Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The main artery of the lower limb may be exposed and tied in any part of
its course from the aorta to the popliteal space. But the situation most
eligible for performing such an operation depends of course upon
circumstances, both anatomical and pathological. If an aneurism affect
the popliteal part of the vessel, or if, from whatever cause arising, it
be found expedient to tie the femoral above this part, the place best
suited for the operation is that where the artery, W, first passes under
cover of the sartorius muscle. [Footnote] For, considering that the
vessel gives off no important branch destined to supply any part of the
thigh or leg between the profundus branch and those into which it
divides below the popliteal space, the arrest to circulation will be the
same in amount at whichever part of the vessel between these two points
the ligature be applied. But since the vessel in the situation specified
can be reached with greater facility here than elsewhere lower down; and
since, moreover, a ligature applied to it here will be sufficiently
removed from the profundus branch above, and the seat of disease below,
to produce the desired result, the choice of the operator is determined
accordingly. The steps of the operation performed at the situation W,
where the artery is about to pass beneath the sartorius, are these: an
incision of sufficient length--from two to three inches--is to be made
over the course of the vessel, so as to divide the skin and adipose
membrane, and expose the fascia lata, through which the inner edge of
the sartorius muscle becomes now readily discernible. A vein (anterior
saphena) may be found to cross in this situation, but the saphena vein
proper is not met with, as this lies nearer the inner side of the thigh.
The fascia having been next divided, the edge of the sartorius is to be
turned aside, and now the pulsation of the artery in its sheath will
indicate its exact position. The sheath is next to be opened, for an
extent sufficient only to carry the point of the ligature-needle safely
around the artery, care being taken not to injure the femoral vein,
which lies close behind it, and also to exclude any nerve which may lie
in contact with the vessel.
[Footnote: This is the situation chosen by Scarpa for arresting by
ligature the circulation through the femoral artery in cases of
popliteal aneurism. The reasons stated in the text are those which
determine the surgeon to perform the operation in this place in
preference to that (the lower third of the thigh) where Mr. Hunter first
proposed to tie the vessel.]
Public-domain text, read in full here on John Shaqi.
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