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Updated: May 28, 2025
#Gangrene following Ligation of Arteries.# After the ligation of an artery in its continuity for example, in the treatment of aneurysm the limb may for some days remain in a condition verging on gangrene, the distal parts being cold, devoid of sensation, and powerless. As the collateral circulation is established, the vitality of the tissues is gradually restored and these symptoms pass off.
There was profuse and continuous hemorrhage for a time, and subsequently a false aneurysm developed, which ruptured in about three months, giving rise to enormous momentary hemorrhage; notwithstanding the severity of the injury and the extent of the hemorrhage, complete recovery ensued.
The risks incident to this class of wounds are: the extreme difficulty, especially when a dense fascia has been perforated, of rendering them aseptic, on account of the uncertainty as to their depth, and of the way in which the surface wound closes on the withdrawal of the instrument; different forms of aneurysm may result from the puncture of a large vessel; perforation of a joint, or of a serous cavity, such as the abdomen, thorax, or skull, materially adds to the danger.
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.
It is characterised by the usual symptoms, and is treated by palliative measures, or by ligation of the artery above and below the point of communication. Aneurysm in the #leg and foot# is rare. It is almost always traumatic, and is treated by excision of the sac.
The Hunterian operation ensures that the ligature is applied to a part of the artery that is presumably healthy and where relations are undisturbed by the proximity of the sac; the best example is the ligation of the superficial femoral artery in Scarpa's triangle or in Hunter's canal for popliteal aneurysm; it is on record that Syme performed this operation with cure of the aneurysm on thirty-nine occasions.
Aneurysm of the internal carotid is of special importance on account of the way in which it bulges into the pharynx in the region of the tonsil, in some cases closely simulating a tonsillar abscess. Cases are on record in which such an aneurysm has been mistaken for an abscess and incised, with disastrous results. Aneurysmal varix may occur in the neck as a result of stabs or bullet wounds.
Colt's method of wiring has been mainly used in the treatment of abdominal aneurysm; gilt wire in the form of a wisp is introduced through the cannula and expands into an umbrella shape.
When resection is impracticable, a subcapsular enucleation is performed, followed by the insertion of radium. #Pulsating Hæmatoma# or #Aneurysm of Bone#. A limited number of these are innocent cavernous tumours dating from a congenital angioma. The majority would appear to be the result of changes in a sarcoma, endothelioma, or myeloma.
When it becomes filled with clot consolidated aneurysm these signs disappear, and the clinical features are those of a solid tumour lying in contact with an artery, and transmitting its pulsation.
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