Thoracic aortic aneurysm historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Salih, MD. [2]
Overview
Pathology of the aorta has been recognized for nearly three and a half millennia, dating back to the first recorded description in the scrolls of Ebers, circa 1550 BC. Since that time, treatment has evolved from magical medicinal remedies and incantations to nearly outpatient percutaneous interventions. From the first attempts at open surgical reconstruction in the 1700s and 1800s, to the latest generations of endovascular devices, innovative pioneers have pushed the envelope of surgical technique in developing unique and novel strategies to treat the ever complex pathology of the aorta. We are just now beginning to understand these pathologies at the molecular and genetic levels, and with that expansive extent of investigation enters a journal, dedicated solely to the aorta. With this article, we hope to illuminate the rich and deep history of aortic pathology, and the innovations leading to the technology of today. A firm understanding of our past provides a strong foundation for further growth into the future.
Historical Perspective
- Aneurysma, aneurysmos … the etymologic roots of Latin and Greek origin, meaning widening or dilation, form the foundation of the modern day word aneurysm.
- Today, the term aneurysm applied in its most strict sense describes a blood vessel one and a half times the diameter of age matched individuals, with loss of vessel wall parallelism.
- Vessels of less dilation are described as ectatic, derived from the Greek origin ektasis, or to stretch out.
- The first documented description of aortic pathology appears circa 1550 BC.
- Over the following three and a half millennia, our understanding of aortic aneurysms has progressed from a mystical and uniformly lethal disease process to one that focuses on preventative intervention and minimally invasive, even percutaneous, repair.
- The term aorta was first applied by Aristotle in the 4th century BC, used to describe the great vessel of the heart.
- Prior to this description, the term had been used by Hippocrates to describe the bronchial tree, consistent with the belief that the vital “pneuma” derived from respiration was delivered to the body by these vessels.
- The respiratory and circulatory systems were seen as one continuous circuit until the early 1600s when separate blood circulation was described by Harvey.
- Since Aristotle's time however, the term aorta has continued to define the primary arterial outflow of the left ventricle.
- Pathology of the great vessel, had been recognized for nearly a millennium before the times of Hippocrates and Aristotle.
- The first preserved written account of the aorta dates back to 1550BC.
- The Ebers Papyrus was a hieratic script of Pharaonic Egypt, thought to be a transcription of an even earlier text.
- It consisted of a 110 page long papyrus scroll containing more than 700 magical and medicinal remedies for ailments of all organ systems[1][2].
- The book of hearts was the largest and most highly regarded of these scrolls.
- It described the heart and great vessels as the center of all being and existence. Within this script lies the first recorded mention of aortic aneurysms, quoted as “… only magic can cure tumors of the major arteries.”
- The scrolls go on to describe other conditions of the cardiovascular system, including peripheral arterial aneurysms.
- This script likely references the development of traumatic pseudoaneurysms but remains the earliest recorded description of major vascular pathology.
- Early 1,000 years pass before the next mention of these vessels again.
- Galen, a Greek physician practicing in Rome, served as the physician to the gladiators.
- He developed rudimentary anatomic charts which were based on canine vivisection[3].
- In his writings, he describes aneurysms on physical examination as “localized pulsatile swellings.” Furthermore, he goes on to describe the first documented ruptured aneurysm as when “an aneurysm is wounded, the blood is spouted out with so much violence that it can scarcely be arrested[4].”
- A contemporary to Galen was Antyllus, another Greek surgeon practicing in Rome.
- He is considered the true father of vascular surgery. He described both true and false aneurysms in his writings and documented the first attempted aneurysm repair in the year 200AD.
- The “Antyllus method” consisted of proximal and distal ligation, central incision of the aneurysm, and evacuation of the thrombotic materials.
- A few hundred years later, Aetius of Amida, a 7th century Byzantine physician and medical writer authored the manuscript De Vasorum Dilatatione, loosely translated “on the dilation of the vessels[5].”
References
- ↑ Thompson JE (October 1998). "Early history of aortic surgery". J. Vasc. Surg. 28 (4): 746–52. doi:10.1016/s0741-5214(98)70107-7. PMID 9786277.
- ↑ "www.ask-force.org" (PDF).
- ↑ "Ch Singer, A short history of anatomy and physiology from the Greeks to Harvey - PhilPapers".
- ↑ "Observations on Aneurism: Selected from the Works of the Principal Writers ... - John Eric Erichsen - Google Books".
- ↑ Cooley DA (June 1999). "Aortic aneurysm operations: past, present, and future". Ann. Thorac. Surg. 67 (6): 1959–62, discussion 1979–80. doi:10.1016/s0003-4975(99)00393-8. PMID 10391347.