Operative treatment of aneurisms of the third portion of the subclavian artery / by Edmond Souchon.

  • Souchon, Edmond, 1841-1924.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Operative treatment of aneurisms of the third portion of the subclavian artery / by Edmond Souchon. 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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    same way the first hitch of a reef-knot (see p. 384), and tighten each separately so that the loop lies in contact with the vessel without constricting it; then taking the two ends on one side together in one hand, and the two ends of the other side in the other hand, constrict the vessel sufficiently to occlude it; finally complete the reef-knot. The simplest method of completing the knot is to treat the two ends in each hand as a single thread, and to tie as if completing a single reef-knot (B. and E., p. 39^)- In no case in man has a stay-knot been employed for liga- tion in continuity (B. and E., p. 469). In one case of amputation the stay-knot has been used for the femoral, which was much diseased, and all went well (B. and E., p. 469). Concerning the Clots.—A clot is almost always present above and below when the walls have not been injured (B. and E., p. 145). But it takes no active part in the constructive process by which an artery is obliterated. Senn and all experimenters agree in this; some think these clots are an actual hinderance to the cicatrization, are as much of a foreign body as the clot on the flap of an amputation stump (B. and E., p. 161). Concerning the H<2morrhage.—It is probable that, except in I those cases in which a large branch is given off just above the ligature, the haemorrhage more frequently occurs from the distal end than from the proximal (B. and E., p. 293). In none of the experiments on the lower animals did second- ary haemorrhage occur (B. and E., p. 464). Conclusions.—To sum up : thorough asepsis, suitable asep- tic ligatures (see above), suitable knot, suitable force; the over- denuding of the artery does not matter; nor the presence of a large collateral, nor a slight atheromatous condition. Retrospect. It is most interesting to revert to the past and see the various suggestions which were offered, and are still offered, by operators for the cure of this terrible disease. (i) Sabine had suggested the simultaneous ligation of the innominate, common carotid, vertebral, also of each branch of the thyroid axis and of the internal mammary. Also of any anom-