D. Emerick Szilagyi, M D - - A n appreciation Roger F. Smith, M D , Detroit, Mich.

The Society for Vascular Surgery and the International Society for Cardiovascular Surgery are dedicating this year's meetings to an appreciation of Emerick Szilagyi's contribution to vascular surgery. During his career a new discipline of surgery has evolved, and much of the progress that has been made in our specialty can be attributed to the pioneering efforts of Dr. Szilagyi. It is appropriate to review some of the highlights of his distinguished career if wc believe the words attributed to Plato, "the unexamined life is not worth living." Certainly, both Dr. Szilagyi's life and his scholarly impact on vascular surgery deserve an appreciative reflection of what it has meant to all of us. Dr. Szilagyi was born in Hungary 80 years ago this month. He completed a classical undergraduate education in Europe where hc attended Calvinist College in Klauscnburg and the University of Dcbreccn both in Hungary and then the Sorbonne in Paris. After joining his family in Michigan he entered the University of Michigan Medical School and graduated in 1935. After graduation he continued his postdoctoral education at the University Hospital in Ann Arbor with an internship and assistant rcsiden~ in surgery fbr 2 years, and then he was a teaching assistant in pathology for an additional 2 years before coming to Henry Ford Hospital in 1939. After finishing his surgical training with Dr. Roy D. McClure in 1942, he was assigned during the war as Medical Director of the vital Ford Rubber Plantation in the Amazon Valley, Brazil. This exceptional clinical opportunity was an important phase in preparing him for a long and productive surgical career. Dr. Szilagyi returned to Henry Ford Hospital in 1945 to serve successively as an assistant surgeon, associate surgeon, Chief of the Second Surgical Division, Chairman of the Department of Surgery, and now Emer-

From the Department of Surgery,Henry Ford HospitalDetroit. Dedication presentedat the joint meetingof the Societyfor Vascular Surgeryand the InternationalSocietyfor Cardiovascular Surgery, Los Angeles,Calif., June 4-6, 1990. Reprint requests: Roger F. Smith, MD, Departmentof Surgery, Hen~ Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202. 24/6/25412

D. Emerick Szilagyi, MD

itus Consultant in the Division of Vascular Surgery. Although Dr. Szilagyi is noted primarily for his major scientific investigations in the field of vascular surgery, it may be interesting to know that during his early career he also made several significant general surgical contributions including one related to the optimal amount of thyroid tissue that should be preserved after thyroidectomy for toxic goiter. In another report to the American Surgical Association he made the observation that insulin requirements after total pancreatectomy were not as great as might be anticipated. ~,2 Dr. Szilagyi's main interest, however, was in vascular disease, which came quite naturally as this new field was starting to emerge just at the time he was beginning his investigative surgical career. He also was further encouraged in this direction by his association with Dr. Roy McClurc who had previously worked directly with Dr. Alexis Carrell in New York. So the stage was set for him to assume an important role in the development of modern vascular surgery. The following comments concern some of the major scientific contributions attributed to Dr. Szilagyi over the past 40 years.




Dr. Szilagyi performed one of the earliest resections in this country o f an abdominal aortic aneurysm with homograft replacement in April 1951 and the first successful operation of this type in Michigan in December 1952. Then a unique operation, it was reported in the Journal o f the American Medical Association. 3 His further early experience with resectional surgery o f the abdominal aorta for both aneurysmal and occlusive disease was reported in the Archives of Surgery. 4 This substantial experience for that period was made possible by Dr. Szilagyi's development of a sterilization method for autopsy harvested cadaver homografts with betapropiolactone, thereby creating Michigan's first regional blood vessel bank at the Henry Ford Hospital. From the very first, the importance of a reliable longitudinal follow-up system for vascular surgical patients was fully recognized by Dr. Szilagyi, and consequently a vascular registry was established at the Henry Ford Hospital, which enabled critical review of the surgical results. This in turn led to the important observation that arterial homografts were not a durable arterial substitute, and a suitable prosthetic graft must be developed, s As convenient access to the popliteal and infrapopliteal arteries became more o f a surgical necessity, Dr. Szilagyi met this technical challenge by describing an innovative anteromedial approach, which is now widely used by most practicing vascular surgeons. 6 O f his nearly 180 contributions to the literature, his early understanding of the role of abdominal aortic aneurysmectomy in prolongation of life is perhaps the most significant and most frequently quoted. 7 This article has also been officially recognized as a Citation Classic. Again through observations made from our extensive longitudinal follow-up system documenting both clinical and angiographic results, Dr. Szilagyi was able to describe in some detail the progressive pathologic changes o f both an angiographic and histologic nature that occur with the use of autogenous vein grafts. 8 The final contribution deserving note is Dr. Szilagyi's study of congenital arterial venous anomalies of the limbs in which he offered a classification based on their embryologic development and emphasized the importance of conservative management. 9 Perhaps the best way to summarize these pioneering efforts of Dr. Szilagyi is to quote from his own words, "I regard it as an accidental stroke of

