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Aneurysmal varix, which was frequently met with in this situation in the days of the barber-surgeons, usually as a result of the artery having been accidentally wounded while performing venesection of the median basilic vein, may be treated, according to the amount of discomfort it causes, by a supporting bandage, or by ligation of the artery above and below the point of communication.
But for the local aneurysmal thrill at the point of the scar the condition would have been diagnosed as angioma, but as a bruit could be heard over the entire mass it was called an aneurysmal varix, because it was believed there was a connection between a rather large artery and a vein close to the mass. There is a curious case reported of cirsoid tumor of the ear of a boy of thirteen.
The arteries were also distorted and could be felt pulsating all over the limb. The patient died at thirty from rupture of the aneurysm. Abbe shows a peculiar aneurysmal varix of the finger in a boy of nine. When a babe the patient had, on the dorsum of the little finger, a small nevus, which was quiescent for many years.
Varicose aneurysm usually develops in relation to a traumatic aneurysm, the sac becoming adherent to an adjacent vein, and ultimately opening into it. In this way a communication between the artery and the vein is established, and the clinical features are those of a combination of aneurysm and aneurysmal varix.
In aneurysmal varix the higher blood pressure in the artery forces arterial blood into the vein, which near the point of communication with the artery tends to become dilated, and to form a thick-walled sac, beyond which the vessel and its tributaries are distended and tortuous.
This laminar coagulation by constant additions gradually fills the aneurysmal cavity and the pulsation in the sac then ceases; contraction of the sac and its contents gradually takes place and the aneurysm is cured.
When a normal person reclines after standing there is a fall in venous pressure, and when he again stands erect there is an increase in venous pressure. Jour Med. Pulsation in veins may be due also to an aneurysmal dilatation, or to direct connection with an artery.
A peculiar sequence of an aortic aneurysm is perforation of the sternum or rib. Webb mentions an Irish woman who died of aneurysm of the aorta, which had perforated the sternum, the orifice being plugged by a large clot. He quotes 17 similar cases which he has collected as occurring from 1749 to 1874, and notes that one of the patients lived seven weeks after the rupture of the aneurysmal sac.
Experience shows that ligation of the vein, or even the removal of a portion of it, is not necessarily followed by gangrene. The risk of gangrene is diminished by a course of digital compression of the femoral artery, before operating on the aneurysm. Aneurysmal varix is sometimes met with in the region of the popliteal space.
In aneurysmal varix, a not infrequent result of a bullet wound or a stab, the communication with the vein may involve the main trunk of the femoral artery.
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