252 



FEMORAL ARTERY. 



obliterated. Of this condition several in- 

 stances are cited by Hodgson,* and a most 

 remarkable one is in the possession of Mr. 

 Adams of this city, through whose liberality 

 the author is permitted to introduce a notice 

 of it. It was obtained from a patient who had 

 been operated on by the late Professor Todd, 

 and is remarkable, 1. because the operation 

 had been performed upon both limbs, and the 

 condition of both is, as nearly as may be, the 

 same ; 2. because the obliteration at the seat 

 of the ligature does not on either side exceed 

 an inch, on one not being more than half that 

 length ; and, 3. because the artery is pervious 

 on both sides from the obliteration of the 

 ligature to the lower part of the popliteal 

 artery, the obliteration at the seat of the dis- 

 ease appearing not to have extended beyond it; 

 and being, on both sides, about two inches 

 long. Thirdly, the artery has been found par- 

 tially and irregularly obliterated, the vessel 

 being closed at and for some distance below 

 the seat of the ligature ; being then pervious, 

 the blood being conveyed into it by the in- 

 osculations between the minor branches of the 

 artery arising below the interruption and those 

 of the profunda from above ; and again im- 

 pervious below, the blood being conveyed 

 from it by similar branches anastomosing with 

 the articular arteries. 



The effect of ligature of the external iliac 

 upon the femoral artery, independent of the 

 influence of aneurism, has been already ad- 

 verted to. That effect is liable to be modified 

 by the presence of the disease ; thus in a case 

 related by Sir A. Cooper in the fourth volume 

 of the Medico-Chirurgical Transactions, in 

 which the iliac was tied for aneurism of the 

 femoral artery at the middle of the thigh, the 

 latter vessel was obliterated from the origin 

 of the profunda downward. The case, re- 

 corded by Mr. Norman, already referred to, 

 in which the external iliac was also tied, 

 presents another remarkable modification : in 

 it the femoral remained pervious, but the root 

 of the profunda was obliterated, while its 

 branches were open. 



Operative relations of the femoral artery. 

 The femoral artery may be the subject of ope- 

 ration at any part of its course, there being 

 nothing either in its situation or relations to 

 forbid the exposure of it at any point, if cir- 

 cumstances should require it. All parts, how- 

 ever, are not equally eligible, the vessel being 

 in some situations more deeply situate, covered 

 by a greater number and depth of parts, and 

 its relations more complicated than at others. 

 It has been taken up in each of the three 

 stages into which its course has been divided, 

 and the operations, which may according to 

 circumstances be performed upon it, may with 

 advantage be referred to those. The propriety 

 of thus distinguishing them will appear in a 

 strong light, when those modifications, which 

 the anatomical relations of the vessel may 

 justify, shall have been discussed, as also from 

 the history of the operations, which have been 



* Op. cit. 278, 9. 



and are proposed to be performed upon the 

 femoral artery. 



In its first stage the vessel may be tied 

 at two points, viz. either above or below the 

 origin of the profunda artery : the operation 

 at the former point, being performed under 

 circumstances different from those in which 

 that at the latter is admissible, may be con- 

 sidered apart from the others, and the de- 

 tail of it be postponed until they have been 

 disposed of; while the operation in the second 

 case, and those in the second and third stages 

 have been at different times performed for the 

 same purpose the cure of popliteal aneurism 

 and therefore a comparison of their several 

 details and advantages merits attention. The 

 situation in which the femoral artery was first 

 taken up for popliteal aneurism is the third 

 stage of its course : here it was tied, as is 

 generally known, by J. Hunter. In his ope- 

 ration Hunter made " an incision on the an- 

 terior and inner part of the thigh rather below 

 its middle ;" i. e. in the third stage ; " which in- 

 cision was continued obliquely across the inner 

 edge of the sartorius muscle and made large :" 

 the other steps of his operation it is not neces- 

 sary at present to particularize ; the author 

 would only remark, as a matter of history, that 

 Hunter's application of ligatures has been mis- 

 understood : he applied in his first operation 

 four ligatures to the artery, and it is com- 

 monly, if not generally, said that they were 

 drawn with various degrees of tightness ; but 

 such was not the case, they were tied all 

 equally tight : the account given in the report 

 of the operation being, " the artery was now 

 tied by both these ligatures/ 7 viz. the two upper, 

 " but so slightly as only to compress the sides 

 together. A similar application of ligatures 

 was made a little lower. The reason for hav- 

 ing four ligatures was to compress such a 

 length of artery, as might make up for the 

 want of tightness, it being wished to avoid 

 great pressure on the vessel at any one part." 



The artery may be and has been frequently 

 taken up in the middle stage, and the ope- 

 ration, as described in several surgical works, 

 will be found to belong to, if not to be in- 

 tended for, that stage. During its two latter 

 stages the artery is covered by the sartorius : 

 in its uppermost it is not covered by the muscle, 

 and consequently if it be necessary to displace 

 the muscle to bring the artery into view above 

 the last stage, it must be in the middle one, 

 and in the account of the operation given by 

 some of the highest authorities, the displace- 

 ment of the sartorius is stated as one of the 

 steps. This the author refers to not in a spirit 

 of criticism, but in order to mark more 

 strongly the distinction between the operations 

 at the several stages, and to direct attention to 

 the advantages possessed by that in the first 

 over the others ; more particularly since de- 

 scriptions, which in strictness apply to the 

 operation in the middle stage, and at a part 

 of the aitery's course below the first, may be 

 found so put forward that the operations at the 

 two points must be confounded ; and thus the 

 advantages contemplated by the proposer of 



