If the aneurism be one of the internal iliac and idiopathic, pressure may be ap plied above it, and, in non-success, co agulating injections, or even ligation by a median laparotomy may be resorted to. If the aneurism is traumatic, the artery should be compressed above the aneu rism, the sac incised, and the artery tied' above and below the wound.
When dealing with the external iliac. artery and the aneurism is idiopathic, compression should be first tried, fol lowed in case of failure by ligation above the sac. This operation may be per formed by a median laparotomy. The modified operation of Antyllus should be used if the aneurism is traumatic.
Case of successful extirpation of an aneurism of the right external iliac ar tery, occupying whole right iliac fossa and as large as the head of a child at term. Recovery uneventful, and patient following his occupation as a clown.. Quenu (Le Bull. Med., Dec., '94).
Case of large ilio-femoral aneurism. Ligation of external iliac artery. Pa tient up by the forty-seventh day. Three. months later aneurism in opposite groin. Operation repeated; recovery much more rapid than on first occasion, collateral circulation being established more promptly. Patient a carpenter. Makins (Brit. Med. Jour., Nov. 30, '95).
Case in which transperitoneal ligation of the external iliac artery for femoral aneurism . was performed with subse quent dissection of the sac. Recovery, but with complete paralysis of sensation over the anterior aspect of the thigh and inability to extend the leg on the thigh, probably due to section of some branches of the anterior spinal nerve while laying the sac open. N. I'. Dandridge (Med. News, Apr. 3, '97).
Two eases of ligature of the external iliac artery for aneurism by the trans peritoneal method. The transperitoneal operation has many advantages over the older operation, provided strict cleanli ness is maintained. In both cases the ordinary operation would have been diffi cult, if not impossible, owing to the position of the swelling. W. II. Brown (Lancet, Oct. 23, '97).
The following conclusions offered as fundamental rules to be observed in the treatment of ilio-femoral aneurism: Whenever possible, compression should he given a trial before resort to more• severe measure. If compression fails,
operative procedures are then indicated, and, when feasible, total extirpation of the sac should be chosen as the surest. These rules are especially applicable to ilio-femoral aneurism, but they are equally so to aneurisms of other portions of the body, if they are so situated as to allow of operative treatment. F. Schops (Wiener Min. Woch., Nov. 24, '9S).
Case of aneurism of uterine artery cured by ligation of internal iliac artery. Patient was originally operated on for a pelvic abscess, which was opened through the vagina. The incision was followed by copious venous hvemorrhage. On ex amination there was found "a softly elastic, strongly pulsating, and thrilling tumor of about the size of a hen's egg, projecting into the left vaginal vault, close to the cervix and extending slightly down on the left vaginal wall." An in cision was made in the left semilunar line and the internal iliac artery was isolated and tied. Pulsation, all but a slight transmitted movement, entirely stopped in aneurism and the patient made a good recovery. In order to doubly insure a cure galvanopuncture was practiced twice, with noticeable benefit. Paul F. MundC; (Med. Rec., Dec. 31, '98).
Aneurism.
Symptoms.—The femoral artery is fre quently the seat of traumatic aneurism on account of its exposed position. It may involve the common, the superficial, or the deep. It is generally sacculated.
In some cases it is fusiform or flattened, as in Hunter's canal.
Differential Diagnosis.—The difficulty here lies in recognizing whether the dila tation is on the superficial or the deep branch, the other characters peculiar to an aneurism being easily determined. The superficial branch is that most fre quently affected, and the arterial pulsa tions below are more affected by it than by an aneurism of the superficial branch. The bruit of aneurism in cases where the femoral or popliteal artery is the seat of the lesion may frequently be made more distinct by placing the patient in the re cumbent position and elevating the limb.