Femoral artery

“ While this artery may seem just a little more difficult to raise, still at times it has its place in arterial embalming.
How to Locate, Raise and Inject the Femoral Artery.
—The femoral artery is usually objected to, because, situated [242] as it is, it requires an undue exposure of the limb, especially in ladies. For this reason, then, the femoral artery should never be raised in the female, excepting in accidental case when it is impossible to raise any other artery. In the male, however, the femoral with many is a favorite. ”

“ When the femoral artery has been fairly divided in the lower part of the thigh, the patient has, in almost all the cases which have come under observation, either died without assistance, or the hemorrhage has ceased spontaneously. ”

“ When a wound occurs in the thigh, implicating the femoral artery or its branches, and the bleeding cannot be restrained by a moderate but regulated compression on the trunk of the vessel, and perhaps on the injured part, recourse should be had to an operation, by which both ends of the wounded artery may be secured by ligature; and the impracticability of doing this should be ascertained only by the failure of the attempt. If the lower end of the artery cannot be found at the time, the upper only having bled, a gentle compression maintained upon the track of the lower may prevent mischief ”

“ The retracting and contracting powers in the lower end of a divided artery are nevertheless considerable, and are sufficient in some cases to nearly close the lower end of the femoral artery when divided by amputation above the knee. ”

“ It leaves the patient exposed to all the risks attendant on the employment of simple pressure. In one case which I saw, the third part of the subclavian artery had been ligatured for axillary bleeding; secondary hæmorrhage, as might have been expected, occurred, and that as late as five weeks after the operation. In another case ligature of the femoral artery for popliteal hæmorrhage was followed by the development of a traumatic aneurism in the ham. ”

“ In the thigh, the femoral artery should be drawn out with a tenaculum or spring forceps, and tied firmly with a single thread of dentists’ silk, one of the two ends being cut off close to the knot. The smaller the vessel, the smaller the thread required. Torsion or twisting the smaller vessels, so as to rupture their inner coats, answers very well in cases in which many small ones bleed. When a nerve is known to accompany an artery, it should be carefully separated from it. ”

“ Reasons to explain the danger are not far to seek, for the numerous small muscular branches, along with the superficial epigastric, circumflex, and pudic trunks, reduce the chances of a good coagulum in the common femoral to a minimum, even without taking into consideration the shortness of the trunk before the great profunda femoris is given off. For the common femoral artery is only from one to two{17} inches in length, and if there are some rare cases in which it is a little later in its bifurcation, there are others in which it divides nearer to Poupart's ligament. ”

“ The decision of the surgeon must generally rest upon the extent of injury to the surrounding structures, the [110] condition of the patient, and other circumstances of each particular case. If the femoral artery and vein have been lacerated, any attempt to preserve the limb will certainly prove fatal.
The femur—the earliest formed, the longest, most powerful, and most compact in structure of all the long bones of the body—can only be shattered by a ball striking it with immense force. ”

“ A Mauser bullet passed from the inner side of the thigh across the neck and great trochanter of the femur beneath the femoral vessels, and probably struck and grooved the bone, since the aperture of exit was large and irregular, some 3/4 of an inch in diameter. One week later no pulse was palpable in either anterior or posterior tibial arteries at the ankle, and [Pg 113] pulsation which was strong in the common femoral artery was very weak in the superficial femoral. ”

“ In the living body the course of the distended saphenous vein may be traced beneath the skin, and easily avoided in surgical operations upon the parts contained in this region. Small branches of the femoral artery pierce the fascia lata, and accompany these superficial veins. Both these orders of vessels are generally divided in the operation required for the reduction of either the inguinal or the femoral strangulated hernia; but they are, for the most part, unimportant in size. ”

“ When the femoral artery is cut across in the upper part of the thigh, whether it be done by a cannon-shot, a musket-ball, or a knife, the patient does not always bleed to death at once, although he frequently dies after a time in consequence of the shock and the loss of blood. ”

“ The patient being laid on his back, and properly supported, the knee is to be bent and turned outward, by which the head of the femur will be rolled in the acetabulum, and the femoral artery will be more distinctly felt at the upper part of the thigh, below Poupart’s ligament. It lies on the psoas muscle, having the vein on its inside, and the anterior crural nerve about half an inch on its outside, having passed between the psoas and iliacus muscles, although some branches soon approach the artery, and run down on the external part of the sheath. ”

“ They are always used in pairs; in the figure, one presses the external iliac on the pubes, the other the femoral artery. The first is fastened to the body round the hips, the second round the thigh. They are constructed as follows: an arm attached to a pad reaches round the limb to the artery, over which it supports a ball and socket joint turning in any direction, but fixed by a screw clamp. ”

“ Convenience usually governs the operator as to the artery he is to use. If blood is to be removed it is best to raise one of the larger blood vessels, such as the carotid artery and the internal jugular vein, or the femoral artery and femoral vein, or the axillary artery and axillary vein. ”

“ By making firm pressure on the tumour, the thrill is lost, and the regular pulsation alone perceived; at the same time, the turgescence of the femoral vein disappears, and on compressing the femoral artery in the middle of the thigh, both pulsation and thrilling are arrested, and the swelling much diminished,—but only temporarily, for the collateral circulation is free and complete. He feels little pain, but exercise and exertion of every kind are seriously impeded ”

