Ligations of the left subclavian artery in its first portion / by William S. Halsted.

  • Halsted, William, 1852-1922.
Date:
[between 1900 and 1999]
Catalogue details

Licence: In copyright

Credit: Ligations of the left subclavian artery in its first portion / by William S. Halsted. Source: Wellcome Collection.

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    carried further upwards along the outer border of the sternal head of the sterno-inastoid. A second incision was made from the lower end of this outwards along the line of the clavicle and this triangular flap of skin was then turned upwards and outwards; the remains of the clavicular head of the sterno-mastoid were drawn outwards and the internal jugular vein exposed. Blunt dissection external to the vein exposed the anterior scalene muscle and phrenic nerve. The jugular vein was drawn inwards and the muscle outwards. The trans¬ verse process of the sixth cervical vertebra was exposed. A vessel of no great size was now defined in the position of the vertebral artery and was ligatured with silk; the ligature unfortunately broke, dividing the vessel, which was secured with difficulty and tied at both ends. No other vessel could be found in this situation, though the foramen through the transverse process could be clearly defined. A second vessel—the inferior thyroid artery—was also tied. A piece of gauze was carried to the bottom of the wound as a drain and the incision was sutured with horsehair. Ligature of these vessels materially diminished but did not arrest the pulsation in the sac and it was therefore deter¬ mined to apply a distal ligature to the third part of the axillary artery, and this was accordingly done just above the subscapular branch and was followed by complete arrest of the pulsation. On June 29th the patient was comfortable.The circulation in the fingers was good. The wound in the neck had oozed a little and the dressing was stained; this had been packed. On the 30th the wound was dressed and a smaller plug of gauze was put in the cervical wound. The wounds were healthy. On July 3rd the patient was progressing satisfactorily and was kept on fluid diet. The dressings had not been touched. The circulation in the arm was good but no pulse was present either at the wrist or the elbow.On the 5th there had been uninterrupted progress. The wound was dressed and the sutures and gauze plug were removed. No pulse was to be felt. The aneurysm was decidedly smaller, harder and denser; there was no trace of pulsation in the sac. On the 11th the wounds were soundly healed. The aneurysm was still smaller and harder; over it slight pulsation could be felt along a transverse line ( ? the transverse cervical artery). The radial pulse was just perceptible. The further progress of the case was uninterrupted. The sac gradually diminished in size and the pulse became stronger in the radial. The patient complained for a few days of stiffness in the fingers. Eemarks by Mr. Stonham: In November [year not stated] I saw the patient and could find absolutely no trace of the sac.The movements of the arm were necessarily weak.I have seen this man as lately as March 1902, and he continues quite well. He is doing light work as a carpenter.^’ In Mr. Stonham’s description of the primary operation no mention is made of the branches given off from the first portion of the artery;