Surgeons and the Evolution of Vascular Surgery

WHO have been members of the Pacific Coast Surgical Association (PCSA) have made significant contributions to the development of modern vascular surgery during the past 40 years. From 1953 to 1993, 147 articles on vascular surgery topics have been presented at the annual meetings of the association. Time will only permit the presentation of those PCSA surgeons and topics that I consider to have been of significant importance in the evolution of modern vascular surgery. I shall never forget the indelible experience I had as a third-year medical student in the surgical admitting ward of the then Los Angeles County General Hospital in 1947. Several classmates and I were making evening teaching rounds with an attending physician, a professor of medicine who took us to the bedside of a critically ill patient with excruciating abdominal pain, shock, and an expanding pulsating upper abdominal mass. We were told that this man had a ruptured abdominal aortic aneurysm and that he would be dead by morning! He further stated that there was no treatment for this catastrophic and fatal vascular compli¬ cation. The patient was given generous amounts of mor¬ phine sulfate by the nursing staff, and the following morn¬ ing he was dead. Much has changed in vascular surgery since then, and it has been a great source of satisfaction to have witnessed and participated in the rapid development of vascular surgery during the past four decades. VASCULAR SURGERY CIRCA 1953 The diagnosis of vascular disease in the early 1950s was based on a history of claudication or abdominal pain and the physical finding of pulse deficits, the presence of a pulsating and expansile mass consistent with an aneurysm, or the presence of gangrene in an extremity. Angiography was in its infancy and was per¬ formed by a direct needlestick into the appropriate vessel. Only a single film was exposed since automated film changers were yet to be developed. Noninvasive circulatory observations consisted of blood pressure re¬