Indian Journal of Vascular and Endovascular Surgery

HISTORICAL VIGNETTE
Year
: 2021  |  Volume : 8  |  Issue : 5  |  Page : 69--71

Arthur B. Voorhees, Jr.: Inventor of prosthetic vascular graft – A birth centennial tribute


Sunil Rajendran1, RC Sreekumar2, Jiny Chandran3,  
1 Department of Vascular and Endovascular Surgery, Starcare Hospital, Kozhikode, Kerala, India
2 Department of General Surgery, Trivandrum Medical College, Thiruvanthapuram, India
3 Department of Anesthesia, Baby Memorial Hospital, Kozhikode, Kerala, India

Correspondence Address:
Sunil Rajendran
Department of Vascular and Endovascular Surgery, Starcare Hospital, Kozhikode, Kerala
India




How to cite this article:
Rajendran S, Sreekumar R C, Chandran J. Arthur B. Voorhees, Jr.: Inventor of prosthetic vascular graft – A birth centennial tribute.Indian J Vasc Endovasc Surg 2021;8:69-71


How to cite this URL:
Rajendran S, Sreekumar R C, Chandran J. Arthur B. Voorhees, Jr.: Inventor of prosthetic vascular graft – A birth centennial tribute. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2022 Jun 26 ];8:69-71
Available from: https://www.indjvascsurg.org/text.asp?2021/8/5/69/324947


Full Text



”Hundreds of thousands of lives, limbs, and brains have been saved throughout the world by the development of vascular surgery, the field opened up by the pioneers, Dr Arthur Voorhees and Dr Arthur Blakemore.” – Levin SM[1]

Arthur Bostwick Voorhees, Jr., [Figure 1] fondly referred to as “Art” was born in 1921 in Moorestown, near Philadelphia, New Jersey. His father, Stephen Court van Voorhees, a Dutch American who served in the Army during World War I, had an inherent ability to innovate techniques to resolve problems in their day-to-day lives.[2] His father's unique ability greatly influenced inquisitive little Arthur, which he tried to emulate throughout his life.{Figure 1}

At the height of World War II, in 1943, Arthur was inducted into medical education at the College of Physicians and Surgeons of Columbia University, as part of an accelerated wartime program sponsored by the Army.[2] During his days at the medical school, he was deeply influenced by Dr. Hugh Auchincloss and was attracted toward the discipline of surgery. After graduation in 1946, during his 1-year surgical internship at Columbia-Presbyterian Hospital, New York, he became acquainted with Dr. Arthur H Blakemore, one of the best portal hypertension surgeons.[1],[2] Greatly impressed by Art's aptitude in medical research, Blakemore offered him a 1-year research fellowship. The association between Art and his mentor spurred the invention and development of prosthetic arterial substitutes.

Blakemore immediately assigned Art to commence animal experiments involving the development of a bioprosthetic mitral valve from inferior vena cava homograft. In these valves, silk support sutures were used to create structures that would function as “chordae tendineae.”[2],[3] In 1948, during one of the autopsies of animals involved in these implantations, Art observed an endocardium-like covering over a silk suture traversing the ventricular cavity.[1],[2],[3] Many years before this serendipitous event, similar observations of silk sutures becoming encapsulated by a fine veil coating and serving as a scaffolding for ingrowth of fibroblasts and later neoendothelium were recorded by Guthrie in the United States, and also later by Dorfler in Germany.[4],[5] It is probable these investigators did not think any further. However, this observation made Arthur speculate that a fine mesh of cloth would behave similarly and could be used to bridge arterial defects.[2],[3] Upon presenting this hypothesis of the “cloth prosthesis” to his chief, Blakemore readily accepted and asked Art to carry on with the animal experiments.[6] Soon after, the first tube prosthesis made out of a silk handkerchief was fabricated by Art on his wife's (Margaret Voorhees) sewing machine.[2],[3] However, after implantation in an acute dog model, this tube functioned for only 1 h, and the animal died soon after.[2]

