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Updated: June 21, 2025
Warren has extirpated one lobe of the thyroid after preliminary ligation of the common carotid on the same side. Green practiced rapid removal of the tumor and ligated the bleeding vessels later. Rose tied each vessel before cutting, proceeding slowly. Senn remarks that in 1878 he witnessed one of Rose's operations which lasted for four hours.
A whole limb even may be avulsed from the body with comparatively little loss of blood. The risk in such cases is secondary hæmorrhage resulting from pyogenic infection. The treatment is that applicable to all wounds, with, in addition, the ligation of the lacerated vessels.
As examples of proximal ligation for secondary hæmorrhage may be cited ligation of the hypogastric artery for hæmorrhage in the buttock, of the common iliac for hæmorrhage in the thigh, of the brachial in the upper arm for hæmorrhage from the deep palmar arch, and of the posterior tibial behind the medial malleolus for hæmorrhage from the sole of the foot.
For women, there is the corresponding, and almost equally simple and harmless method of Kehrer, by section and ligation of the Fallopian tubes through the vagina, as recommended by Kisch, or Rose's very similar procedure, easily carried out in a few minutes by an experienced hand, as recommended by Zuccarelli.
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.
Aneurysmal varix, which was frequently met with in this situation in the days of the barber-surgeons, usually as a result of the artery having been accidentally wounded while performing venesection of the median basilic vein, may be treated, according to the amount of discomfort it causes, by a supporting bandage, or by ligation of the artery above and below the point of communication.
While the development of the collateral circulation after the ligation or obstruction from other cause of a main arterial trunk may be sufficient to prevent gangrene of the limb, it may be insufficient for its adequate nourishment; it may be cold, bluish in colour, and there may be necrosis of the skin over bony points; this is notably the case in the lower extremity after ligation of the femoral or popliteal artery, when patches of skin may die over the prominence of the heel, the balls of the toes, the projecting base of the fifth metatarsal and the external malleolus.
Experience shows that ligation of the vein, or even the removal of a portion of it, is not necessarily followed by gangrene. The risk of gangrene is diminished by a course of digital compression of the femoral artery, before operating on the aneurysm. Aneurysmal varix is sometimes met with in the region of the popliteal space.
In the acute cases of Graves' disease the explosive conversion of latent energy into heat and motion is unexcelled by any other known normal or pathologic phenomenon. The ligation of arteries, the division of its nerve supply, or the excision of part of the gland, may reverse the foregoing picture and restore the normal condition.
We have met with a chronic form of arterial degeneration in elderly women, affecting especially the great vessels at the root of the neck, in which the artery is remarkably attenuated and dilated, and so friable that the wall readily tears when seized with an artery-forceps, rendering ligation of the vessel in the ordinary way well-nigh impossible.
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