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A History of Vascular Surgery - part 5

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cắt bỏ một phình động mạch chủ bụng ở một người đàn ông 50 tuổi và liên tục phục hồi động mạch với một homograft động mạch chủ ngực được thu hoạch từ một cô gái trẻ 3 tuần trước đây (xem hình 20,1 và 20,2). | Evolution of aortic surgery 83 Figure 7.8 Shumacker s aneurysm resection with restoration of arterial continuity from Shumacker HB Jr. Coarctation and aneurysm of the aorta. Report of a case treated by excision and end-to-end suture of aorta. Ann Surg 1948 127 655 . replacement Figure 7.9 . The 27-year-old prophecy of René Leriche had been fulfilled. In March 1951 Charles Dubost also of France resected an abdominal aortic aneurysm in a 50-year-old man and restored arterial continuity with a thoracic aortic homograft harvested from a young girl 3 weeks previously see Figures 20.1 and 20.2 . These techniques were soon adopted in the United States by Julian DeBakey and Szilagyi. One month prior to Dubost s operation Freeman excised an abdominal aortic aneurysm in a 61-year-old woman and restored arterial continuity with one of her common iliac veins. The patient died 6 hours after surgery. Freeman attempted this procedure in three more patients with good results in one. The enthusiasm for homografts during the decade from 1945 to 1955 was similar to the enthusiasm for rigid arterial prostheses 50 years earlier. Both methods were quickly embraced by surgeons throughout the world as a sure way to bridge arterial defects. Almost as quickly however interest in both techniques waned. The popularity of rigid prostheses lasted for two decades until it became clear that they all eventually thrombosed. The use of homografts was even more short-lived owing to degenerative changes resulting in poor longterm patency rates and the difficulties associated with harvesting and preserving them. The brief homograft period was an important one however as it enabled surgeons to become skillful in performing operations upon the aorta. It also led directly to attempts to use synthetic fabrics as vascular conduits thereby ushering in the present era of reconstructive arterial surgery. 84 Chapter 7 Figure 7.9 Resected aortic bifurcation from Oudot s second case of homograft replacement for .