gms | German Medical Science

Antyllos together with Heliodor, Leonides and Archigenes belong to the most recognized Roman surgeons living between 1st and 3rd century AD. Antyllos main surgical work „cheirurgoumena“ got lost but passages of it can be found in the encyclopedic medical work of the Byzantinean physician Oreibasios (325-403AD).

In the ancient time only palpable periferal aneurysms were known. Antyllos treated differently two types: spontaneous and traumatic aneurysms. The first fusiform in appearance and if not too great in size were cured ligating the artery at the proximal and distal end of the pathology. To prevent fatal intraoperative bleeding he gave a meticulous surgical description of the procedure. He paid great attention to the preparation of the aneurysm removing all sheets around the aneurysm and parts of the adjacent normal artery till it was “naked” (gymnazomene). Then with great caution he pushed a probe under the aneurysm and a needle with a twice boiled linen thread or string. The thread was cut close to the needle resulting in two threads each placed proximally and distally of the pathology. After ligation, the aneurysm could be safely punctured and the blood inside evacuated without danger of causing bleeding. Opposed to other surgeons Antyllos did not recommend to remove the aneurysm between the two ligatures because, he argued, sometimes by intravascular pulsation of blood and air at the stoma the ligation can loosen and slip.

For traumatic aneurysms, saccular in appearance, he proposed after sizing as much as possible of the skin with the aneurysma to set stitches underneath and ligate the artery on both sides transcutaneously before evacuating the aneurysma by skin incission.

This trapping technique was nearly identically taken over by the Byzantinean physicians such Aetios in the 6th, Paulus in the 8th century and the Arabic physicians Rhazes in the 9th and Albucasis in Andalusia in the 10th century.

Although Antyllos never treated intracranial aneurysms, this is the first description of a surgical treatment of an aneurysm which credibly could have been successful if done by a skillful surgeon and the collateral blood supply was sufficient. The way how Antyllos describes the preparation of the aneurysm confirms his extraordinary anatomical knowledge and surgical skills.