Carotid artery

“ From the arch of the aorta are sent off those arteries which are distributed to the head and arms; the principal ones among these are named as follows:
The carotid artery, which ascends in the side of the neck and divides into the temporal artery which is distributed in the temple, and the facial artery which supplies the face, and also sends a branch called the internal carotid to the parts within the skull. The sub-clavian artery, lying beneath the clavicle, or collar bone—that part of the continuation of this artery which passes through the axilla or arm-pit, is called the axillary artery ”

“ Should the carotid have been tied, its mesial communications, already mentioned, especially those within the skull, and about the thyroid gland,—assisted at those places and elsewhere by anastomoses with the subclavian,—adequately fulfil their vicarious duty. So abundant are these various communications, that the ligature of a main trunk, in the dead subject, in no degree interferes with the distension of its branches by fine injection: if we inject water, or any equally fluid material, through one carotid artery, it freely returns by the other. ”

“ The carotid artery may be tied, in almost any part of its course, in the following manner: The patient being seated, with the shoulders supported, so that the light may fall on the neck, the head is to be bent a little forward, to relax the muscles on the fore part. An incision is then to be made on the line of the inner edge of the sterno-cleido-mastoideus muscle, by which the integuments, the platysma myoides, and the superficial cervical fascia are to be divided. ”

“ Observation should be made also of the site of the carotid artery on each side, and of the jugular veins, since aortic regurgitation may be indicated by violent action of those arteries or tricuspid regurgitation by pulsation of the veins in the neck.
Long before vaso-motor physiology had any place in science the pulse was known to afford valuable indications in disease. Either of the accessible arteries will answer instead of the radial; its convenience merely makes the wrist the common place of comparison. ”

“ Convinced that this practice, induced by a physiological error, was useless and injurious; and that hæmorrhage was more dependent on the inosculation than the arborescence of vessels, or at least equally so, he determined to save the constitution of his patients from so grave and useless a hazard. “To tie up,” says he, “the carotid artery, before the performance of an operation, can only prove that the life of the patient is able to resist a double hazard, while his surgeon is gaining all the advantages which can be realized from such a precaution.” ”

“ If we tie superiorly the carotid artery of a dog, the blood pushed against the ligature that stops its course, reacts violently upon the parietes and yet the dilatation is hardly perceptible. We must not think however that the arteries do not yield at all. ”

“ Shock and hemorrhage lower it. Hemorrhage lowers also the pulse pressure, and it may be possible to prognosticate internal hemorrhage by frequent estimations of the systolic and diastolic pressures (Wiggers) . Compression of the superior mesenteric artery or the celiac axis in dogs raises the blood pressure measured in the carotid artery for a period of at least an hour. This seems to be dependent on purely mechanical causes, and is not a reflex vasomotor phenomenon. ”

“ Then there is given off the anterior and the posterior thoracic arteries; and finally, the pectoral, which supply the pectoralis muscles and later terminate in the carotid, the vertebral, and the cervical arteries. The carotid artery gives off an esophageal artery. The other arterial trunk given off from the common aorta is the right brachio-cephalic or brachio-cephalic dexter (Fig. 61B, No. K, 18) . The right brachio-cephalic artery gives off the subclavian, which continues as the axillary, and continues as the brachial artery. ”

“ In the same year he took an active part in the formation of the Medico-Chirurgical Society, and published in the first volume of its Transactions an account of an attempt to tie the common carotid artery for aneurism. ”

“ The place of division of the common carotid is not definite, and, therefore, the precise situation in the upper two-thirds of the neck, where it may present as a single main vessel, cannot be predicted with certainty in the undissected body. There is no other main artery of the body more liable to variation than that known as external carotid. ”

“ The patient made a good recovery, only disturbed by a slight attack of vomiting, and at the end of a week the wound had healed, and pulsation in the aneurism had completely ceased. The thrill persisted as before.
Six months later, a small sac still exists beneath the sterno-mastoid. The pulse still reaches 110-120 in pace. The purring thrill is very slight. The condition gives rise to little or no trouble. Pulsation is strong in the external carotid artery, there is little in the common carotid. The voice is strong and good. ”

“ Such injury of the artery does not prove that hanging took place during life because it has been produced on the cadaver; but hemorrhage into the wall of the vessel or wound or rupture after death is very improbable. Maschka says the lesion is very rare. Tardieu says that the injury to the carotid is rare and therefore unimportant. Pellier reports 4 cases of rupture of carotid in a total of 23. Levy records the experiments of Hofmann, of Vienna, and Brouardel [754] and himself, of Paris, 5 in number. ”

“ It is argued that when a man has his internal carotid cut on the inside of his throat, by a foreign body of any kind thrust through his mouth, the artery cannot be tied by two ligatures at the wounded part through the mouth, not even if it were enlarged from ear to ear. What, then, is to be done? The artery should be secured by ligature by an incision made on the outside of the neck. ”

“ Ellis mentions ligature of both carotids in four and a half days, as a treatment for a gunshot wound, with subsequent recovery. Lewtas reports a case of ligation of the innominate and carotid arteries for traumatic aneurysm (likely a hematoma due to a gunshot injury of the subclavian artery) . The patient was in profound collapse, but steadily reacted and was discharged cured on the forty-fifth day, with no perceptible pulse at the wrist and only a feeble beat in the pulmonary artery. ”

“ The precept so strongly insisted upon, that no operation should be done on a wounded artery unless it bleed, and at the place from which it bleeds, has been particularly opposed with reference to the neck, the opponents believing that placing a ligature on the primitive carotid is an operation not attended with much risk, and that it may therefore be done as a precautionary measure when the wounded part does not bleed ”

