Notes of cases illustrating surgical lesions of the vascular system / by Rudolph Matas.

  • Matas, Rudolph, 1860-1957.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Notes of cases illustrating surgical lesions of the vascular system / by Rudolph Matas. 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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    There the large dilated vessel became suddenly contracted, and forming a curve folded on itself and returned over the trachea, following the contour of the thyroid and returned to the right carotid region, where it terminated in an apparently normal common carotid that bifurcated at the usual level. The vessel in its first portion had the caliber of a large innominate trunk; its coats were very thick, and the impression conveyed was that it was a large artery that had undergone a uniform dilation with some thickening of its coats, but without any sac- ciform or fusiform dilation. The diagnosis was, therefore, arterial varix or cirsoid aneurism of the common carotid. This condition was so peculiar and novel to us that we hes- itated for a moment, but concluded that it would be safe to apply a distal ligature to the common carotid on the Brasdor princi- ple, just below the bifurcation. This was done without diffi- culty and a sterilized silk ligature was used. As the coats of the dilated aitery over the trachea were thick but soft and apparently free from calcareous deposit, we decided to risk the application of another ligature over the middle of the varix itself. This was not done until an attempt had been made to trace the varix to its origin at the root of the neck. The fear of injuring the left innominate vein, which was separated with difficulty from the arterial trunk, compelled me to desist from satisfjdng myself as to the exact origin of the dilated trunk, but it appeared to me from its length and depth that it must have arisen from the arch of the aorta itself or from a very short innominate trunk. As stated previously, the condition of the abnormal artery was such tliat I felt justified in applying a ligature over the middle of the dilated portion, using a double heavy aseptic catgut ligature and employing just sufficient force to merely approxi- mate and keep in contact the arterial coats. No attempt was made to lacerate the intima, only simple approximation of the arterial surfaces was aimed at. The object of this second ligature was to produce sufficient irritation at the point of liga- ture to excite adhesive inflammation, and in conjunction with the distal ligature, below the bifurcation of the carotid, to oblit- erate the vessel. A marked diminution in the size of the ves-