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Updated: June 12, 2025
As there is little tendency to spontaneous cure, and as the aneurysm is liable to increase in size and finally to rupture, operative treatment is usually called for. This is carried out on the same lines as for aneurysmal varix, and at the same time incising the sac, turning out the clots, and ligating any branches which open into the sac. If it can be avoided, the vein should not be ligated.
Also when an artery is wounded and the wound in the skin and superficial structures heals, the blood may escape in to the tissues, displacing them, and by its pressure causing them to condense and form the sac-wall. The coats of an artery, when diseased, may be torn by a severe strain, the blood escaping into the condensed tissues which thus form the aneurysmal sac.
Sometimes the arterial vessels are so dilated as to impart to the tumour an aneurysmal pulsation and bruit. The enlargement or "expansion" of the bone results in the cortex being represented by a thin shell of bone, which may crackle on pressure parchment or egg-shell crackling.
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.
Two varieties are recognised one in which the communication is direct aneurysmal varix; the other in which the vein communicates with the artery through the medium of a sac varicose aneurysm.
Portions of malignant tumours also may form emboli, and their impaction in the vessels may lead to the development of secondary growths in distant parts of the body. Fat and air embolism have already been referred to. Pyogenic. Non-suppurative inflammation of the coats of an artery may so soften the wall of the vessel as to lead to aneurysmal dilatation.
Atheromatous degeneration is most common in the large arterial trunks, and the changes are most marked at the arch of the aorta, opposite the flexures of joints, at the mouths of large branches, and at parts where the vessel lies in contact with bone. The presence of diseased patches in the wall of an artery diminishes its elasticity and favours aneurysmal dilatation.
These symptoms are due, in the majority of cases, to an aneurysmal varix of the internal carotid artery and cavernous sinus, which is often traumatic in origin, being produced either by fracture of the base of the skull or by a punctured wound of the orbit.
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