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Updated: June 28, 2025
The injury to the artery may be a subcutaneous one such as a tear by a fragment of bone: much more commonly it is a punctured wound from a stab or from a bullet. The aneurysm usually forms soon after the injury is inflicted; the blood slowly escapes into the surrounding tissues, gradually displacing and condensing them, until they form a sac enclosing the effused blood.
All the coats of the vessel are stretched and form the sac of the aneurysm, and the affected portion is not only dilated but is also increased in length. This form is chiefly met with in the arch of the aorta, but may occur in any of the main arterial trunks.
Embolism plays an important part in determining one form of gangrene, as has already been described. Infective emboli are the direct cause of the secondary abscesses that occur in pyæmia; and they are sometimes responsible for the formation of aneurysm.
In other cases they are due to aneurysm of the ophthalmic artery, to thrombosis of the cavernous sinus, and, in rare instances, to cirsoid aneurysm. If compression of the common carotid is found to arrest the pulsation, ligation of this vessel is indicated.
When circumstances prevent these measures being taken, the bleeding may be arrested by making firm pressure over the wound with a pad; but this procedure is liable to be followed by the formation of an aneurysm.
Extirpation of the sac is difficult and dangerous, especially when the aneurysm has spread into the pelvis. #Femoral Aneurysm.# Aneurysm of the femoral artery beyond the origin of the profunda branch is usually traumatic in origin, and is more common in Scarpa's triangle than in Hunter's canal.
The needles are made to touch the opposite wall of the sac, and the pulsation of the aneurysm imparts a movement to them which causes them to scarify the inner surface of the sac. White thrombus forms on the rough surface produced, and leads to further coagulation.
Digital compression of the feeding artery has been given up except as a preparation for operations on the sac with a view to favouring the development of a collateral circulation. Macewen's acupuncture or "needling" consists in passing one or more fine, highly tempered steel needles through the tissues overlying the aneurysm, and through its outer wall.
The Moore-Corradi method has been successfully employed, access to the sac having been obtained by opening the abdomen. Ligation of the aorta has so far been unsuccessful, but in one case operated upon by Keen the patient survived forty-eight days. #Innominate aneurysm# may be of the fusiform or of the sacculated variety, and is frequently associated with pouching of the aorta.
A further risk attends this form of injury, in that the intra-vascular tension may in time lead to gradual stretching of the scar tissue which closes the gap in the vessel wall, with the result that a localised dilatation or diverticulum forms, constituting a traumatic aneurysm.
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