Gradual Hunterian ligation for infected prosthetic bypass

Dominique Anel, John Hunter, and the Eponymous Hunterian Ligation of Aneurysms: Conception to Current Practice

The contributions of both Dominique Anel and John Hunter in the development of the eponymous Hunterian ligation of aneurysms are presented. John Hunter, the "father of scientific surgery" lent his name to the eponymous practice of applying ligatures to aneurysmal dilatation of arteries. However, evidence suggests that the operation might antedate him by decades. Dominique Anel was a surgeon in the time of Louis XIV who, after his initial apprenticeships in Toulouse and Montpellier, subsequently served in the French navy. He famously described the lacrimal syringe that bears his name but was also interested in diseases of the bones and arteries. Anel described his technique of ligating an aneurysm of the brachial artery in the winter of 1709-1710 in Turin. His description of ligating just the upper end of the aneurysm without touching the sac was described in his collected works in 1714. This technique was exactly the same as that used by Hunter. However, Hunter had based his decision not to excise the sac on his own research. Hunterian ligation was used routinely before endoaneurysmorrhaphy, after which its popularity declined. Hunterian ligation has been superseded by development of surgical clips and endovascular techniques for intracranial aneurysms. However, the technique is still described occasionally in vascular and neurosurgical literature in the context of treating large aneurysms not amenable to traditional treatment modalities.

Methods of Gradual Vascular Occlusion and Their Applications in Treatment of Congenital Portosystemic Shunts in Dogs: A Review

OBJECTIVE

To provide a comprehensive review of the experimental and clinical data related to gradual vascular occlusion of congenital portosystemic shunts (CPS) in dogs.

STUDY DESIGN

Literature review.

METHODS

PubMed literature search (1966-2004).

RESULTS

Surgical intervention and complete vascular occlusion have been recommended for CPS therapy in dogs; however, acute complete ligation of CPS is often associated with life-threatening portal hypertension. Recently, several investigators have attempted to reduce the risk of postoperative portal hypertension by using gradual vascular occlusion. Successful vascular occlusion has been achieved using partial ligation with silk suture, ameroid constrictors, cellophane bands, thrombogenic coils and hydraulic vascular occluders. Objective comparisons of the reliability and rate of vascular occlusion produced by each of these methods have been limited by differences in experimental models and a lack of definitive follow up evaluation in some clinical studies.

CONCLUSIONS

Gradual vascular occlusion is widely used in the clinical treatment of CPS in dogs. Objective evaluation of the experimental and clinical data on each of the techniques for gradual vascular occlusion is necessary for informed clinical practice and for the planning of future research into this important area.

CLINICAL RELEVANCE

Even from the limited data available, it is clear that the ideal method for gradual vascular occlusion of CPS has yet to be identified.