Surgical treatment of cervical, thoracic and abdominal aneurism / by Charles Beylard Nancrede.

  • Nancrede, Charles B. (Charles Beylard), 1847-1921.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Surgical treatment of cervical, thoracic and abdominal aneurism / by Charles Beylard Nancrede. 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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    resiliency of the sac and the surrounding tissues tends to diminish the size of the aneurism. If, at the same time, an actual pad be supplied by the gradual deposition of a material which can actively contract, one which, if left under proper conditions for a sufficient length of time, will actually become organized into connective tissue obliterating the aneurism, we have achieved all that art theoretically need do. If permanent closure of the sec- tion of artery from which the aneurism springs can also be secured, the ideal has been attained, rendering relapse impossible. A recapitulation of the chief points of importance concerning the formation of thrombi in the living vessels will render easier of comprehension the rationale of certain surgical methods com- monly employed in the treatment of aneurisms. Not only the physical conditions of the blood and sac, but also the vital con- ditions of the sac wall and of the sac contents, mutually con- tribute to, or interfere with, the deposition of white thrombi. Absolute or, preferably, partial physical rest of the blood favors thrombosis. These conditions can be secured by complete or partial arrest of the direct blood-current flowing through or by the sac : (i) By lessening the force and frequency of the heart’s action ; (2) by dilatation of the peripheral capillaries, i.e., reduc- ing blood pressure ; (3) by physical interruption of direct access of blood to the sac by proximal pressure or ligation ; (4) by preventing the blood passing freely out of the sac by distal mechanical obstruction of the artery. All that is effected by proximal arrest of circulation is a temporary absolute quietude of blood in the sac; with later—from establishment of the collateral circulation—only that marked diminution in velocity of the current which is most favorable, as will shortly be explained, to the formation of a thrombus. Experiments have proven that after damage of the vascular walls moderate slowing of the blood favors the accumulation of white blood cells in the plasmatic current, but that a more marked diminu- tion in the velocity is required to allow the blood plaques to gather in numbers in this peripheral layer, while at the same time the leucocytes relatively diminish. The plaques promptly heap up at the site of injury, according to Eberth and Schim-