The collateral circulation in aneurism : report of the successful ligation of the innominate, the common carotid, the vertebral, and the internal mammary arteries in a case of right subclavian aneurism / by A.W. Smyth.

  • Smyth, A. W.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: The collateral circulation in aneurism : report of the successful ligation of the innominate, the common carotid, the vertebral, and the internal mammary arteries in a case of right subclavian aneurism / by A.W. Smyth. 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.

    27/29 page 24
    imiomiimte and common carotid arteries, with the ligation of the vertebral to arrest secondary hemorrliage from the distal side of the ligated innominate artery, is a success- fnl operation for the cure of subclavian aneurism, compared with the operations ot tlie past. We have learned, I think, the reason why it is objectionable under some circumstances, when it can be avoided, to ligatci a collateral branch carry- ing the retrograde current of blood to the distal side of a ligated artery, to ar rest secondary hemorrhage from it. And we have learned something about the collateral circulation and its action in bringing about a cure of aneurism. Surely all this knowledge, derived from the successful ligation of the innominate artery, should be enough to disprove the stereo- typed denunciations of this as an “ unjustitiable ” operation. We have also learned from the present case that ligation of the innominate and common carotid arteries alone, without that of the vertebi'al, woidd iu all probability etiect a com- plete cure of subclavian aneurism. It seems to me the course to be adopted in the future is quite plain. We must endeavor to ligate the innominate and common carotid arteries, iu some way that will prevent the occurrence of secondary hemorrhage, which alone has proved fatal to the vast majority of the patients hitherto operated upon. In this attempt, recourse to the ligation of the vertebral artery, if secondary hemorrhage should come on, makes it safe to adopt any procedure that promises a chance of success. The discovery of a means of arresting the secondary hem- orrhage from the distal side of the ligature on the innominate artery, and effecting a cure of aneurism for a period of ten years, is a long step forward from the past. Patients will not be allowed to bleed to death from’this hemorrhage as they have been heretofore. The abundance of loose cellular tissue iu the root of the neck makes it an unfavorable locality for trying the a!itiseptic ligature; still it may be worth the attempt. I have thought for .some time that should another case of right subclavian aneurism present itself to me, I would tie the innominate and common carotid arteries, and, making a longitudinal incision opposite the origin of the subclavian.
    digitised image 1
    digitised image 2
    digitised image 3