. Text-book of operative surgery . e same light as all other large veins in the body, not only can itbe ligatured, but it can also be excised when adherent to tumours or thrombosed. It must be pointed out, however, that the above remarks only apply to the vena«ava below the entrance of the renal veins, as ligature above this point is to Goldinann, this has been proved by Gösset and Lecene, while Purpura ^ Cf. Niebergall, Z)ei6i; Ghir., 1892, Bd. 33. Schede, Laugenbecks Archiv, Bd. 43,;1892. Houzel, de Chir. Bd. 23.^ Beiträge zur Min. Chir. Bd. 47,
. Text-book of operative surgery . e same light as all other large veins in the body, not only can itbe ligatured, but it can also be excised when adherent to tumours or thrombosed. It must be pointed out, however, that the above remarks only apply to the vena«ava below the entrance of the renal veins, as ligature above this point is to Goldinann, this has been proved by Gösset and Lecene, while Purpura ^ Cf. Niebergall, Z)ei6i; Ghir., 1892, Bd. 33. Schede, Laugenbecks Archiv, Bd. 43,;1892. Houzel, de Chir. Bd. 23.^ Beiträge zur Min. Chir. Bd. 47, 1905. SURGERV OF THE VENO US SYSTEM 163 has found experimentally that death need not occur, if, from an already existingStenosis of the vena cava, a collateral circulation lias been established. , Goldmann quotes 112 cases of thrombosis of the vena cava observed by these the congestion was more marked (oedema and ascites) than after ligatureand closure of the vena cava. In the latter the Symptoms of congestion may be. Fig. 73.—Osteoplastic resection of the manubriuiu sterni. The sterno-mastoids are detached fromthe steruum and turned upwards, the sterno-clavicular joiuts opened, and the cajjsule on theleft side is detached from the stermim. The first and second costal cartilages are thendivided close to the sternum, and the sternum is cut across with a chisel below the level ofthe second cartila^e. absent. Injection experiments by Lappe, Poirier, Goldmann, and others, have shownthat after ligature of the inferior vena cava the blood is returned to the heart IIa 104 OPERATIVE SURGERY without difficulty and, tliat of tlie numerous auxiliary anastomoses in existence, theveins in and aboiit tbe spinal canal, in the groin and the azygos veins, are theprincipal Channels by which it is elFected. It would seem, therefore, quite legitimate to ligature the vena cava below therenal veins, and even to resect a portion of its length. A case has recently been Right sterno-cla
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