On the operative treatment of popliteal aneurism / by Thomas Annandale.

  • Annandale, Thomas, 1839-1908.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: On the operative treatment of popliteal aneurism / by Thomas Annandale. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    having after the application an elastic bandage constantly round the limb, but not used so as to interfere with the circulation, in the second case two applications of the tourniquet, at an interval of a week, were required, and the use of the elastic bandage for two weeks alter the second compression. It is a well-known fact that cases of popliteal aneurism are occasionally very easily cured, and it may be that my two cases belonged to this class; but, as they were both under treatment about the same time, I have thought a brief note of them might be interesting.1 When compression fails to cure a popliteal aneurism, or when the case is one unsuitable for it, the treatment almost invariably suggested and practised is ligature of the femoral artery at the apex of Scarpa’s triangle. Should ligature of the femoral artery fail to cure the disease, or should pulsation in the sac return and persist alter this operation, the usual advice and practice is to try compres- sion above the seat of ligature, or to try the flexion method; or, these failing, to tie the external iliac or common femoral arteries. Should these plans not succeed, there is, as Erichsen2 {Science and Art of Surgery, 8th edition, vol. ii., page 130) remarks, only the choice between “amputation and opening the sac.” He further says:—“ Of these measures I should certainly prefer amputation, as offering the most favourable chance to the patient.” Mr Erichsen continues:—“ The operation of opening the sac, turning out its contents, and ligaturing the vessel supplying it, is in any circum- stances a procedure fraught with the greatest danger to the patient, and full of difficulty to the surgeon, even when he knows in what situation to seek the feeding vessel.” There are certain local conditions of a popliteal aneurism which are recognised by all surgeons to render the case unsuitable for compression. Among tire principal of these local conditions are:— (1.) Large and rapidly growing aneurisms. (2.) Diffused and ruptured aneurisms. (3.) Aneurisms tending to involve or involving the knee- joint. (4.) Inflamed and suppurating aneurisms. In addition to these local conditions may be mentioned an un- healthy state of the arterial system. In the first three of these conditions the common rule followed is to try ligature of the femoral artery, but most authorities qualify this opinion by stating that the ligature of the artery is a very uncertain treatment in these cases, and that amputation will not unfrequently be required. In aggravated examples of these con- ditions immediate amputation is advised by some, as the ligature 1 A third case recently treated by this same method was not cured, and ligature of the femoral artery was required. 2 I quote Erichsen because lie is a deservedly high authority upon the subject, and his work on Surgery has been quite recently carefully revised ancl brought up to date.