Cross-Clamping of the Diseased Thoracic and Abdominal Aorta

Roberto Chiesa, Germano Melissano, Enrico Maria Marone, Yamune Tshomba, Chiara Brioschi, Efrem Civilini, Francesco Setacci, Luca Bertoglio, Fabio Massimo Callari, Luca Del Guercio, Gabriele Dubini

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The development of vascular surgery has been made possible by several technologcal_5_5 breakthroughs such as the introduction of heparin, vascular grafis and also through the manufacturing of appropriate instruments, most importantly vascular clamps. We owe the idea of instruments suitable for clamping vessels with the least possible damage to the tissues to the ingenuity of surgeons such as DeBakey, Dardick, Dubost, Fogarty and many others. In spite of several decades of continuous efforts in order to improve the design and the materials of vascular clamps, we must admit that even the most atraumatic instrument may still be traumatic at some level, especially on the diseased vessels that occur in our surgcal practice. It was only at the end of the last century that techniques were developed for reconstructing and anastomosing arteries [l]. Atraumatic vascular clamps were, therefore, required to prevent arterial lesions. Until 1897, there had been only occasional, often unsuccessful, reports dealing with vascular sutures when John B. Murphy published his invagnation technique requiring clamping of the vessel on both sides. In 1902, Alexis Carrel published his work dealing with vessel anastomosis with a circular non-interrupted vascular suture. In 1903, Edmund Hopfner developed the first atraumatic clamp specifically developed for vascular surgery. This instrument was about 15 centimeters long and its spring steel jaws were separated in the middle, graduated towards the ends and rubber-coated. Hopfner used this clamp during his studies at the University of Berlin for clamping of arteries temporarily to perform end-to-end anastomoses in dogs. His atraumatic vascular clamps were copied, commonly used and sold by various companies until the 1960s. Erns Jeger and Rudolf Stitch later modtjied the shape of this vascular clamp [2]. The construction of tangential holding vascular clamps for the partial occlusion of vessels to allow partial blood pow for reconstruction or side-to-side anastomosis of large vessels started only after the dmelopment of atraumatic straight vessel clamps at the begznning of this century. The first surgeon who developed a tangential holding uascular clamp was Friedrich Trendelenburg in 1907. He used it during pulmonary artery embolectomy. After removal of the pulmonary embolus via arteriotomy, tangential clamping allowed arterial repair [3]. In 1925, Arthur W Meyer observed that the Trendelemburg vascular clamp was too broad and allowed only insufficient blood pow and, therefore, he modzfied its angle. The tangential vascular clamp developed by Trendelemburg and later modified by Meyer is the ancestor of modern side clamps (Satinsky, Derra, Cooley and DeBakey). The introduction of new materials and technologzes borrowed from the military and space industries in more recent years allowed the development of new high quality surgzcal instruments.

Original languageEnglish
Title of host publicationUnexpected Challenges in Vascular Surgery
PublisherBlackwell Publishing Ltd
Pages55-72
Number of pages18
ISBN (Print)1405134704, 9781405134705
DOIs
Publication statusPublished - Jan 30 2008

Fingerprint

Abdominal Aorta
Thoracic Aorta
Constriction
Blood Vessels
Sutures
Arteries
Embolectomy
Steel
Rubber
Berlin
Embolism
Jaw
Pulmonary Artery
Heparin
Industry

Keywords

  • Arteriotomy
  • Calcified aorta
  • Pulmonary embolus
  • Surgeons
  • Vascular clamps

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Chiesa, R., Melissano, G., Marone, E. M., Tshomba, Y., Brioschi, C., Civilini, E., ... Dubini, G. (2008). Cross-Clamping of the Diseased Thoracic and Abdominal Aorta. In Unexpected Challenges in Vascular Surgery (pp. 55-72). Blackwell Publishing Ltd. https://doi.org/10.1002/9780470760314.ch6

Cross-Clamping of the Diseased Thoracic and Abdominal Aorta. / Chiesa, Roberto; Melissano, Germano; Marone, Enrico Maria; Tshomba, Yamune; Brioschi, Chiara; Civilini, Efrem; Setacci, Francesco; Bertoglio, Luca; Callari, Fabio Massimo; Del Guercio, Luca; Dubini, Gabriele.

Unexpected Challenges in Vascular Surgery. Blackwell Publishing Ltd, 2008. p. 55-72.

Research output: Chapter in Book/Report/Conference proceedingChapter

Chiesa, R, Melissano, G, Marone, EM, Tshomba, Y, Brioschi, C, Civilini, E, Setacci, F, Bertoglio, L, Callari, FM, Del Guercio, L & Dubini, G 2008, Cross-Clamping of the Diseased Thoracic and Abdominal Aorta. in Unexpected Challenges in Vascular Surgery. Blackwell Publishing Ltd, pp. 55-72. https://doi.org/10.1002/9780470760314.ch6
Chiesa R, Melissano G, Marone EM, Tshomba Y, Brioschi C, Civilini E et al. Cross-Clamping of the Diseased Thoracic and Abdominal Aorta. In Unexpected Challenges in Vascular Surgery. Blackwell Publishing Ltd. 2008. p. 55-72 https://doi.org/10.1002/9780470760314.ch6
Chiesa, Roberto ; Melissano, Germano ; Marone, Enrico Maria ; Tshomba, Yamune ; Brioschi, Chiara ; Civilini, Efrem ; Setacci, Francesco ; Bertoglio, Luca ; Callari, Fabio Massimo ; Del Guercio, Luca ; Dubini, Gabriele. / Cross-Clamping of the Diseased Thoracic and Abdominal Aorta. Unexpected Challenges in Vascular Surgery. Blackwell Publishing Ltd, 2008. pp. 55-72
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