Further experiments with nylon parachute cloth also met with limited success, in which only one out of six dogs survived at 1 month with a patent graft.[2] After these initial experiments, Arthur noted in conclusion that “The cloth had to be strong, inert, stable, of right porosity, supple and yet traversed by a fine needle.”[6] The quest for a suitable material for his experiments ended in early 1950 when he met the orthopedic resident, Wallace Blunt, who was working on a synthetic tendon project. Blunt suggested using fabric Vinyon-N supplied by the Union Carbon and Carbide Corporation, which met almost all of Art's criteria for a tubular prosthesis.[7]

Over the next year, a variety of tubular prostheses were fashioned using Vinyon-N fabric on his wife's sewing machine and implanted into abdominal aortas of thirty mongrel dogs.[2] The ends of grafts were folded back in French cuff style [Figure 2] to minimize fraying, and silk sutures or Vitallium cuffs designed by Blakemore and Lord were used for anastomosis.[2],[8] A preliminary report of their experience with Vinyon-N fabric in the first 15 dog experiments was published in the Annals of Surgery in 1952.[8] By early 1953, the team at Columbia-Presbyterian Medical Center was ready for human implantation of synthetic vascular grafts, but its first use in humans was more of an accident.{Figure 2}

In recent years before 1953, preserved aortic homografts were successfully used by many surgeons all over the world to repair defects in the aorta.[3] Aortic homografts were made available through aorta banks to the surgeons and, in 1951, a similar facility was also opened in New York.[1] In February 1953, Blakemore, Voorhees, and Levin operated on a patient with a ruptured abdominal aortic aneurysm at the Presbyterian Hospital, New York.[1] Only after the surgery had begun, did the nurse inform the team that the homograft was not available at the aorta bank in the city. Blake turned to his team and said, “We'll just have to make one of our own.”[9] Art and Levin scrubbed out of the operation, rushed to the experimental laboratory, and customized a tube graft from Vinyon-N on the sewing machine and got it autoclaved.[9] Three hours into the operation, Blake and his team used this graft to replace the aorta of that patient, which marked the first human implantation of a prosthetic aortic graft.[1],[3],[9] Unfortunately, the patient died due to a postoperative bleeding complication unrelated to graft insertion.[2]

However, Blakemore was highly impressed with the Vinyon prosthesis and, from then on, used these grafts for both emergency and elective aortic repairs. The results of these human implantations were published in the Annals of Surgery in 1954.[10] Around this time, there was a growing skepticism among surgeons about the long-term durability of aortic homografts. Szilagyi et al., in an extensive experience with arterial homografts, reported deterioration as early as 2 years and predicted their failure as a durable vascular substitute.[11] This renewed the interest in many vascular surgeons for further research into the development of prosthetic grafts and provided the much-needed impetus for Art's invention. Voorhees, like his chief, was the epitome of ethical medical practice, and he never sought any recognition for their contributions to the field of medicine. Vinyon graft and its further modifications never carried with it the name of its inventors. His team also never made any effort to patent their groundbreaking invention, which would have been worth millions. They simply wished that this product should be freely available for the benefit of all patients.

Soon, Michael DeBakey in Houston and Sterling Edwards in Alabama embarked on a similar project and developed prostheses made of Dacron and Nylon, respectively. By the 1960s, these products were marketed by the U.S. Catheter and Instrument Company as DeBakey Dacron grafts and Edwards-Tapp nylon grafts.[12],[13] Over the years, more such prosthetic materials were introduced, leading to the development of smaller diameter grafts made of inert materials such as polytetrafluoroethylene and, eventually, the present-day aortic stent-grafts.

Today, prosthetic grafts are an indispensable part of vascular surgery and present-day vascular and cardiac surgeons remain greatly indebted to the path-breaking efforts of this gentleman surgeon. Voorhees is one of the lesser-known vascular surgeons of the past, who deserved far more accolades, honor, and glory for his contributions. In recognition of his meritorious work, D.E. Szilagyi wrote, “It is a well-known truism that the development of vascular surgery would have been unthinkable without the introduction of clinically serviceable arterial substitutes.”[14] On the 100th birth anniversary of Arthur B. Voorhees, Jr., the Vascular Society of India is proud to honor this genius vascular surgeon.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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