. Medical and surgical therapy . itateto perform an extensive laparotomy. Having ex-posed the site, the next step is to ascertain the natureof the lesion, whether aneurismal varix or varicoseaneurism, and if the latter, to discover the size ofthe sac. In the case of aneurismal varix, the best methodis to arrest the circulation by means of clamps appliedto both vessels above and below the affected is best to begin with the artery, applying a clampto it first above and then below. The vein shouldnot be clamped above until the last moment, for thesudden occlusion of the central end preven
. Medical and surgical therapy . itateto perform an extensive laparotomy. Having ex-posed the site, the next step is to ascertain the natureof the lesion, whether aneurismal varix or varicoseaneurism, and if the latter, to discover the size ofthe sac. In the case of aneurismal varix, the best methodis to arrest the circulation by means of clamps appliedto both vessels above and below the affected is best to begin with the artery, applying a clampto it first above and then below. The vein shouldnot be clamped above until the last moment, for thesudden occlusion of the central end prevents the J 34 WOUNDS OF THE VESSELS discharge of the blood brought to the intermediatesegment by the collaterals, with the result that thesegment becomes enormously distended. The anas-tomotic segment is now dissected out, and the veinis separated from the artery as far as the point ofcommunication. Where possible the communicatingchannel between the two vessels is ligatured. Whereligature is impossible, the channel is cut and the. Fig. 39.—Arterio-venous aneurism of the subscapulai vessels.(Tixiers case. Val-de-Grace Museum.) resulting arterial wound closed by lateral of the venous wound is superfluous, as ligatureabove and below meets all requirements. Wherethis, the ideal, operation is not feasible, quadrupleligature must be employed, and the arterio-venoussegment between the ligatures extirpated. Ligatureabove and below the anastomosis may require thea})plication of five ligatures, as in the case of aneu-rismal varix affecting the venous tributaries or an THERA PFAJTICA L CONSIDERA T10NS 135 arterial bifurcation. Under such conditions, extirpa-tion of the vascular segment may be impracticable. In the case of varicose aneurism the tumour isfirst extensively exposed. Artery-clamps are afhxedfirst to the afferent and efferent arteries, and after-wards to the veins. The tumour is then minutelydissected out and extirpated, together with thesegments of both artery a
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
