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.
No authentic report of Mr. South's operations of ligature of the abdominal aorta has been as yet published by himself; he has, however, most kindly favored me with the following interesting particulars connected with his case:—" The man was thirty years of age and a hard drinker, —had had a strange uneasy sensation two months before his admission, and six weeks after noticed a small hard pulsating swelling in his right groin, which grew rapidly, and when admitted was as big as a goose egg.—Soon suffered paroxysms of violent pain, and leg became numb. Eleven days after, the aorta was tied without difficulty by a cut from the tip of the tenth rib to the superior iliac spine. In course of a few hours, first one, and subsequently the other limb became discolored; was in constant profuse perspiration, and exceedingly restless. Died forty-two hours after. Examination showed false aneurism of right external iliac artery".
* Lond. Med. Gaz., 1834.
The foregoing cases suggest the following considerations:— In certain wounds the ligature of the aorta may be attempted: —in aneurism it can only be had recourse to in order to prolong life for a few days, as no surgeon would venture to propose so serious an operations for an early aneurism; and in an old one it will in all probability fail, or may hasten the death of the patient. Under these circumstances, would it not be more advisable to have recourse to internal or medical treatment than to propose an operation of so serious a character, and which we have no reason for hoping may be attended with success? In considering the dangers and difficulty of the operation, it may be well to observe that Dr. Murray's case shows that the aorta may be generally tied, without wounding the peritoneum; and Mr. South's case that it may be tied " without difficulty".
The branches of the abdominal aorta are the following, and from above downwards they arise in the following order:—
Proper Phrenic, or Renal.
Superior Mesenteric. Lumbar.
Capsular. Middle Sacral.
These arteries should, however, be dissected in the succeeding order:—