The history of vascular surgery in Canada.

The clinical specialty of vascular surgery in Canada began before the Second World War with the introduction of heparin into clinical practice by Gordon Murray of Toronto. He showed that heparin could prevent thrombosis during the repair of blood vessels and was useful in the treatment of spontaneous arterial and venous occlusion. The unfavourable war experience with arterial ligation for trauma led to an interest in the direct repair of vascular injuries by surgeons returning to civilian practice. Embolectomy, first performed in the late 1940s, was the other early vascular operation. Aortic surgery initially depended upon the use of cadaver homografts, and a number of programs were started in the early 1950s, only to be abandoned as synthetic grafts became available. Infrainguinal bypass grafting with saphenous vein evolved in clinics set up to treat varicose veins and varicose ulcers. The first in-situ grafts were done by Paul Cartier of Montreal in 1960. By this time, reconstruction for aneurysmal and occlusive disease was well established throughout Canada. Specific fellowships in vascular surgery were first offered in the 1970s, as clinical units were set up in teaching hospitals. Surgeons concentrating on vascular disease founded the Canadian Society for Vascular Surgery (CSVS) in 1978 and approached the Royal College of Physicians and Surgeons of Canada to establish training requirements in their specialty. The first qualifying examination was held in 1983, and by 1994 certificates of special competence had been awarded to 178 candidates. The pioneers in Canadian vascular surgery are acknowledged and their contributions summarized.