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Interposition bypass of the popliteal artery using the popliteal vein in 1943

2016; Elsevier BV; Volume: 63; Issue: 5 Linguagem: Inglês

10.1016/j.jvs.2015.12.033

1097-6809

Anil Hingorani, Enrico Ascher, Natalie Marks, Daniel Jung, I. M. Ignatiev, Amrit Hingorani,

Vascular anomalies and interventions

This is a case report of an 85-year-old man who presented to our office in 2005 with increased lower extremity swelling, and a well healed ulceration with hemosiderin deposition of his right leg (Fig 1). The patient was noted to have no palpable popliteal or pedal pulses but a normal femoral pulse. Further examination revealed an old scar from posterior incision in the right popliteal fossa and a well healed left leg below the knee amputation. Upon further evaluation and examination, it was learned the patient was a former soldier in the Soviet army and was wounded after a land mine explosion during World War II (WWII). This patient produced a note written by a surgical assistant to Dr Bogoraz attesting to a right arterial bypass performed in 1943 (Fig 2). The patient consented to publication of this report.Fig 2Note given to our patient by Dr Bogoraz’s associate (translation from Russian):“08/15/1952From the desk of Professor Yakov VoloshinDear comrade Pritykin!In response to your letter, I can inform you that Professor Bogoraz N.A. during the surgery undertaken to repair your popliteal artery (traumatic aneurysm), in which I also took part, was able to transplant vein segment to replace injured segment of the artery. I remember that very well (although without all small details) but cannot give you an official physician's report. Wishing you health.Professor Yakov Voloshin”Reproduced with permission from Bogoraz.1Bogoraz N.A. Reconstructive surgery. Volume I. Government Medical Publishers, Moscow, Russia1949Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT) In our office, duplex imaging showed what appeared to be a conduit from the superficial femoral artery to the posterior tibial artery with multiple tributaries in the left lower extremity. A computed tomography angiogram confirmed the presence of this conduit but suggested it might be only collaterals (Fig 3). The patient was followed for 2 years but was lost to follow-up after 2007. Upon examination of the Social Security Death Index, the patient was noted to have died on April 22, 2009. The note that the patient presented with prompted us to contact our colleagues in Russia. They were able to find a monograph on reconstructive surgery written by Dr Bogoraz from Russian Military Medical Library archives in Saint Petersburg.1Bogoraz N.A. Reconstructive surgery. Volume I. Government Medical Publishers, Moscow, Russia1949Google Scholar Dr Nikolai Alekseyevich Bogoraz (1874-1952) was an eccentric and very talented surgeon known for pushing the envelope with innovative surgeries. Dr Bogoraz was a trainee and a follower of famous professors P. I. Tihov and V. I. Razumovskiy, who invented or improved many vascular surgical maneuvers such as venous and arterial suturing, aneurysm repairs, suturing of small arteries, etc. Dr Bogoraz developed numerous techniques in reconstructive plastic surgery and was reportedly the first to perform a penile implant. A bilateral amputee himself from a train accident during his teen years, his methods were unprecedented and showed that he possessed an excellent knowledge of anatomy and physiology. To perform numerous challenging and at times unique procedures in the evacuated hospital behind the front line on thousands of wounded soldiers during WWII, he was wheeled from one operating room to another by his assistants. After the war Dr Bogoraz returned to Moscow where he continued to operate, teach in Medical University and write numerous scientific articles and textbooks on the basis of his unique experience. In 1952, our patient visited Dr Bogoraz in his clinic for a follow-up, requested more detailed information about what procedure had been performed on his right leg, and was given the aforementioned note by Dr Bogoraz's associate Dr Voloshin. In addition to diverse post-traumatic soft tissue and neurosurgical reconstructions, Dr Bogoraz's monograph described multiple techniques of arterial repairs with various types of anastomoses and interposition of the femoral and popliteal arteries using the vein conduits (Fig 4, Fig 5, Fig 6, Fig 7). This monograph suggests that Dr Bogoraz was developing the vascular anastomosis and using the technique on his patients before the report of Dr Kunlin. We hypothesize that our patient underwent an interposition of the injured right popliteal artery with the adjacent popliteal vein as described in the monograph. Despite the subsequent thrombosis of the bypass, the patient did not lose his right leg.Fig 5Translation from Russian: “Suturing of vessels with various calibers by Dobrovolskaya.”Reproduced with permission from Bogoraz.1Bogoraz N.A. Reconstructive surgery. Volume I. Government Medical Publishers, Moscow, Russia1949Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 6Diagram of “interposition of popliteal artery with adjacent popliteal vein for repair or arteriovenous aneurysm.” Translated from Russian.Reproduced with permission from Bogoraz.1Bogoraz N.A. Reconstructive surgery. Volume I. Government Medical Publishers, Moscow, Russia1949Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 7Technique of “vein interposition for arterial injury repair.” Translated from Russian.Reproduced with permission from Bogoraz.1Bogoraz N.A. Reconstructive surgery. Volume I. Government Medical Publishers, Moscow, Russia1949Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT) Indeed, in his monograph, Bogoraz describes that upon arrival to his clinic, our patient had injuries of the left superficial femoral artery in the midthigh with leg gangrene that prompted superficial femoral artery ligation and an above the knee amputation. The right lower extremity had suffered a popliteal artery transection with pseudoaneurysm and arteriovenous fistula formation, which was repaired via posterior incision with a 14-cm bypass with popliteal vein. Previous literature suggested that the use of the arterial bypass was developed in Europe. Kunlin has described having performed the first bypass for occlusive disease using a venous conduit in 1945.2Kunlin J. Le Traitement de l'arteritique par la greffe veineuse longue.Arch Mal Coeur. 1949; 42: 371-372Google Scholar As reported by DeBakey and Simeone, only 40 cases of arterial repair using a venous conduit were performed during WWII. Paul Cartier, Karl Hall, and Charles Rob began clinical trials of in situ vein bypass in 1959.3Corson J.D. Leather R.P. Shah D.M. Naraynsingh V. Karmody A.M. The use of the long saphenous vein for lower limb salvage: the evolution of the in situ bypass.Contemporary Surgery. 1986; 23: 39-43Google Scholar Bogoraz described his successful replacement of an injured long segment of the superficial femoral artery with an interposition bypass with the great saphenous vein in 1935.4Pokrovsky A. Bogatov Y.P. Vascular surgery in Russia.J Angiol Vasc Surg. 2000; 6: 8-20Google Scholar In 1912, he also described transposition of the superior mesenteric vein to the inferior vena cava in patients with liver cirrhosis. Although Kunlin contributed significantly to vascular surgery, this case report suggests Bogoraz and others might have played an important role in the development of the bypass using a venous conduit. These data illustrate the expression of Sir Isaac Newton, “If I have seen further, it is by standing on the shoulders of giants.” Although the work of Dr Bogoraz was not published in Western literature, he should be listed among the pioneers of vascular surgery. Furthermore, as the history of surgical techniques continues to be reassessed, we will need to re-examine the origins of many modern vascular techniques.