HISTORY OF VASCULAR ANASTOMOSIS

The first name that one comes across with regard to vascular anastomosis and organ transplantation is
Alexis Carrel, who is also known as the father of vascular anastomosis. He was way ahead of his time
when he developed the fine suturing techniques that he learned from textile embroiders at his native of
France, after being moved by the death of the French president, Sadi Carnot. Carnot had a stab injury to
the portal vein which could not be repaired by the then physicians.

All great things come about with collaboration among few great minds who inspire each other. Alexis
Carrel was associated with several other notables including, Jaboulay, Rene Leriche, Charles Guthrie,
Henry Dakin and Jean Kunlin.

As early as 1896, Jaboulay, had published an article on end-to-end anastomosis of the carotid artery.
This was a milestone that abolished the earlier idea that sutures placed on blood vessels could lead to
their early thrombosis hence furthering the damage.

From 1904 to 1906, Alexis Carrel worked at the University of Chicago along with Charles Guthrie
perfecting the technique of vascular anastomoses and the use of vein graft for damaged arteries.
Several scientific papers were co-authored by them, during this time. Later on, he moved to New York to
work for the Rockfeller foundation where he worked towards the preservation of vascular grafts to
replace the aorta.

Alexis Carrel’s work is remarkable in that he had ventured into the field of vascular surgery even before
the era of anticoagulants. He had developed his own straight needles with a curve at the end and very
fine silk sutures coated with paraffin and preferred using his hands instead of a needle holder. He used
black drapes on his operating table for better visualization of the fine white needle and sutures. His
concepts of gentle tissue handling and the technique of triangulation for vascular anastomosis were
critical to the development of vascular surgery. It was for these contributions that he received Nobel
prize for medicine in the year 1912.

His early suturing technique was consistent with the popular belief at the time that manipulation of the
intima would lead to thrombosis. Later on, he modified his technique of suturing through all the layers,
including the intima.

Rene Leriche attributed his enthusiasm for experimental surgery to his former chief, Carrel. During
World War I he took up vascular injuries for special study. Here he collaborated with Micheal deBakey,
Jao Cid dos Santos and Jean Kunlin. In 1909, he attempted to restore arterial flow in a thrombosed
artery using vein graft, but could not proceed because the distal limit of the artery could not be
delineated.

Years later, his student Jean Kunlin, in the year 1948 performed the first femoral popliteal bypass using
saphenous vein on a 54 year old man who was experiencing ischaemic rest pain and gangrene for 3
months. Within 3 weeks of the bypass, the patient’s lower limb had healed. Kunlin had introduced a
revolutionary technique to join a vein graft to artery by end-to-side interposition. With the introduction
of heparin in experimental arterial surgery by Gordon Murray, Kunlin could now use a combination of
heparin and Coumadin on his patients.

These major contributions to vascular surgery has had a significant effect on the care of patients with
peripheral arterial disease, as well as patients with vascular trauma, aneurysms, coronary artery disease
etc, and vascular surgeons all over the world would forever be indebted to them.