A case of ligature of the abdominal aorta just below the diaphragm, the patient surviving for forty-eight days : with a proposed instrument for the treatment of aneurisms of the abdominal aorta by temporary compression / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1900
Catalogue details

Licence: In copyright

Credit: A case of ligature of the abdominal aorta just below the diaphragm, the patient surviving for forty-eight days : with a proposed instrument for the treatment of aneurisms of the abdominal aorta by temporary compression / by W.W. Keen. 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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    removed wlieu the object had beeu attained. The two most serious objections which seem to me to lie against this plan are, first, that structures other than the aorta would be liable to injury, especially the thoracic duct, and, secondly, the possibility of infection and the more extensive injury, neither of which, however, need be taken too seriously. The instrument that I have devised avoids the danger just alluded to —of pressure on the thoracic duct—and requires only Ihe opening of the abdomen and its application to the vessel. It consists of two parts (Fig. 10): First, a shank with a horizontal plate, which passes at right angles to the shank behind the aorta. The aortic sur- face is slightly roughened, in order to prevent slipping. Secondly, a second shank, with another horizontal plate, which can be introduced separately and fastened to the shank of the first piece by slipping the narrowed portion under the two projecting teeth of the first shank. This upper horizontal plate is also slightly ribbed on its under surface and provided with a lip which overlaps the lower horizontal plate, the object of the lip being to prevent the slipping of the aorta from the grasp of the blades. I have measured the human aorta, and find that when flattened out it measures about 36 mm. transversely. This would give the proper measurement for the width of the plates. In order to make the narrowing of the aorta a conical or gradual one, instead of the abrupt narrowing caused by the ligature, the sides of the upper horizontal plate shelve gently upward. For application to the human subject the length of the plates should be about 15 mm. in the horizontal portion, the shelving portion at the upper and lower border being about 5 mm. each. The length of the shanks or handles would be greater or less in accordance with the build of each patient. In a very stout person they would have to be much longer than in a thin patient. The instrument can be introduced either as a whole, or, probably more readily, in two parts, which are then fastened together by passing the narrow portion of the handle of the upper blade into the grasp of the two prongs or teeth on the handle of the lower blade. By means of the screw at the upper end the upper blade is now gradually approximated to the lower, and when an assistant, with his finger on the femoral artery, finds that the pulsation has disappeared, occlusion of the aorta would be complete. By means of the little crossbar and by unscrewing the screw the upper blade can be retracted to any desired extent. By this manipulation it is evident that the circulation can be absolutely arrested or can be reduced to any degree that is desired. By this means Murray’s method of temporary compression can be adapted to the aorta for any length