Vasa vitae--keeping the channels open.

Surgical attitudes to blood vessels through the millennia and leading up to the middle of the twentieth century were, with anecdotal exceptions, limited to life-saving cautery or ligation. The practice of vascular surgery was initiated only in the fifties when arteries and veins-these vasa vitae or vessels of life-were deliberately sought out and reconstructed. Keeping the channels open in order to preserve life, to revitalise an organ or to salvage a limb has been the raison d'etre of the vascular surgeon. The objectives of surgical intervention are also its rewards. The fun and the reward of vascular surgical practice lies in the challenge of dealing with patients with major cardiovascular and other risk factors, in the precision of operative technique and in the generally gratifying outcomes, tempered on occasion by the experience of failure. It is a specialty which has grown enormously in the range and complexity of procedures undertaken. Over a third of the large numbers treated require emergency attention. The ubiquitous presence of diseased blood vessels makes for refreshing changes of clinical and operative scene and also accounts for the close links between vascular surgeons and other doctors. These fortuitous associations generate varied interdisciplinary research programmes which not only straddle the neat boundaries of prescribed research groupings but also extend outwards to the sciences, engineering and so on. It is exactly such collaborative vascular research which has enriched our knowledge of the microcirculation, led to advances in haemodynamic monitoring, introduced the concept of the non-invasive ultrasound investigation, stimulated prosthetic graft development and brought about innovations in surgical instrumentation. During the seventies, the broadening repertoire of exciting operative procedures in this relatively young specialty, in personal terms, proved both captivating and timely. My objective on being appointed to the very firm where the distinguished surgeons Mr Sinclair Irwin and the late Mr Reginald Livingston had once been my mentors, was the conversion of a general surgery unit with 11% vascular throughput into a dedicated, regional vascular centre and to set up a clinical vascular laboratory. This process of engineered metamorphosis was entirely in keeping with the best progressive traditions of the Royal Victoria Hospital wherein interlinking specialties have evolved to create a favourable milieu for clinical care and research. This Vascular Surgery Unit at the Royal, one of the first of three or four such centres in the British Isles, has contributed to vascular research and specialist development at …