Abdominal Aortic Ligation 1817 – Tying Off an Abdominal Blood Vessel

According to author Harold Ellis, British surgeon Astley Cooper was "the father of arterial surgery" and the first person in history to ligate "the mother of all arteries", the abdominal aorta. After leaving the heart (the left ventricle), the aorta descends through the chest cavity and passes through the diaphragm into the abdomen. After giving off branches to various organs, it divides in the lower abdomen and continues as the arteries of the legs.

In 1811, Cooper studied whether the abdominal aorta could be ligated in dogs without causing death (compressed by tying it off). His observations suggested that sufficient blood flow could be supplied by other arteries.

In 1817, Charles Huston had a giant iliac artery aneurysm (a bulge) in his left groin. This serious problem results from weakening and balloon-like expansion of an artery wall. Because blood flow in the patient's right leg was substantially reduced, urgent intervention was needed to save his life.

Experimenting on Huston, Astley Cooper wanted to ligate the aorta and interrupt blood flow, using a technique learned from successful experiments in dogs. To save Huston's life, Cooper attempted to tie off the abdominal aorta approximately 1 inch (2.5 cm) before it divided into the iliac arteries. Without moving Huston, he made an incision near the navel, advanced his finger along the aorta and turned to the witnesses, saying, "The aorta is now between my fingers, and I am pleased." Carefully passing his finger between the aorta and spine, he tied off the aorta and completed the operation.

However, Charles Huston died approximately 40 hours after the operation. It is not known for certain whether his death was related to surgery, although his right leg appeared healthy as evidence of the operation's success. The event was an important development in the history of treating aortic aneurysms.

Finally, in 1923, American surgeon Rudolph Matas successfully treated an aortic aneurysm by ligating the aorta. The patient survived for more than a year before dying from unrelated complications of tuberculosis.

Aortic aneurysms may result from weakness in the aortic wall and can occur anywhere, but abdominal aortic aneurysms are the most common type. Aneurysms may enlarge, rupture and be fatal if untreated. One modern treatment is endovascular aortic repair (EVAR), which involves placing a tubular stent inside the aorta. This minimally invasive procedure shortens the patient's recovery time.

Description of the article image: “First image on the left: Rudolph Matas. Middle image: a schematic depiction of an aneurysmal (dilated) abdominal aorta just above its division into the common iliac arteries, the two major arteries. Last image: Astley Cooper.”

Historical figures mentioned in the article: Astley Paston Cooper (1768–1841), Rudolph Matas (1860–1957)

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