History of Vascular Surgery at RUSH University

VASCULAR SURGERY AT RUSH, THE RUSH MEDICAL COLLEGE, AND THE RUSH VASCULAR FELLOWSHIP

Vascular surgery, if defined as the ability to perform actual arterial reconstructions, is a fairly young specialty. The Society for vascular surgery was not formed until 1947. It is not surprising that RUSH has been at the forefront of vascular surgery since the very beginning. Besides the medical schools in the original 13 colonies, RUSH Medical College is the fourth oldest medical school in the United States and the oldest in Chicago. The school was chartered on July 2, 1837 which was three days before the city of Chicago received its own charter! The school is named after Benjamin Rush, a Philadelphia physician, who was a signer of the Declaration of Independence. Rush was a close personal friend of Franklin, Jefferson, and John Adams. In it’s first hundred years RUSH medical college had graduated 11,000 physicians!

One of these graduates performed the very first arterial anastomosis ever reported in a human. Graduating in 1879, John B. Murphy managed perhaps the largest surgical practice in Chicago until his death in 1916. He lived and practiced within a few blocks of where the RUSH University Medical Center is currently located. Remarkably, he had an active canine surgical lab on his property above the garage that his wife helped him manage. With the dogs, Murphy developed a technique of end to end arterial anastomosis. In 1896, after having been successful with many dogs, he used his technique for an end to end anastomosis of the femoral artery of a tailor who had a penetrating groin injury. This seminal case, which Murphy soon published, was the very first case of a successful arterial anastomosis in a human. Murphy went on to many other accomplishments including being the chairman of surgery at RUSH during his illustrious career. We have a visiting professor ship at RUSH named in Murphy‘s honor.

Very little human reconstructive arterial surgery was practiced around the world until World War II.  With only a few simple repairs reported from that war, almost all blood vessel injuries were managed with ligation. This changed in Chicago when Ormand Julian returned from military service and began practicing. Dr. Julian had received all of his training from college and finished his surgical residency at the University of Chicago. Graduating in 1942, he immediately joined the Army Air Force Medical Corps and ended up in the Assam province of India directing an air rescue and surgical unit in the Himalayas until the end of World War II.

In the first few years after returning to Chicago in 1945, Dr. Julian formed the surgical practice that has resulted in the current structure of how vascular and cardiac surgery is currently organized at RUSH. That is, since the 1960’s, we are the department of “cardiovascular and thoracic surgery”. We are a separate department, not within the department of surgery.

Julian was aware of innovative developments in France where Jean Kunlin had perform the worlds first femoral-popliteal reverse saphenous vein bypass graft on June 3, 1948. Dr. Julian performed the first femoral-popliteal bypass operation in Chicago in May, 1951 which he then published in the Annals of Surgery in September, 1952.

Early in his career Dr. Julian hired three of his most promising trainees: William (Sam) Dye, Husang Javid and James A. Hunter. They performed the first aortic bifurcation graft in Chicago in October, 1952 and were treating ruptured aortic aneurysm’s soon afterwards using homografts. They reported these cases in the Annals of Surgery in 1953 and 1955 respectively.

Dr. Javid did among the first carotid endarterectomy operations in the world and invented the carotid shunt. The shunt bearing his name is still used today. We have a visiting professorship named after Dr. Javid at RUSH.

Dr. Julian's practice became the prominent vascular practice in Chicago and they began formally training young surgeons in 1961.

When Rene Favaloro performed the worlds first reversed saphenous vein bypass graft from the aorta to a coronary artery in May 1967, at the Cleveland Clinic, Dr. Julian’s vascular practice already had tremendous experience with saphenous vein grafting. This allowed the practice at “Rush Presbyterian St. Luke’s” to become one of the dominant practices of vascular and cardiac surgery in the United States.