“ They laid me down again while somebody fetched a stretcher. As soon as I knew that the bullet had gone clean through my neck I took it for granted that I was done for. I had never heard of a man or an animal getting a bullet through the middle of the neck and surviving it. The blood was dribbling out of the comer of my mouth. ‘The artery's gone,’ I thought. I wondered how long you last when your carotid artery is cut; not many minutes, presumably. Everything was very blurry. There must have been about two minutes during which I assumed that I was killed. ”

“ The carotid and right subclavian arteries will then be felt lying close together crossed by the pneumogastric and recurrent nerves, the latter turning behind the subclavian. The nerves must be drawn inwards; the cardiac filaments of the sympathetic will then be observed, and drawn outwards. The subclavian vein lies below, concealed by the clavicle, and will probably not be seen during the operation. The needle should be passed round the artery from below upwards, care being taken not to injure the pleura, which lies beneath and behind the artery. ”

“ She had no mercy. He looked at her neck and thought how he would like to jab it with the knife he had for his muffin. He knew enough anatomy to make pretty certain of getting the carotid artery. And at the same time he wanted to cover her pale, thin face with kisses. ”

“ A third point of improvement in surgery by McClellan, is that of not shocking the system in the extirpation of large or deep-seated tumours, by the serious preliminary operation of tying a main artery, as for example the carotid, when its branches are involved in the disease. ”

“ On examination Hunter ascertained that the external carotid had been duly tied, but that certain small branches of the artery above and below the ligature had enlarged, and by their anastomoses had restored the blood supply of the growing part. Thus it was evident that under “the stimulus of necessity,” to use a phrase of the experimenter, the smaller arterial channels are capable of rapid increase in dimensions to perform the offices of the larger. [23] It happened that, in the ensuing December, there lay in one of the wards of St George’s Hospital a patient admitted for popliteal aneurism. ”

“ In both families the vessels that are relatively constant in appearance are: a subclavian giving rise to the carotid and axillary arteries, and becoming the pectoral trunk; the thoracic artery arising variously, and passing posteriorly to the rib cage; and the coracoid complex of vessels. The coracoid complex includes the coracoid artery, the vessels to Mm. sternocoracoideus and coracobrachialis posterior, and the sternal artery, which is variously present, and more extensive in some species than in others. ”

“ It occurs with greater frequency and with greater severity in men than in women.
Atheromatous degeneration is most common in the large arterial trunks, and the changes are most marked at the arch of the aorta, opposite the flexures of joints, at the mouths of large branches, and at parts where the vessel lies in contact with bone. The presence of diseased patches in the wall of an artery diminishes its elasticity and favours aneurysmal dilatation. Such a vessel also is liable to be ruptured by external violence and so give rise to traumatic aneurysm. ”

“ Quite different would it be should one of the small arteries of the brain, the lenticulo-striate, for example, which supplies the corpus striatum, become the seat of a thrombosis or embolism caused by arteriosclerosis. The arteries of the brain are terminal [195] arteries and the blood supply would be cut off entirely with a resulting anemic necrosis of the part supplied by the artery and a loss of function of the part. What would be of no moment in the leg or arm might prove even fatal in the brain. ”

“ In arterial hæmorrhage the blood is bright red in colour, and escapes from the cardiac end of the divided vessel in pulsating jets synchronously with the systole of the heart. In vascular parts—for example the face—both ends of a divided artery bleed freely. The blood flowing from an artery may be dark in colour if the respiration is impeded. When the heart's action is weak and the blood tension low the flow may appear to be continuous and not in jets. The blood from a divided artery at the bottom of a deep wound, escapes on the surface in a steady flow. ”

“ The most dreaded of all the ills of the cardiac and vascular systems nowadays seems to be arterio-sclerosis, or hardening of the arteries. It is possible for a man of forty-odd, like Mr. Pitts, to have arteries in a condition which would not be encountered normally in persons under seventy years of age.
"The hard or hardening artery means increased blood pressure, with a consequent increased strain on the heart. ”

“ A direct fatal hemorrhage is very rare; likewise an arterial hemorrhage of any extent, especially if the possible anomalous position of certain arteries, such as the thyroidea ima, be borne in mind and care in making the incision exercised. Nothing but gross carelessness on the part of the surgeon and entire loss of presence of mind can account for the opening of the carotid or innominate arteries, as has been done. ”

“ We have met with a chronic form of arterial degeneration in elderly women, affecting especially the great vessels at the root of the neck, in which the artery is remarkably attenuated and dilated, and so friable that the wall readily tears when seized with an artery-forceps, rendering ligation of the vessel in the ordinary way well-nigh impossible. ”

“ Hence the pulmonary arteries yawn nearest for the blood, and, being short, wide vessels, present the least resistance to the first rush of blood-- mainly venous blood for the right auricle. As they fill up, the back resistance in them becomes equal, and then greater, than the resistance at A, and the rush of blood, now of a mixed quality passes through that aperture. It selects the dorsal aorta, because the carotid arch, plugged by the carotid gland, offers the greater resistance. ”

“ In this manner a vascular circle, the circle of Willis, is formed, which permits of freedom of the arterial circulation by the anastomoses between arteries not only on the same side, but on opposite sides of the mesial plane. The vertebral and internal carotid arteries, which are the arteries of supply for the brain, are distinguished by lying at some depth from the surface in their course to the organ, by having curves or twists in their course, and by the absence of large collateral branches. ”