good fortune that the beginning of my career as a surgeon coincided with the birth of a new branch of the surgical art: The surgery o f the arterial system. Thus I had the rare opportunity of making and publishing observations that were original and useful, not because of their brilliance but because of the newness. The contribution for which I may perhaps take personal credit was a firm determination to describe my observations objectively and draw my conclusions honestly." It has not only been through his scientific writings that Dr. Szilagyi has made a significant impact on vascular surgery. M o n g with Sterling Edwards, Jesse Thompson, and the late Jack Wylie, he developed and established the essentials for vascular surgical training programs, which in turn promoted the concept of certification in general vascular surgery. His contributions in recent years have had major impact on our discipline. Through his expert editorship Dr. Szilagyi has guided the development of the JOURNAL OF VASCULAR SURGERY tO the point where it is now recognized as one of the world's premier surgical journals. Dr. Szilagyi has received much well-deserved recognition. He has been President of the Central Surgical Association, the Western Surgical Association, the Midwestern Vascular Surgical Society, the North American Chapter of the International Society for Cardiovascular Surgery, and the Society for Vascular Surgery. In 1981 he had the honor of giving the Matas Memorial lecture before the Fifteenth International Congress o f the International Society for Cardiovascular Surgery in Athens, Greece.1° Dr. Szilagyi has been variously described as a scientific surgeon, critical thinker, teacher, and the conscience of vascular surgeons. MI of these attributes are most appropriate. It is indeed unusual for such characteristics to be found in one individual, but that is why he has been able to contribute so much over the years to our understanding of vascular disease and how it should be treated. He has also enriched the lives of a generation of surgical residents aspiring to the academic practice of vascular surgery and served as a role model for all of us. As a measure of our great admiration and appreciation for all that Dr. Szilagyi has contributed to vascular surgery, these meetings are dedicated to his honor. REFERENCES

1. SzilagyiDE, Barrett JL, Preuss LE. The amount of tissue to be preserved at subtotal thyroidectomy: an estimate based on serial isotope tracer measurements. J Clin Endocrinol Metab 1955;15:1409-21.

Volume 13 Number 1 January. 1991

D. Emerick Szilagyi: An appreciation 5

2. Fallis LS, Szilagyi DE. Observations on some metabolic changes after total pancreatoduodenectomy. Ann Surg 1948; 57:234-44. 3. Szilagyi DE, Hemmer JA. Resection of aortic bifurcation and replacement with homologous graft for aneurysm. JAMA 1954;154:751-3. 4. Szilagyi DE, Smith R.F, Overhulse PR. Resectional surgery of the abdominal aorta. Arch Surg 1955;71:491-511. 5. Szilagyi DE, McDonald RT, Smith RF, Whitcomb JG. Biologic fate of human arterial homografts. Arch Surg 1957; 75:506-29. 6. Szilagyi DE, Whitcomb JG, Smith RF. Anteromedial approach to the popliteal artery for femoro-popliteal arterial grafting. Arch Surg 1959;78:647-51.

7. Szilagyi DE, Smith RF, DeRusso FJ, Elliott JP, Sherrin FW. The contribution of abdominal aortic aneurysmectomy to prolongation of life. Ann Surg 1966; 164:678-9. 8. Szilagyi DE, Elliott JP, Hageman JH, Smith RF, Dall'Olrno CA. Biologic fate of autogenous vein implants as arterial substitutes: clinical, angiographic, and bistopathologic observations in femoro-popliteal operations for atherosclerosis. Ann Surg 1973;178:232-4, 9. Szilagyi DE, Smith RF, Elliott JP, Hageman JH. Congenital arteriovenous anomalies of the limbs. Arch Surg 1976;111: 423-9. 10. Szilagyi DE. Vascular substitutes, 1981: achievements, disappointments, prospects. J Cardiovasc Surg 1982;23:183-93.

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D. Emerick Szilagyi, MD--an appreciation.

DEDICATION D. Emerick Szilagyi, M D - - A n appreciation Roger F. Smith, M D , Detroit, Mich. The Society for Vascular Surgery and the International...
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