Dominique Anel, John Hunter, and the Eponymous Hunterian Ligation of Aneurysms: Conception to Current Practice

The contributions of both Dominique Anel and John Hunter in the development of the eponymous Hunterian ligation of aneurysms are presented. John Hunter, the "father of scientific surgery" lent his name to the eponymous practice of applying ligatures to aneurysmal dilatation of arteries. However, evidence suggests that the operation might antedate him by decades. Dominique Anel was a surgeon in the time of Louis XIV who, after his initial apprenticeships in Toulouse and Montpellier, subsequently served in the French navy. He famously described the lacrimal syringe that bears his name but was also interested in diseases of the bones and arteries. Anel described his technique of ligating an aneurysm of the brachial artery in the winter of 1709-1710 in Turin. His description of ligating just the upper end of the aneurysm without touching the sac was described in his collected works in 1714. This technique was exactly the same as that used by Hunter. However, Hunter had based his decision not to excise the sac on his own research. Hunterian ligation was used routinely before endoaneurysmorrhaphy, after which its popularity declined. Hunterian ligation has been superseded by development of surgical clips and endovascular techniques for intracranial aneurysms. However, the technique is still described occasionally in vascular and neurosurgical literature in the context of treating large aneurysms not amenable to traditional treatment modalities.