“ 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. ”

“ When the great artery has been torn, this fainting saves life, for an artery of the magnitude of the common femoral does not close its canal by retracting and contracting in the same manner as a smaller vessel; it can only diminish it; and the formation of an external coagulum is necessary to preserve life, which the shock, alarm, and fainting, by taking off the force of the circulation, aid in forming; and without which the patient would bleed to death. An amputation, in this state of extreme depression, might destroy life, although aided by the exhibition of chloroform. ”

“ But when man assumed the upright posture the femoral artery, which in the quadrupedal position is placed out of reach on the inner part of the thigh, became exposed. Were not this defect greatly compensated by man's ability to protect this part in ways not open to brutes, he, too, might have become extinct. ”

“ In accident cases the seat of injury will determine the artery to be raised, using the one through which you can give the body the greatest supply of fluid to all parts. Often it will be necessary to raise several arteries to complete the injection.
There is no necessity for undue exposure in either sex, however it is hardly ever advisable to inject the femoral in the female, as some mischief-maker might without any real cause influence others in the community against your methods. ”

“ Even this operation, however, in two cases of femoral varix failed to effect more than a temporary cessation of the symptoms, although the ligatures were placed but a short distance from the communication. Failure is due to the presence of collateral branches, which are not easy of detection. Even when the vessels lie exposed, the even distribution of the thrill renders determination of the exact point of communication difficult, and the difficulty is augmented by the temporary arrest of the thrill following the [Pg 148] application of a proximal ligature to the artery. ”

“ In some instances, the vessel crosses the ring; a vein generally accompanies the artery. These peculiarities in the origin and course of the obturator artery, especially that of passing on the pubic side of the ring, behind Gimbernat’s ligament and the conjoined tendon, E H, are fortunately very rare.
As the course to be taken by the bowel, when a femoral hernia is being formed, is through the crural ring and canal, the structures which have just now been enumerated as bounding this passage, will, of course, hold the like relation to the hernia. ”

“ When an arterio-venous sac has once formed, clinical observation shows that the general tendency is towards extension in the direction of least resistance. This direction of course varies with the situation of the aneurism, and also with the nature of the wound track.
Speaking generally the direction of least resistance in a typically pure perforation is towards the vein. Initial flow of blood from the wounded artery is naturally favoured towards the potential space afforded by a canal occupied by blood flowing at a lower degree of pressure. ”

“ I supposed that it came from one of the lumbar or inter-costal arteries that had been injured by the supposed fracture of the process of the vertebra. If so, it comes from an artery inclosed in a bony cavity, and one that cannot contract and close spontaneously, and since its origin is so close to the aorta, it will continue to bleed until the patient dies of hemorrhage.
While I was thus examining the fluctuating mass, and conjecturing as to origin and results, I fancied that the quantity of fluid was [Pg 11] sensibly increasing. ”

“ Arteries are compressed, not taken up when cut, and if a large one is cut, the consequence is either mortification from the ligature or, if loosely tied, death by bleeding, which invariably happens when the large artery of the thigh is separated. ”

“ When matter forms beneath the palmar fascia, it is liable, owing to the unyielding nature of this fibrous structure, to burrow upwards into the forearm, beneath the annular ligament D, Plates 17 and 18. All deep incisions made in the median line of the forepart of the wrist are liable to wound the median nerve B, Plate 17. When the thumb, together with its metacarpal bone, is being amputated, the radial artery E, Plate 19, which winds round near the head of that bone, may be wounded. It is possible, by careful dissection, to perform this operation without dividing the radial vessel. ”

“ In cases of hæmorrhage for suppuration of an aneurismal sac, it might possibly be advisable, and there are certain cases of rupture of the artery, without the existence of an external wound, in which attempts have been made to save the limb by tying the vessel. [10] From the complexity of the parts, the numerous tendons, veins, and nerves crowded together in a narrow hollow, and chiefly from the great depth at which the artery lies, any attempt at ligature is very difficult. ”

“ 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. ”

“ The closure of the lower orifice being less perfectly accomplished than of the upper, it is the more likely to suffer from secondary hemorrhage, which may be distinguished from that from the upper end of the artery at an early period after the accident, by the venous color of the blood, and from its flowing or welling out in a continuous stream, as water rises from a spring, and not with an arterial impulse. ”

“ If, from some complication of injury, the axillary or other artery should give way during the treatment, the extremity is not to be amputated. The artery is to be secured by one ligature applied above the opening in it and by another below it, the surgeon always bearing in mind the fact that the proper way to get at the axillary artery is by cutting across the fibers of the pectoral muscle, and not in their direction, and that it will be better to amputate the arm than to tie the subclavian artery above the clavicle. ”

“ Deep-seated hemorrhages, in the abdomen or chest, can often be controlled by pressure directly over the wound until an open operation can be performed.
Deep pressure, with the fist upon the abdomen just to the left of the vertebral column, will compress the aorta and greatly reduce the escape of blood from any artery supplied by the descending aorta.
Hemorrhage in Chiropody. For the chiropodist, bleeding is an annoying and especially perplexing occurrence. The feet are the most bacteria-laden part of the body ”