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GUEST EDITORIAL


DR. ANAND SHROFF

Over the years the speciality of vascular surgery had taken a back seat within the broader speciality of Cardio-Vascular and Throacic surgery. The glamour of the big brother cardiac surgery slowed down the development of the speciality of vascular surgery as also the development of the ancillarys like grafts, instruments and most of all awareness of its problems. Especially in India patients have been losing limbs to gangrene unnecessarily over the years due to the dearth of trained Vascular physicians. The clinical presentation and severity of diseases like, Thromboangiitis obliterans Takayasuís Pulseless disease, Diabetic Vasculitis and even, Atherosclerosis is so different in India than what we see and read about in Western Literature. The sheer magnitude of the problem of Vascular Disease in India is staggering. Although we still donít have an accurate vascular registery the fact that there are over 25 million Diabetics in the country is just a small pointer to the vast numbers of the undiagnosed Vascular cases. Patients of severe vascular disease have been treated for low backache and arthritis for years. It is only the onset of peripheral gangrene which brings to light the fact that arterial pulsations have been absent for long periods of time hitherto unnoticed. After diagnosis also the only treatment of these unfortunate cases has been amputations leaving the primary vascular problem unsolved. It is therefore upto the proponents of vascular surgery to perform the optimum procedures on these patients in order to save limbs and so allow the patient to continue his gainful occupation and continue to provide for his family.

It was with a view of increasing the awareness of vascular disease and to improve the training and facilities available to Vascular surgeons that we formed a Vascular Society of India in 1994.

Since it formation the Society has been conducting annual conferences with Workshops involving foreign delegates in Mumbai (1995) Delhi (1996) Bangalore (1997) Ahmedabad (1998) Hyderabad (1999) and Chennai (2000). It is a forum for interaction of Vascular surgeons, Cardio Thoracic Surgeons, Radiologist and Cardiologist along with Peripheral Vascular problems and other management. The Society has grown 6 fold from the original 30 to almost 200 numbers to date. It has started a Fellowship training programme approved by the National Board of Examinations.

Historically Vascular reconstruction was first reported by Lambert in 1762 By 1882 Schede had done the first lateral vein repair. In 1877 Nikolac Eck did the First Porto-Caval shunt in clogs. In 1899 Kummel performed the first end to end anastomosis of an artery in a human. In 1906 Goyanes used a piece of popliteal vein to repair an aneurysmal popliteal artery. The Golden Era of vascular surgery began just after World War II.

Arterial homografts were introduced followed by various Dacron and PTFE grafts used to replace and repair all diseased medium and large sized arteries. This concomitant development of vascular suture materials, vascular instruments and devices such as embolectomy catheters have progressed at an exponential rate.

Before I end I would like to thank Dr. TP Kulkarni the pioneer and best known Vascular Surgeon in the country. He is a most skilled and experienced Vascular Surgeon who has been associated with Bombay Hospital for over thirty years. He planted the seed of Vascular Surgery in me and I would like to thank him on behalf of the speciality of Vascular surgery and myself for keeping the Vascular flag flying through all these difficult years.

Finally I do hope all the readers of this prestigious journal will enjoy some of the articles in this issue by eminent Indian Vascular Surgeons and it will spread more awareness of the specialty and its proponents among the medical and lay community of this country at large.

DR. ANAND SOMAYA
Consulting Cardio-Thoracic and Vascular Surgeon



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