Rudolph Matas, M.D, is yet another of the famous surgeons of the past 2 centuries to whom the sobriquet “father of Vascular Surgery” has been applied, primarily for his pioneering studies on and surgical treatment of aneurysms before the era of prosthetic grafts. This September is the 50th anniversary of his death.
His amazingly long career (he was born in 1860 on a Louisiana plantation and lived to age 97) spanned the period in which belief in spontaneous generation and contaminated airs and humors transformed into a new germ theory of disease. He saw the revolutions begun by Pasteur, Koch, and Lister, the development of sterilization techniques, antibiotics, surgical rubber gloves (or “boiled hands” as they were colloquially known), as well as countless procedural innovations (many of his own) that enabled surgery to become a mainstay rather than last resort option in modern medicine.
Dr. Matas earned his M.D. degree in 1880 at the Medical Department of the University of Louisiana (later Tulane University). The greater part of his career after a stint in private practice was spent as professor and chief of the department of surgery at Tulane, a post he began in 1895 and held for over 32 years, then becoming an honored emeritus.
His achievements in the surgical treatment of aneurysms began in 1888 when a manual laborer presented to him with a pulsatile swelling between his elbow and axilla two weeks after an accidental shotgun wound in the left upper arm. Unwilling to amputate or perform the standard treatment of proximal and distal ligation on a man who required both arms for his livelihood, Dr. Matas, after 3 weeks of failed attempts to thrombose the aneurysm via tourniquet or compression and then failed ligations, finally performed the endoaneurysmorrhaphy technique for which he would become famous.
According to Dr. Michael E. DeBakey, who knew Dr. Matas late in his career, the reason for his success in this and other operations was his profound curiosity. In this first aneurysm case, after he ligated both above and below the aneurysm he noticed the next day that the aneurysm was still pulsing. “He was curious as to why this happened. He couldn’t believe that his ligature had opened. So he went back in and found that his ligatures were absolutely tight. There was nothing wrong with them but the aneurysm was still pulsing. He said the only way he was going to find out was by opening it up and that is when he found the collaterals. He said it became obvious . . . to oversew the opening of these collateral vessels in the aneurysm wall, and to bring the two walls together so as to obliterate it completely. That came to him as he was operating. It was innovative in a sense, but it was his curiosity that stimulated him to do it.”
The patient recovered rapidly and more than 11 years later was still gainfully employed with both arms and a palpable radial pulse.
With both tremendous modesty, and in demonstration of his profound knowledge of and interest in medical history, Dr. Matas credited Antyllus, a Greek surgeon who lived in 2nd century Rome with the original description of the surgery almost 18 centuries earlier.
Dr. Matas eventually expanded his repertoire of endoaneurysmorrhaphy to comprise obliterative, restorative, and reconstructive methodologies. The latter two techniques were modifications of the obliterative type which allowed preservation of arterial patency. He would place a catheter into the main arteries and obliterate the sac over the catheter with sutures. Versions of these techniques are still in use today.
He attempted various treatments of abdominal aortic aneurysms (AAAs), starting with use of a wire and an electric current in 1900—a failure. In 1923, he ligated the infrarenal aorta proximal to a large aneurysm—this was the first successful use of proximal ligation for an AAA.
In 1940, Dr. Matas reported on his personal experience with over 620 aneurysm operations, 101 of which were variations on the endoaneurysmorrhaphy technique. His patients had a mortality rate of less than 5%, and none of his procedures resulted in gangrene—an especially remarkable record when considering that these operations were all performed before the dawn of modern antibiotics. (Penicillin, though discovered in 1928, was not available medically until the early 1940s.) These achievements are even more remarkable when considering that Dr. Matas went permanently blind in one eye in 1908 because of to surgical splash contamination from a patient with a gonorrheal pelvic infection.
Not only were Dr. Matas’s achievements in vascular surgery profound, he was also one of the first to use spinal anesthesia; he pioneered the use of saline solutions to treat hypovolemia; he promoted operating for acute appendicitis; and he encouraged the use of nasogastric and endotracheal tubes in surgery. Dr. Matas contributed to the advancement of the surgical discipline as a whole, and in fact was one of the founders of the American College of Surgeons, which was formed, in part, to root out the practice of fee-splitting. He was one of the ACS’s first presidents.
Dr. Matas was highly revered by his colleagues and students, but he was not without his idiosyncracies. According to Dr. John Ochsner, who as a child was acquainted with the famous surgeon through his physician father, “[Dr. Matas] had one bad quality in that you could never shut him up when he started talking. . . . Dr. Matas would call and would never get off the phone, so my father would put the phone on the table and occasionally say ‘Yes, Dr. Matas,’ just to make sure he wasn’t insulting him and [he would] keep on working.” And, although known as a good, if verbose lecturer (who once gave an hour and a half of remarks on a 40-minute presentation), Dr. Matas is not known for having trained large numbers of significant practitioners of academic medicine, as are many other surgical pioneers.
Dr. Matas loved to read trashy mystery novels and was a devotee of silent motion pictures from their inception. Before his death, glaucoma and cataract and a failed operation to alleviate them eliminated sight in his left eye, leaving him completely blind in 1952—the year of the first aneurysm resection of the aorta with graft replacement—the next great achievement in aneurysm surgery after his own. Dr. Matas died 5 years later, on Sept. 23, 1957, after a year of hospitalization.
“Even in the eighties (1880s), noli me tangere was written large on the head, chest and abdomen, and their contained organs were still held as in sanctuaries which no one dared to open with unhallowed hands.”
—Rudolph Matas, M.D., in “Surgical Operations Fifty Years Ago” (Am. J. Surg. 1951;82:111-21)
More information about Dr. Matas can be found in the following sources:
• “Rudolph Matas—How I Remember Him: An Interview with Dr. Michael E. DeBakey” (J. Vasc. Surg. 2001;34:384-6).
• “A History of Vascular Surgery” by Steven G. Friedman, M.D. (Mount Kisco, N.Y.: Futura Publishing Co. 1989).