– The first interventions on blood vessels are lost in the depth of history.

– However, all classical physicians such as Hippocrates described methods of treating varicose veins even by stripping!

– Also, the Greek Antyllus described an operation for aneurysms by the application of two ligatures to the artery, cutting in between them.

– This School has been the nursery of angiologists and vascular surgeons in Europe and USA.

– Finally, heparin was used by Crafood in Stockholm in 1937, to treat patients with DVT.

– The first endarterectomy of the brachial artery was carried out under local anaesthesia in Lisbon, in 1946, by Jean Cid dos Santos.

– At the age of 40, he crashed his powerful sport car and sustained fatal injuries.

– The first operation to repair an abdominal aortic aneurysm was carried out in 1952 by another Frenchman, Charles Dubost. He performed the operation using a thoracic aortic allograft from a young accident victim.

– The patient lived another 8 years before dying from MI.

– Felix Eastcott is credited with the first reported carotid reconstruction for recurrent TIA’s in London, in 1954.

– However, it has been claimed that Michael DeBakey carried out a similar operation just before Eastcott in Huston.

– Andreas Gruntzing has opened the gates for endovascular surgery by the invention of an effective balloon catheter for arterial dilatation.

– He carried out the first femoral and iliac angioplasties in 1972, and the first coronary angioplasty in 1977, in Zurich.

– Juan Parodi performed an endovascular repair of an AAA in Buenos Aires, in 1990, using a straight graft, stented at the proximal end.

– However, the first modular intra-aortic stent/graft was introduced by Claude Mialhe.

– Few years ago, the focus of endovascular interventions was the treatment of peripheral occlusive disease, located in the lower extremities.

– Nowadays, aneurismal disease and carotid artery stenosis as well as visceral artery stenosis have joined the target list for percutaneous intraluminal therapy.

– With the use of endoluminal grafts, large and small aneurysms in the thoracoabdominal aorta and the ilio-femoral arteries can be treated without major surgery.

– The same intraluminal prosthetic concept has been applied to long-segment occlusive disease in which the simple intraluminal techniques do not produce satisfactory results.

– In all these cases the endoluminal devise acts as an internal by-pass which behaves as neointimal lining and does not allow smooth muscle cell proliferation to produce restenosis.

– Endoluminal repair of carotid artery stenosis by means of angioplasty and stenting, with the use of cerebral protection, seems to provide to-day equally good results as surgical endarterectomy.

– This field is multidisciplinary in character, but remains to the vascular surgeon to select and combine the best and more efficient therapies from the classical and catheter-based armamentarium, in order to achieve optimum revascularization with a minimum of invasiveness.

– To-day, vascular surgeons are no-longer confined to a step-by-step progressive treatment of peripheral arterial disease, including exercise, medication and by-pass surgery.

– The options have expanded to include thrombolysis, laser angioplasty, atherectomy, balloon dilatation, intravascular stents, endovascular grafts with protection of the target organ.

– Fundamental principles were established throughout the twentieth century and vascular practice has evolved into a well defined speciality.

– Today, advances in the management of vascular diseases continue to progress at an accelerating pace.

– Now it is depended upon vascular surgeons to appreciate the strategies for selecting endovascular interventions which could provide results equal to those methods used in the past but with less invasiveness.