ray Computed , Treatment Outcome , United States , Vascular System Injuries/diagnosis , Vascular System Injuries/surgeryABSTRACT
Percutaneous atherectomy provides an alternative approach to the endovascular treatment of peripheral atherosclerotic occlusive disease beyond angioplasty and stenting, and has the theoretical advantage of lesion debulking and minimizing barotrauma to the vessel wall. Atherectomy has evolved greatly during the last decade, with currently four FDA approved devices for the treatment of peripheral arterial disease. Several reports have focused on the initial technical success rates, and demonstrated the safety and short as well as mid-term efficacy of atherectomy devices. This article will review the evolution of current atherectomy devices and the associated literature.
