This section is from the book "Anatomy Of The Arteries Of The Human Body", by John Hatch Power. Also available from Amazon: Anatomy of the Arteries of the Human Body, with the Descriptive Anatomy of the Heart.
The treatment of aneurism by compression upon the artery leading to the tumor, may be considered as one of the greatest achievements in modern surgery. In this city it has almost entirely superseded the operations of tying the femoral artery. It accomplishes without danger what Hunter's operation effected with the risk of human life. It is obvious, however, that it is not applicable to every form of this disease ; nor can it be exercised on many of the arteries of the body. Mr. Todd had recourse to this method in June, 1820, for the cure of a popliteal aneurism in the right ham. He observes, " The disease in this case was so recent that it was resolved to watch its progress for some time before an operation should be decided on. The patient was accordingly directed to remain in a horizontal posture; he was put upon low regimen and occasionally blooded and purged. The tumor was so much under the control of pressure on the inguinal portion of the artery, that I was not altogether without hope that by diminishing the current of blood in the trunk of the artery, so as to favor the coagulation of the contents of the sac, a cure without operation might be effected: at all events, it was obvious that by giving time to the collateral arteries to be dilated, the success of the operation would be rendered less uncertain." The instrument employed by Mr. Todd resembled a common' truss for femoral hernia, but the " spring was much stronger, and the pad longer, of a more oval form and more firmly stuffed than in the truss." After a trial, however, of several weeks, the patient " could not be persuaded that the plan adopted was productive of benefit ; during this period the tumor had obviously diminished, and its contents had acquired a firm consistence, but the patient complained that the instrument gave him much pain, and that his health and spirits had suffered materially from confinement, rigid abstinence, etc.; the operation was accordingly agreed to, and I performed it on the 1st of September, being two months after his admission into the hospital." In July of the same year, Mr. Todd had another opportunity of trying this mode of compression on the femoral artery for the cure of popliteal aneurism in the left ham; in a few weeks no alteration could be observed in the tumor; the man became impatient and refused to submit to the treatment, so that in this case also the operation was finally performed.* On the 27th of August, 1824, Mr. M'Coy applied compression to the femoral artery for the cure of aneurism of that vessel occurring in a stump after amputation for a diffused popliteal aneurism. The patient perfectly recovered, and lived for several years afterwards.† In the year 1825, compression of the femoral artery was successfully employed by Mr. Todd for the cure of a popliteal aneurism.‡ In the year 1842, this mode of treatment was successfully revived in this city by Dr. Hutton: the patient, Michael Duncan, set. 30, a laborer, was admitted into the Richmond Hospital on the 3d of October, in the same year, laboring under a popliteal aneurism in the right ham. Dr. Hutton states, that " on November 1st, the patient being still reluctant to undergo the operation, I resolved to try compression of the femoral artery, and I entertained some hope of succeeding, being informed by Mr. Adams that the late Mr. Todd had succeeded in a similar case, of which no account has been published. Having at hand an instrument constructed for the suppression of secondary hemorrhage after ligature of the femoral artery, I applied it in this case. It was so contrived as to admit of pressure being made by a screw and pad upon the course of the femoral artery, and the counter-pressure upon the opposite surface of the limb, without interfering with the collateral circulation. In the first instance the compression was made upon the femoral artery in the middle third of the thigh, and, although it was effectual in compressing this vessel, it produced so much uneasiness that it could not be sustained, and after a few applications the apparatus was removed and adapted to the upper part of the limb. On November 12th, the apparatus was applied on the femoral artery in this case, immediately below Poupart's ligament, and the pressure was maintained for more than four hours. From this date to December 1st, the instrument was occasionally applied for a given number of hours at each time, and on this day the tumor was quite solid, much diminished in size, and altogether free from pulsation. On the 27th of December the patient was discharged at his own request." Dr. Hutton further reports :—" In six weeks he visited the hospital at my request: the tumor was about the size of a nutmeg, and solid. He had been at his usual employment".
* Dublin Hospital Reports, vol. iii. p. 91, etc.
