HISTORY OF VASCULAR SURGERY: PERSONALITIES, TECHNIQUES, TURNING POINTS   

Giornale Italiano di Chirurgia Vascolare 1999 March;6(1):67-82

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English, Italian

Two aneurysms, presumibly of the innominate artery surgically treated by Luigi Porta in 1871

Argenteri A., Odero A.

From the Faculty of Vascular Surgery Pavia University, Pavia, Italy

Luigi Porta (1800-1875), Professor of Clinical and Surgical Medicine at Pavia University, is a dom­i­nant fig­ure in the sur­gi­cal land­scape of the sec­ond ­half of the 19th cen­tu­ry due to his intui­tive under­stand­ing of and the qual­ity of his ­research ­into the ­human vas­cu­lar ­system. That rep­u­ta­tion ­resides pri­mar­i­ly on his ­book “On the path­o­log­i­cal alter­a­tions to arter­ies ­caused by lig­a­ture and tor­sion” ­which ­describes ani­mal experi­ments on the var­i­ous arte­ri­al dis­tricts and the col­lat­er­al cir­cu­la­tions affect­ed by occlu­sions. His ­many oth­er stud­ies of the vas­cu­lar ­system ­reflect the influ­ence of his mas­ter, Antonio Scarpa, ­author of a fun­da­men­tal ­text of the peri­od, a mono­graph on Aneurysms, ­whose teach­ing ­helped to ­make Porta a found­ing ­father of vas­cu­lar sur­gery in Italy. Porta’s aca­dem­ic ­career (1832-1875) ­took ­place in a peri­od of pro­found polit­i­cal and ­social ­change dur­ing ­which the king­dom of Lombardy and Venice was sub­sumed ­into the king­dom of the new­ly United Italy, a peri­od too, of inten­sive sci­en­tif­ic activ­ity.
At a ­time ­when the under­stand­ing of aneu­rysms was lim­it­ed and treat­ment was restrict­ed to dis­tal lig­a­ture of the aneur­sy­mat­ic sac the ­book Porta pub­lished in 1871 “On an aneu­rysm pre­sumed to be of the innom­i­nate ­artery sur­gi­cal­ly treat­ed by the Brasdor tech­nique of carot­id and sub­cla­vian lig­a­ture ­which had a ­fatal out­come ­caused by a ­neck ­abscess” was of par­tic­u­lar sig­nif­i­cance. In ­that ­book Porta ­describes a ­case of sus­pect­ed bra­choc­e­phal­ic aneu­rysm ­that was on the ­point of split­ting and was treat­ed by lig­a­ture of the com­mon carot­id and the ­right sub­cla­vian ­artery, but with­out suc­cess ­since with­out ­there ­being any aneu­rys­mat­ic throm­bo­sis, the sac rup­tured caus­ing the ­patient’s ­death. In the ­light of the autop­sy find­ing of a rup­tured aor­toth­o­rac­ic aneu­rysm ­that was prob­ably syph­i­lit­ic in ori­gin, Porta con­ducts an extreme­ly objec­tive exam­ina­tion of the clin­i­cal fac­tors ­that led to his inac­cu­rate diag­no­sis and ­hence his inap­pro­pri­ate sur­gi­cal ­approach.