European Contributions to Aortic Aneurysm Surgery: A 300-Year Historical Perspective

Historically, aortic aneurysms were considered incurable with rupture leading to catastrophic outcomes. But over the centuries, with advances in surgery and in medicine generally, significant progress has been achieved often by small steps, but occasionally by critical insights and major breakthroughs. Understanding the historical evolution of aortic repair illustrates how incremental innovations transformed a once incurable condition into a treatable disease. A number of important advances took place in America, and many historical reviews have, justly, highlighted these contributions. But this manuscript focuses on the ground-breaking innovations that occurred in Europe and divides the history into successive eras: "The Beginnings;" the 18th-century, marked by ligation techniques that laid foundational principles; the 19th-century, characterized by early reconstructive attempts; and the 20th-century, where breakthroughs were made at an exponential pace, culminating in the endovascular era, in which Europe led the first clinical evaluation and regulatory approval of aortic stent grafts.