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Updated: June 28, 2025
The external carotid and the cervical portion of the internal carotid are seldom the primary seat of aneurysm, although they are liable to be implicated by the upward spread of an aneurysm at the bifurcation of the common trunk. In addition to the ordinary signs of aneurysm, the clinical manifestations are chiefly referable to pressure on the pharynx and larynx, and on the hypoglossal nerve.
When electrolysis is employed, it should be directed towards the afferent vessels; and if it fails to arrest the flow through these, it is useless to persist with it. In some cases ligation of the afferent vessels has been successful. #Arterial Angioma# or #Cirsoid Aneurysm#. This is composed of the enlarged branches of an arterial trunk.
If such a patient with the disease advanced to this stage must overwork, or sustains any severe muscle strain, an aneurysm of the aorta may occur. In the meantime, with the advancing degeneration of the cerebral arteries, some sudden cerebral congestion, caused by leaning over, lifting, vomiting or hard coughing, may rupture a cerebral vessel, and all the symptoms of apoplexy are present.
In the limbs gangrene may ensue, especially if the wound is infected. Punctured and gun-shot wounds implicating both artery and vein are liable to be followed by the development of arterio-venous aneurysm.
The diagnosis has to be made from solid or cystic tumours overlying the artery; from a "pulsating aorta"; and from spinal caries; much help is obtained by the use of the X-rays. The condition usually proves fatal, either by the aneurysm bursting into the peritoneal cavity, or by slow leakage into the retro-peritoneal tissue.
Amputation of the limb is indicated in cases complicated by suppuration, by secondary hæmorrhage after excision or ligation, or by gangrene. Amputation at the shoulder was performed by Fergusson in a case of subclavian aneurysm, as a means of arresting the blood-flow through the sac.
The term neuralgia is applied clinically to any pain which follows the course of a nerve, and is not referable to any discoverable cause. It should not be applied to pain which results from pressure on a nerve by a tumour, a mass of callus, an aneurysm, or by any similar gross lesion. We shall only consider here those forms of neuralgia which are amenable to surgical treatment.
#Gluteal Aneurysm.# An aneurysm in the buttock may arise from the superior or from the inferior gluteal artery, but by the time it forms a salient swelling it is seldom possible to recognise by external examination in which vessel it takes origin. The special symptoms to which it gives rise are pain down the limb from pressure on the sciatic nerve, and interference with the movements at the hip.
This method is suitable to sacculated aneurysm of the limbs, so long as they are circumscribed and free from complications. It has been successfully practised also in aneurysm of the subclavian, carotid, and external iliac arteries. It is not applicable to cases in which there is such a degree of atheroma as would interfere with the successful ligation of the artery.
The development of the collateral circulation which follows upon ligation of the artery at a distance above the sac may be attended with just that amount of return stream which favours the deposit of laminated clot, and consequently the cure of the aneurysm; the return stream may, however, be so forcible as to prevent coagulation of the blood in the sac, or only to allow of the formation of a red thrombus which may in its turn be dispersed so that pulsation in the sac recurs.
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