Ligature of the subclavian artery, in a case of hemorrhage from the axillary artery / by R.J. Mackenzie.

  • Mackenzie, R. J. (Richard James), 1821-1854.
Date:
[1846]
Catalogue details

Licence: Public Domain Mark

Credit: Ligature of the subclavian artery, in a case of hemorrhage from the axillary artery / by R.J. Mackenzie. Source: Wellcome Collection.

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    A return of tlie hemorrhage from the axilla was certainly the danger to be most apprehended, and was, perhaps, the only real cause of anxiety for the issue of the case. The free anastomosis, existing between the branches of the axillary and subclavian ar-^ teries, is sufficient, in general, to admit of a return of pulsation in aneurismal tumours in this situation, at a shorter or longer pe¬ riod after lisfature of the subclavian artery. Had the re-establish- ment of the circulation, in the present case, proved sufficient to renew the hemorrhage, amputation must have been immediately performed, as further pressure in the axilla would then have been inadmissible. The destruction of the coats of the vessel, however, I believe to have been of very limited extent, as rapidly fatal, and much more copious hemorrhage than appears to have taken place in the present instance, often occurs from a very trifling lesion of the arterial coats. The surface of the wound, after the separation of the eschar, was healthy, and, as far as could be seen at the time of the ope¬ ration, showed no further disposition to unhealthy action, than was probably induced by the pressure of the compress. These circumstances led me to believe that the shrinking of the artery after the application of the ligature, and the contraction of the wound, which would probably take place after the removal of the compress, would prove sufficient to close the opening in the vessel, before the collateral circulation was established. Had the opening in the vessel, on the contrary, been of larger size, and produced by unhealthy or phagedsenic ulceration, the prognosis must undoubtedly have been much less favourable than under the conditions above mentioned. The risk of secondary hemorrhage, at the separation of the liga¬ ture, was comparatively small, seeing that the artery at the point where the ligature was applied was sound; and all suspicions of that chronic disease of the arterial system, which is such a fre¬ quent cause of dread in similar operations for aneurism, were here absent. PRINTED BV HUGH PATON, EDINBURGH*