Results of the treatment of aneurysm by wiring / by D'Arcy Power and G.H. Colt.

  • Power, D'Arcy, 1855-1941.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Results of the treatment of aneurysm by wiring / by D'Arcy Power and G.H. Colt. 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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    The chief indications for the operation of wiring are: (1) An aneu- rysm of the ascending part of the arch of the aorta, especially if X-ray examination in two planes at right angles to each other indicates sacculation. (2) Abdominal aneurysm in the usual situation—namely, at the origin of the cceliac axis. Both these types of aneurysm are usually saccular, and the louder the bruit the greater is the chance of a case being a suitable one for wiring, because the aneurysm is probably saccular and the opening of the sac small. Medical treatment is of no avail. The chief contra-indications are: (1) Bapid increase of pain or of pressure symptoms. These are probably indicative of an early and fatal termination. If these symptoms pass away under treatment the question of operation can be again considered. (2) The presence of a second aneurysm. (3) Sepsis. (4) Involvement of the transverse part of the arch. The cases recorded by Hodgson show clearly that the patient’s discomfort is much increased by consolidation taking place in this situation. As regards the instruments, Nos. 1 and 2 are now obsolete. The advantages claimed for instrument No. 3—the one here shown—are: First, that asepsis is absolutely secured; secondly, that there is a minimal risk of wire entering the aorta; thirdly, that the operation can be performed easily, quickly and gently. It is important to emphasize the latter point, because the idea has become prevalent that force is needed. The whole secret of avoiding shock in this part of the operation seems to lie in pushing home the piston very gently. The record of cases just given shows that it is absolutely essential to see blood spurting through the cannula before the cartridge is inserted, for there is otherwise no certainty that the wires will open out in the sac or that they will enter the blood-stream at all. It is also advisable to withdraw the cannula until the end only just projects into the blood- stream, because if the wires, on emerging from the cannula, are close to the opposite wall of the sac they may not open out properly. Much damage might be done in this way, especially if any force were used. Fourthly, the exact quantity of wire is known and its probable arrange- ment in the sac may be assumed with some degree of accuracy. Lastly, the dull gilding of the wire provides a granular surface, as proved by Holt’s case, which is most efficient in collecting firmly adherent fibrin from the blood. John Sale, Sons & Danielsson, Ltd., 83-&1, Great 'Litchfield Street, London, W.