Illustrations
Charts
1. Graphic recording of skin temperaturedeterminations inrelation to changes in room temperature.
2. Incidence of arterial wounds among battlecasualties in various wars.
3. Incidence of arterial wounds among Americanbattle casualties inWorld War II.
4. Incidence of arterial wounds among wounds ofextremities in Americanbattle casualties in World War II
5. Causes of amputations among American battlecasualties in World WarII.
6. Distribution of arterial wounds according toanatomic location inwounds of extremities in various wars.
7. Effect of time lag between wounding andoperation on incidence ofamputation in arterial wounds of the extremities among American battlecasualties in World War II.
8. Effects of presence or absence of associatedfractures on incidenceof amputation in arterial wounds of extremities among American battlecasualties in World War II.
9. Effects of site of arterial wounds of theextremities on incidenceof amputation in American battle casualties in World War II and inBritish battle casualties in World War I.
10. Effect of site of arterial wounds of theextremities on incidenceof amputation in American battle casualties in World War II.
11. Effect of site of wounds of the brachial andfemoral arteries onincidences of amputation in American battle casualties in World War II.
12. Effect of type of arterial wounds of theextremities on incidenceof amputation in American battle casualties in World War II.
13. Results of ligation of comparable arterieswith and withoutligation of concomitant veins in British casualties in World War I.
14. Results of ligation of comparable arterieswith and withoutligation of concomitant veins among British casualties in World War I.
15. Results of various therapeutic measures onincidence of amputationin arterial wounds of extremities in American battle casualties inWorld War II, with special reference to the type of arterial repair.
16. Incidence of amputation in arterial wounds inAmerican battlecasualties in World War II according to method of management.
17. Results of sympathectomy and sympatheticblock in comparablearterial wounds in American battle casualties in World War II.
18. Temperature chart of patient withStreptococcus viridans septicemiapreceding and following operation.
19. Oscillometric and skin temperaturedeterminations in left plantararteriovenous fistula.
20. Effects of temporary occlusion ofarteriovenous fistula on arterialpressure, stroke, volume, heart rate, cardiac output, and atrialpressure.
21. Effects ( in percentages of normal values) ofarteriovenous fistulaon cardiac output.
22. Ballistocardiographic observations before and afterexcision of femoral arteriovenous fistula.
23. Effects on blood volume (expressed as changesper square meter ofbody surface) of excision of arteriovenous fistula.
24. Ballistocardiographic studies in poplitealartreriovenous fistulabefore and after intravenous administration of 2 mg. of atropinesulfate.
25. Distribution of measurements of cardiacfrontal area ( in terms ofpredicted area) after operative cure of arteriovenous fitulas in 119patients in whom the preoperative measurements had not exceeded 115percent of the predicted.
26. Distribution of measurements of cardiacfrontal area ( in terms ofpredicted area) in 153 patients before and in 161 patients afteroperative cure of arteriovenous fistula.
27. Proportion of distribution of measurements ofcardiac frontal areain percentage of predicted area in 153 patients before and in 161patients after operative cure of arteriovenous fistula.
28 Proportionate distribution of alteration incardiac frontal ara in132 patients after operative cure of arteriovnous fistula.
29. Comparative distribution of preoperativemeasurements of cardiacfrontal area ( in percentages of predicted value) and of postoperativedecreases ( percentages of preoperative values) in fistulas caudad andcephalad to the heart.
30. Comparative measurements of cardiac frontalarea ( in percentagesof predicted valus) in relation to magnitude of response of pulse andblood pressure to temporary occlusion of fistula.
Figures
1. View of room with temperature andhumidity controls used forexamination and testing of patients with vascular injuries anddiseasees at vascular center of DeWitt General Hospital.
2. Mechanical compressor for carotid artery.
3. Special arteriographic study of restorativeopeation in femoralarteriovenous fistula.
4. Through-and-through wound of popliteal artery.
5. Laceration of popliteal artery treated bynonsuture anastomosis.
6. (Case 10) Laceration of femoral artery andvein treated by nonsutureanastomosis.
