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A careful consideration of the position in which the swelling first appeared, of the direction in which it has progressed, of its pressure effects, and of the condition of the pulses beyond, may help in distinguishing between aortic, innominate, carotid, and subclavian aneurysms. Skiagraphy is also of assistance in recognising the vessel involved.
Popliteal, carotid and other aneurysms, which are not of traumatic origin, are sometimes dealt with on this plan, which is the old "Method of Antyllus" with modern aseptic conditions. Speaking generally, if an aneurysm can be dealt with surgically the sooner that the artery is tied the better. Less heroic measures are too apt to prove painful, dangerous, ineffectual and disappointing.
#Intracranial aneurysm# involves the internal carotid and its branches, or the basilar artery, and appears to be more frequently associated with syphilis and with valvular disease of the heart than are external aneurysms. It gives rise to symptoms similar to those of other intracranial tumours, and there is sometimes a loud murmur. It usually proves fatal by rupture, and intracranial hæmorrhage.
Rupture may take place externally, or into the cellular tissue of the iliac fossa. These aneurysms have to be diagnosed from pulsating sarcoma growing from the pelvic bones, and from an abscess or a mass of enlarged lymph glands overlying the artery and transmitting its pulsation.
Anatomy INJURIES OF ARTERIES: Varieties INJURIES OF VEINS: Air Embolism Repair of blood vessels and natural arrest of hæmorrhage HÆMORRHAGE: Varieties; Prevention; Arrest Constitutional effects of hæmorrhage Hæmophilia DISEASES OF BLOOD VESSELS: Thrombosis; Embolism Arteritis: Varieties; Arterio-sclerosis Thrombo-phlebitis Phlebitis: Varieties VARIX ANGIOMATA Nævus: Varieties; Electrolysis Cirsoid aneurysm ANEURYSM: Varieties; Methods of treatment ANEURYSMS OF INDIVIDUAL ARTERIES.
An aneurysm may prove fatal by exerting pressure on important structures, by causing syncope, by rupture, or from the occurrence of suppuration. Pressure symptoms are usually most serious from aneurysms situated in the neck, thorax, or skull. Sudden fatal syncope is not infrequent in cases of aneurysm of the thoracic aorta.
On the other hand, some arteries, especially if the calcareous deposits are considerable, may become weakened in spots and dilation may occur, causing either smaller or larger aneurysms. Histologically the disease is a connective tissue formation beginning first as a round-cell infiltration in the subendothelial layer of the intima.
The division, of aneurysms into two classes, true and false, is unsatisfactory. On the face of it, an aneurysm which is false is not an aneurysm, any more than a false bank-note is legal tender. A better classification is into spontaneous and traumatic.
It is less successful than the proximal ligature, and is therefore restricted to aneurysms so situated as not to be amenable to other methods; for example, in aneurysm of the common carotid near its origin, the artery may be ligated near its bifurcation, or in aneurysm of the innominate artery, the carotid and subclavian arteries are tied at the seat of election. Compression.
But in those aneurysms which are fusiform dilatations of the vessel there is but slight chance of such cure, for the blood sweeps evenly through it without staying to deposit clot or laminated fibrine.
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