An account of a case of aneurismal dilatation of the popliteal artery, treated with pressure / by James Paget.

  • Paget, James, Sir, 1814-1899.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: An account of a case of aneurismal dilatation of the popliteal artery, treated with pressure / by James Paget. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    3/4 (page 99)
    was much reduced by his illness during this time. On the 14th November, liis lather, a surgeon, wrote to me—“ There is a tumor, about the size of a small nut- meg, where the anemism was, but it does not pulsate. There is no pulsation in the femoral’ artery, from the middle of the thigh to below the tumor; but both the anterior and the posterior tibiid arteries pulsate at the foot. The limb is not so strong as it was before the aneurism was found, and it is cold and numb till it is warmed by exercise. The only help it needs is warmth %vhen not in use.” In commenting upon this case, one may notice, first, that the disease was, probably, an example of aneurismal dilatation, or, as Mr. Luke has named it, tubulai’ anemism; an aneurism of tlie cylindrifonn or fusiform variety described by Cruveilhier,—that is, a dilatation affecting, almost uniformly, the whole circumference of the artery in a certain portion of its length. Such dilatations are, indeed, I believe, vei-y rare in the popliteal artery yet that such an one existed here is made very probable by many things observed in the case, and especially by the great diminution of size of the aneurism while under treatment. The cure of popliteal and other simi- lar aneurisms, whether treated by pres- sure or ligature, is usually accomplished much more by the filling of the sac with blood-clot, than by the conti’ac- tion of the sac. Hence, usually, after the pulsation has ceased, the swelling, with comparatively little diminution of size, remains firm and nearly solid, till slowly its size is diminished by the absorption and shrinking of its contents. Thus, to mention but a few instances:— In a case of brachial aneurism, I found thattheswelling,sixmonthsafterligatm’e of the ai'tery, retained two-thirds of its former size; in a popliteal aneurism, there was not more than this amount of diminution eighteen months after ob- literation of the femoral artery by li- gature ;f in the first case of j^opliteal aneurism for which Mr. Hunter per- formed his operation, a tumor, as lai'ge as a hen’s egg, remained fifteen mouths * Specimens may be seen in the Pathological Museum of the College of Surgeons, No. 1638; and in that of Saint Bartholomew’s Hospital, Ser. 13, No. 53. t. Museum of Saint Bartholomew’s Hospital, Senes xiii. No. 114. after the apiilicatiou of the ligature and in another of his cases the specimen in our museumf shows that even after fifty yeai-s the -whole aneiu-ismal swell- ing was not removed. So, too, in the case I have related, though the swelling diminished gi-eatly under rieatment, yet no perceptible diminution has taken place during the seven months that liave followed the cessation of pulsation. T believe these cases are only exam pies of a general rule,—namely, that popliteal aneurisms being usually lateral and saccular dilatations of only part of the circumference of the artery, the obstruction of the passage of blood through them leads to its coagulation in and within the sac, but is attended -with very little coincident contraction of the sac. MHierefore, even after the pulsa- tion has ceased, tlie greater part of the swelling remains, and, consisting prin- cipally of blood-clot, requires conside- rable time for its removal. On the other hand, when, as I be lieve in the case here related, a popliteal aneurism consists in a dilatation of the whole circumference of the artery, we may believe that there is the same in- disposition to the formation of clot as in the similar dilatations of the arch of the aorta, and of other great arteries in which no part of the dilatation is far remote from the main stream of blood. In all these cases it is matter of common and just observation, that fibrinous deposits are scanty and rare; and therefore, in the similar dilatations of the smaller arteries, we might expect that the effect of any continued obstnic- tion of the trunk would be the gi-adual contraction of the dilated portion, rather than its filling up with clot Other considerations sriengthen this opinion of the natui'e of the case here related; especially, first, that as the enlargement of the artery after the injury was very slow, there was proba- bly no rupture or serious damage of its coats, but that such a change as might lead to their slow and ex- tensive impairment of structure; and, 2ndly, that the sensation derived from the touch of the dilatation was always that of a sac tensely filled with fluid * Museum of the College of Surgeons, No. 3472. t Series xiii. F. 4. t In six cases, recorded by Dr. Crisp (Treatise on Diseases of the Blood-vessels, p. 201), in which aneurisms were examined by dissection, at periods varying from four to eighteen years alter cure by ligature, four still presented remains of the sac ; in two no trace of it appeared.