Study of one hundred and fifteen oper ated cases of subclavian aneurisms. De ductions as to treatment: Strict asepsis the sheet-anchor. The best plan is to ligate the first portion of the subclavian with a double or, better, triple, non contiguous, absorbable ligature, without rupturing the coats. When it is decided to ligate the subclavian and the common carotid in one operation, it is best to first ligate the subclavian. In idiopathic aneurisms the defective general condi tion of the patient should be borne in mind. Souchon (Annals of Surg., Nov., '95).
Case of left subclavio-axillary trau matic aneurism; ligation of subclavian artery in its second part; recovery, with perfect use of arm. Croly (Med. Press and Cire., Feb. 16, '98).
Axillary Aneurism.
A peculiarity of this form is its rapid growth. Being surrounded by lax tis sues, it develops very quickly and is soon of considerable size. The same anatom ical feature causes the sac to be easily inflamed, its location tending to assist this by the exposure to traumatism, press ure, etc.
Pain is usually a prominent symptom, owing to pressure on the nerves of the brachial plexus. CEdema of the forearm usually follows the venous obstruction induced by pressure of the aneurism on the venous trunks. The pulse at the wrist is slower than that of the opposite side.
An axillary aneurism may compress the lung, causing dry pleurisy or hyper plastic pneumonia, or may erode the ribs. It may invade the shoulder-joint, inter fere with the motion of the arm, and cause ankylosis.
Traumatic axillary aneurisms are caused by a wound, an attempt to re duce an old dislocation, etc.
Etiology. — Aneurism of the axillary artery is sometimes traumatic. At other times it may be due to elongation of the artery by too free motion of the shoul der-joint, or to stretching during the re duction of an old dislocation, especially when the vessels are atheromatous.
Case of axillary aneurism caused by the pressure of a crutch. Bardeleben (Berliner klin. Woch., Dec. 16, '89).
Case of axillary traumatic aneurism caused by the jamming of a pair of scis sors up into the axilla, making a punct ured wound about 1 inch in depth. The aneurism consolidated spontaneously and was almost entirely absorbed. This re sult was probably induced by elevation of the arm, with the patient in the re cumbent position. Willett (Practitioner.
Dec., '93).
Prognosis.—Spontaneous cure of these aneurisms is very rare. The sac, if al lowed to do so, rapidly becomes larger and ruptures into the surrounding cell ular tissue, the shoulder-joint, or the thorax.
Treatment.—Compression of the third portion of the subclavian may be first tried, with or without an elastic band age applied to the arm. Compression is usually very painful. Should these methods fail, the third portion of the subclavian may be tied.
The most satisfactory treatment in general is to ligate the subclavian as far away as possible, dividing the scalenns anticus. When the incision involves considerable tissue the phrenic nerve should be watched for, and pushed aside if met. Collateral branches of the artery should also be tied to diminish the risk of secondary hmmorrhage.
Cases of axillary aneurism, with suc cessful ligation of subelavian artery. Neugebauer (Centralb. fur Chi., Aug. 17, '95) ; Horwitz (Then Gaz., May 15, '95); W. E. Waters (Medical Record, May 25, '95).
The treatment of traumatic aneurism should consist in arresting the circula tion by pressure on the third portion of the subclavian, opening the sac, and re moving its contents. The wound in the artery should then be found and the artery divided at that point, both ex tremities being tied.
Brachial.
Brachial aneurism is usually traumatic in origin. Venesection, carelessly per formed, occasionally causes aneurismal varix or varicose aneurism at the bend of the elbow.
Aneurism half the size of an orange in the bend of the elbow, subsequent to renesection, cured by ligature of the brachial artery in middle third. Gallo (Le Dauphine Med., Mar., '94).
Case diagnosed as a neuroma of me dian nerve found, on exposing swelling, to be a cured traumatic aneurism of the brachial artery. On account of excru ciating pain artery cut above and below aneurism and sae dissected out. Bland Sutton (Med. Press and Circular, Sept. 26, '94).
Idiopathic brachial aneurism may be treated by Hunter's method, by the modified method of Antyllus, or by com pression. In either of these, however. gangrene of the forearm is a possibility. When this complication occurs, amputa tion becomes necessary.