Hematoma pulsátil de la arteria axilar

Abstract

The author deals with a case of pulsatile hematoma of the axillary artery and makes the following considerations: 1st The pathogenesis of traumatic arterial aneurism becomes clear, if the symptoms which the patient present are examined and above all, by those events observed during the intervention. The description which Petit made so many years ago, and where he established so clearly the distinction between true and false aneurism is fully confirmed in the case which we present. The projectile strikes tan- gently all the coats of the vessel, shedding blood and distending the perivascular space of the axillary artery, thereby forming a big hematoma. The blood coagulates in the periphery of the hematoma, but remains fluid in the centre, or in the vecinity of the lumen of the artery, thereby resulting a cavity through which blood circulated synchronous with the beating of the pulse. These beats are transmitted all over the hematoma, simulating a great dilatation which in reality does not exist. For this purpose, the names which are used to designate this affection are various as we announced at the beginning but undoubtedly the one that better suits the case is that of pulsatile hematoma. The word aneurism, in accordance to its etiology should be reserved for the dilatations of the arteries and not for their ruptures. 2nd The arteriography, according to our judgements has an unquestionable value in the precision of its diagnosis. The magnitude of the lumen of the artery, the extension of the fluid portion of the effusion, its situation with regard to the collaterals, its topographic relation regarding other organs of the region, are all elements of judgement which should be employed with advantage, to establish the therapeutic management, and these only can be supplied by arteriography. As the technique of the present time, and the medium of contrast employed do not offer any danger, nor any technical difficulties, it is a symptom-diagnotic procedure, which should be done in all eases before proceeding with the intervention in patients of this nature. 3rd The intervention which was realized in two times, seeking in the first occasion the diminution of the diameter of the artery without its total • suppression, compelling the collaterals to supply the circulation of the principal vessel, at the same time taking advantage of the dissection of the artery a contrasting medium was injected. If then, during the intervention on the aneurism, it is observed that the restorating operation is impossible, and only it is feasible to suture, or to use the occlusive ligature of the lumen, then the supplementary collateral circulation thus already remain assured. A demonstration of its existence was the hemorrhage observed when the aneurismal sac was opened, insfrite of the occlusion of the subclavian artery, and later on, the vitality of the superior extremity was conserved with progressive recuperation of its functional capacity.