Cross-Clamping of the Diseased Thoracic and Abdominal Aorta

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. © 2005 Blackwell Publishing.