In 1972 Dr. Julian retired for health reasons and one of his young trainees, Hassan Najafi, became chairman and directed the department for the next 25 years. Dr. Najafi performed all vascular operations, specialized in thoraco-abdominal aneurysms and did cardiac surgery and heart transplant surgery. He was involved with vascular training in the United States and gave oral boards for vascular surgery. He established a formal ACGME vascular fellowship in 1988. This was organized so that trainees could spend three years at RUSH and receive board eligibility for both cardio-Thoracic and vascular surgery. The other members of the practice at that time included Jack DeLaria, David Monson, Milton Weinberg, William Piccione, Michael DeValle, Robert March and Marshall Goldin.

We need to mention another distinguished RUSH faculty member from those days. Gaza DeTakas was the first surgeon in Chicago to practice vascular surgery exclusively. He worked at several universities and later in his career was a faculty member at RUSH medical college. He had worked with Dr. Julian in the 1950s . He was one of the founding members of the Society for Vascular Surgery in 1947.

In the mid 1990s, with tibial artery bypass possible, the noninvasive laboratory becoming sophisticated and endovascular aortic repair on the horizon, Dr. Najafi decided to select a section chief for vascular surgery. He chose Walter McCarthy who had been in practice at Northwestern for 13 years after completing all of his surgical and Vascular training there. By mutual agreement, the fellowships were separated so the trainees would be either cardiothoracic or vascular fellows. Soon afterwards the one-year vascular fellowship was extended to two years to include not only open but endovascular skills. The fellowship remained in the traditional format with applicants having finished five years of general surgery training before their vascular fellowship. One vascular surgeon has thus been graduated from RUSH every year.

When Dr. McCarthy came to RUSH April 1, 1998 almost all arterial reconstructions were done with open surgery except for straightforward iliac artery angioplasty. He was most interested in the open repair of thoracoabdominal aneurysms, tibial bypass and carotid surgery. This was about to change! At RUSH and across the world the evolution to endovascular treatment began in earnest in September 1999 when the FDA approved the first device that was designed for infrarenal aortic aneurysms. There followed the development of successful endovascular treatment of virtually every arterial system in the body over the next 20 years.

As an interesting footnote, in 2001 Dr. McCarthy established a baccalaureate of science curriculum for training vascular ultrasound technicians with Eileen French-Sherry RVT. The majority of the current vascular technologists in the Chicagoland area are now RUSH graduates.

Originally, in 1998 Dr. McCarthy had joined with the existing surgeons who practiced vascular surgery at RUSH including Marshall Goldin, Cyrus Serry, William Piccione and Robert March. Chad Jacobs who had finished the vascular fellowship at RUSH became the associate program director.  Dr. Jacobs has since moved to be the chief of vascular surgery at Lutheran general hospital in Chicago. Samantha Minc was recruited after training at the University of Chicago and since has moved to West Virginia.

In 2016 the department recruited a replacement chief for vascular surgery. The person selected was A. Reed who had been in Hershey, Pennsylvania. Dr. Reed came to RUSH 2-1-2016 but had to leave RUSH for personal reasons 13 months later. At that time the fellowship becoming dormant for two years due to low faculty volume.

Dr. McCarthy again became the chief of vascular surgery. Several non-accredited fellows were trained during those years. Dr. McCarthy was able to recruit new faculty, Joseph Durham, Nikita Tihonov, Charles Mesh and Daniel Katz to the section. Both Dr. Mesh and Durham have subsequently left RUSH.

Recently the department was delighted to recruit Alexandre d’Audiffret to become the chief of vascular surgery. Dr. d’Audiffret trained in general surgery in Minneapolis and had vascular fellowship training in New York with John Riccotta. He also had the unique experience of an endovascular fellowship in France with pioneer vascular surgeon Jean-Pierre Becquemin. Previously Practicing at West Virginia University, he was program director for the vascular fellowship there.

Dr. d’Audiffret began as Chief at RUSH on August 1, 2019. The ACGME vascular fellowship had reopened July 1, 2019. Dr. McCarthy has remained as the vascular fellowship program director. Recently, in the fall of 2020 Dr. D’Audiffret has recruited two outstanding young members to the section: Dr. Sungho Lim, trained at the Cleveland clinic, and Dr. Michele Richard, trained in Virginia.  Doctors Tihonov and Katz remain as full-time faculty members.

Walter J. McCarthy