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Aneurysm

1911 Encyclopedia Britannica

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or Aneurism (from Gr. av€Vpcaµa, a dilatation), a cavity or sac which communicates with the interior of an artery and contains blood. The walls of the cavity are formed either of the dilated artery or of the tissues around that vessel. The dilatation of the artery is due to a local weakness, the result of disease or injury. The commonest cause is chronic inflammation of the inner coats of the artery. The breaking of a bottle or glass in the hand is apt to cut through the outermost coat of the artery at the wrist (radial) and thus to cause a local weakening of the tube which is gradually followed by dilatation. Also when an artery is wounded and the wound in the skin and superficial structures heals, the blood may escape into the tissues, displacing them, and by its pressure causing them to condense and form the sac-wall. The coats of an artery, when diseased, may be torn by a severe strain, the blood escaping into the condensed tissues which thus form the aneurysmal sac.

The division of aneurysms into two classes, true and false, is unsatisfactory. On the face of it, an aneurysm which is false is not an aneurysm, any more than a false bank-note is legal tender. A better classification is into spontaneous and traumatic. The man who has chronic inflammation of a large artery, the result, for instance, of gout, arduous, straining work, or kidneydisease, and whose artery yields under cardiac pressure, has a spontaneous aneurysm; the barman or window-cleaner who has cut his radial artery, the soldier whose brachial or femoral artery has been bruised by a rifle bullet or grazed by a bayonet, and the boy whose naked foot is pierced by a sharp nail, are apt to be the subjects of traumatic aneurysm. In those aneurysms which are a saccular bulging on one side of the artery the blood may be induced to coagulate, or may of itself deposit layer upon layer of pale clot, until the sac is obliterated. This laminar coagulation by constant additions gradually fills the aneurysmal cavity and the pulsation in the sac then ceases; contraction of the sac and its contents gradually takes place and the aneurysm is cured. But in those aneurysms which are fusiform dilatations of the vessel there is but slight chance of such cure, for the blood sweeps evenly through it without staying to deposit clot or laminated fibrine.

In the treatment of aneurysm the aim is generally to lower the blood pressure by absolute rest and moderated diet, but a cure is rarely effected except by operation, which, fortunately, is now resorted to more promptly and securely than was previously the case. Without trying the speculative and dangerous method of treatment by compression, or the application of an indiarubber bandage, the surgeon now without loss of time cuts down upon the artery, and applies an aseptic ligature close above the dilatation. Experience has shown that this method possesses great advantages, and that it has none of the disadvantages which were formerly supposed to attend it. Saccular dilatations of arteries which are the result of cuts or other injuries are treated by tying the vessel above and below, and by dissecting out the aneurysm. Popliteal, carotid and other aneurysms, which are not of traumatic origin, are sometimes dealt with on this plan, which is the old "Method of Antyllus" with modern aseptic conditions. Speaking generally, if an aneurysm can be dealt with surgically the sooner that the artery is tied the better. Less heroic measures are too apt to prove painful, dangerous, ineffectual and disappointing. For aneurysm in the chest or abdomen (which cannot be dealt with by operation) the treatment may be tried of injecting a pure solution of gelatine into the loose tissues of the armpit, so that the gelatine may find its way into the blood stream and increase the chance of curative coagulation in the distant aneurysmal sac. (E. O.*)