† Medical Press, April 26, 1843; and Mr. Adams in Dub. Quar. Jour., Aug. 1846. ‡ Dub. Quar. Jour., Aug. 1846.
* Dublin Medical Journal, vol. xxiii. p. 364, etc.
Since this case occurred, Dr. Cusack has treated with success, by similar means, a case of popliteal aneurism in Dr. Stevens's Hospital, and Dr. Bellingham another in St. Vincent's Hospital. It would appear that this plan of treatment has been too hastily abandoned by the profession, probably from the compression employed being so excessive as to render it quite insupportable to the patient. The least possible pressure, which may be sufficient to close the vessel, should be used, and when this cannot be sustained, it will prove of use to partially compress the artery so as to lessen the impulse of the circulation."*
At a meeting of the Surgical Society, held on the 22d of April, 1843, Dr. Bellingham reported " two cases of popliteal aneurism recently cured by pressure upon the femoral artery." The first case, that of Michael Duncan as already stated, was treated by Dr. Hutton, the second by Dr. Bellingham himself, and as Dr. Hutton was prevented from attending, he furnished the notes of his own case to Dr. Bellingham, who read them to the society. This report of Dr. Hutton's case we need not quote, as the student is already in possession of the principal facts connected with it. In his communication, however, Dr. Hutton observes, " As the apparatus made use of by Dr. Bellingham was far superior to that which I had at my command, and as he will publish a description of it, it is unnecessary for me to refer to this part of the subject".
In the same communication Dr. Bellingham related the following particulars of his own case:—
" Patient a servant, aet. 32, healthy, admitted into St. Vincent's Hospital, under Dr. Bellingham, March 25th, 1843, laboring under popliteal aneurism upon the right side. Tumor noticed three months previously; patient's attention attracted to it by a feeling of weakness in the limb; no cause assigned for it. The aneurism, seated high in the popliteal space, measures about three inches transversely, and a little more from above downwards; the sac can be completely emptied by pressure upon the artery in the thigh. Compression commenced April 3d; the pressure applied upon the artery as it passes over the ramus of the pubis; discontinued on the following day; reapplied April 6th; pulsation ceased on the following day, at which period the tumor is reported to have been about the size of a small orange, solid and hard. Instruments removed April 11th. Patient discharged a month afterwards; the tumor being then very small; he had perfect use of the limb. Duration of compression, two days." The report of the proceedings of this meeting, published in the Medical Press of May 3d, 1843, are accompanied with an engraving of the apparatus employed by Dr. Bellingham, and to which Dr. Hutton refers in his communication. In the Medical Press of May 15th, 1849, Dr. Hutton mentions a case of popliteal aneurism, in which he compressed the femoral artery with Dr. Carte's apparatus. The compression was employed for only seven hours and a half successively; after this, the tumor became solid, and absorption soon commenced.
Many other cases have also been recently treated by several surgeons in this city as well as in England, with the most complete success; these cases appeared in the periodicals of the day, and have since been published in a collective form up to the year 1847, by Dr. Bellingham of St. Vincent's Hospital. Since that date the subject has been continued up to the year 1851 by Mr. Tufnell, one of the surgeons to the City of Dublin Hospital, in his " Practical Remarks on the Treatment of Aneurism by Compression".
The femoral artery gives off the following branches:—
Superficial Epigastric. Profunda Femoris.
External Pudic, Muscular.
Superficial Circumflexa Ilii. Anastomotica Magna.
The Superficial Epigastric Artery arises a little below Poupart's ligament, pierces the fascia lata, and ascends towards the umbilicus in front of Poupart's ligament. It supplies the glands of the thigh, and the fascia and integuments of the abdomen, and anastomoses with the internal epigastric and mammary arteries.
The External Pudic Arteries are two in number, a superficial and a deep: the superficial comes off a little below Poupart's ligament, croses superficial to the fascia lata, to reach the scrotum in the male, or labium in the female, in which parts, and in the abdominal muscles, it is lost; the deep pudic branch crosses behind the fascia lata, and below the former branch, and supplies the scrotum in the male, and the labium in the female, and terminates in the perineum. These branches anastomose with each other, and the superficial anastomoses with the superficial epigastric.