Milestones in the Treatment of Aortic Aneurysm

he history of the treatment of aortic aneurysm is remarkable and worthy of study because it parallels most of the great advances in medicine over the past 2,000 years. In the 2nd century AD, Antyllus provided the first record of the cause and treatment of aneurysm. Osler described him as one of the most daring and accomplished surgeons in history, due to his early proximal and distal ligation of aneurysms. In 1555, Vesalius was first to diagnose an abdominal aortic aneurysm. Lancisi published a comprehensive text on the pathology of aneurysms, complete with case studies, in 1728. The British surgeons William and John Hunter performed a number of ligations of peripheral aneurysms, while Astley Cooper was first to ligate the abdominal aorta for a ruptured iliac aneurysm in 1817. A major advance in the treatment of aneurysms came in 1888 with Rudolf Matas’s concept of endoaneurysmorrhaphy. After obtaining proximal and distal control, he obliterated the aneurysmal sac, oversewing collaterals yet preserving a lumen for blood flow (Fig. 1).