Case in which arterio-venous aneurism followed a wound of the popliteal artery and vein by a spicule of glass. Operation was performed four and one-half weeks after the accident. The sac was opened, both vessels discovered to be injured, and, after an unsuccessful attempt to close the vein by suturing. both were ligated. Of 7 cases of simultaneous ligation of the popliteal artery and vein, in 6 of which these vessels had been wounded. all recovered, 1 after amputation for gan grene. In S other cases the results were entirely favorable. G. P. Newboldt (Lancet, Apr. 23, '92).
In varicose aneurism of the neck or femoral vessels, it is best to cut down upon the artery below and above the sac and ligate without touching the vein or the sac. This method was suggested by Spence, of Edinburgh.
In cutting down upon a varicose an eurism, the incision intended to open the enlarged vein should be followed by one opening the sac, so as to bring the aperture within the artery into the field of operation.
Hunter's method of ligating the artery above the sac is not successful, as the unimpeded circulation of blood into the sac through the vein prevents coagula tion of the fibrin. In a general way, it may be said that all small aneurisms, not involving the larger vessels of a limb, should be extirpated, unless important nerves are jeoparded by the dissection, or, as on the face, where it is important to not leave a scar. The treatment se
lected for larger aneurisms depends upon their situation. Those of the neck which involve the external jugular vein will rarely require treatment, but, should it be necessary, such cases are best treated by double ligation of both vessels. In other situations the simple ligature of the vessels should not be chosen, for it will, in most eases, require as much dis section as will incision or extirpation, while not giving the same immunity from relapse. The surgeon should make an incision down upon the sac in its entire length, and attempt to dissect it from its bed. If this prove difficult or impossible because of inflammatory thick ening or intimate connection with impor tant parts, the sac should be incised, for it is often easier to secure the vessels when the sac is freely opened. The sac could then be left entirely in place or it could be partly removed. Suture and simple drainage of the sac have been found sufficient, and it is unnecessary to resort to packing. (Farquhar Curtis.)