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Gurlt, in his "History of Surgery," calls attention to the fact that two of our modern methods of treating varicose veins are thus discussed in Aëtius, that by ligation and that by the cautery. The cautery was applied over a space the breadth of a finger at several points along the dilated veins.
The origin of the tumour from bone may be revealed by the presence of egg-shell crackling, and by examination with the X-rays. If the condition is believed to be innocent, the treatment is the same as for aneurysm preferably by ligation of the main artery; if malignant, it is the same as for sarcoma.
Anel's ligature is only practised as part of the operation which deals with the sac directly. Distal Ligation.
Definition Types: Dry, Moist Varieties Gangrene primarily due to interference with circulation: Senile gangrene; Embolic gangrene; Gangrene following ligation of arteries; Gangrene from mechanical causes; Gangrene from heat, chemical agents, and cold; Diabetic gangrene; Gangrene associated with spasm of blood vessels; Raynaud's disease; Angio-sclerotic gangrene; Gangrene from ergot.
In excision the hæmorrhage is controlled by an elastic tourniquet applied horizontally round the head, or by ligation of the feeding trunks. In large tumours the bleeding is formidable. In many cases electrolysis is to be preferred, and is performed in the same way as for nævus.
Any of the methods already described is available for their treatment the choice lying between Matas' operation and ligation of the external iliac. Aneurysm of the profunda femoris is distinguished from that of the main trunk by the fact that the pulses beyond are, in the former, unaffected, and by the normal artery being felt pulsating over or alongside the sac.
Ligation of the saphenous vein at two points, one above and the other below the distended ligamentous capsule, is an old operation, which has undoubtedly given good results in some cases, although it does not seem to be a rational procedure. After-Care. After swelling has fully developed which occurs within a week the subject is turned to pasture and no attention is necessary thereafter.
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.
Amputation is the last resource, and should be decided upon if the hæmorrhage recurs after proximal ligation, or if this has been followed by gangrene of the limb; it should also be considered if the nature of the wound and the virulence of the sepsis would of themselves justify removal of the limb. Every surgeon can recall cases in which a timely amputation has been the means of saving life.
The ligature may be applied on the cardiac side of the aneurysm proximal ligation, or to the artery beyond distal ligation. Proximal Ligation.
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