7. A. Details of nonsuture technique.
B. Transection of poplitealartery treated bynonsuture technique.
8. Tense swelling of muscles of calf, withoutsignificant subcutaneousedema, 12 hours after transection of popliteal artery.
9. (Case 24) Complete severance of right femoralartery and veintreated by ligation below profunda femoris.
10. Diagrammatic representation of various typesof arteriovenousfistulas and associated aneurysms.
11. Roentgenograms showing change in heart sizeand evidence ofpulmonary infarction.
12. Kodachrome of specimen removed at operationviewed from venous sideof arteriovenous fistula.
13. Photomicrograph of portion of excisedarteriovenous fistula showingtwo bacteria-studded vegetations, (H. and E. stain, high powermagnification).
14. Diagrammatic showing of location and generalappearance of the fourarteriovenous fistulas present following injury by land mine.
15. A. Plantar arteriovenous fistula.
16. Serial teleoroentgenograms in femoralarteriovenous fistulas.
17. Exposure of lower femoral and poplitealvessels by medial approachanterior to sartorius muscle.
18. Skin incision for exploration of poplitealvessels.
19. Exposure of popliteal vessels.
20. Resection of head of fibula for exposure oftibial and peronealvessels.
21. Exposure of arteriovenous fistula ofposterior tibial vessels byremoval of upper third of fibula.
22. (After Henry). Exposure of plantar vesselsthrough medialapproach, which is facilitated by detachment of abductor hallucismuscle from its origin.
23. Incisions for exposure of A innominate, Bsubclavian, and Caxillary vessels.
24. Incision for exploration of distal portionof axillary and firstportion of brachial vessels.
25. Incisions for exposure of vessels inantecubital fossa.
26. Exposure of fistula between brachial arteryand vein in antecubitalspace.
27. A and B show cirsoid aneurysm of the scalpcondition beforeoperation, 8 May 1945. C. and D. Apperance of head 3 months afteroperation.
28. Resection of clavicle subperiostally toexpose aneurysm ofsubclavian artery.
29. Operative exposure of vessels of superioranterior mediastinum bydivision of sternum and resection of inner third of left clavicle.
30. Normal range of shoulder motion in patientsubmitted to exposure ofblood vessels in superior anterior and mediastinum by technique shownin figure 29.
31. (Case 2) Roentgenograms showing successivechanges in size of heartin traumatic arteriovenous fistula involving innominate vessels.
32. (Case 2) Exposure of innominate vessels forcorrection ofarteriovenous fistula.
33. (Case 5) Roentgenograms showing innominateaneurysm.
34. Surgical approach to a fistula between lowerportions of the rightvertebral vessels.
35. Surgical approach to a fistula between upperportions of the leftvertebral vessels
36. (Case 4) Transvenous repair of arteriovenousfistula involving leftsubclavian artery and innominate vein.
37. (Case 7) Carotid-jugular arteriovenousfistula.
38. (Case 10) A. Preoperative arteriogramshowing arteriovenous fistulainvolving upper portions of superficial femoral vessels, with smallaneurysm on lateral aspect of artery. B. Postoperative arteriogramfollowing diagonal suture.
39. Ligation and transfixion of arteriovenousfistula.
40. Lateral arteriorrhaphy.
41. End-to-end suture.
42. (Case 28, Table 31.) Postoperativeartriogram taken 10 weeks afterresection of fitula between femoral and profunda femoris arteries andfemoral vein, with end-to-end suture of profunda artery proximally tofemoral arrtery distally.
43. Vein transplantation.
44. Infrared photograph of patient witharteriovenous fistula involvingabdominal aorta and vena cava.
45. Diagrammatic representation of findings atoperation forarteriovenous fistula of abdominal aorta and vena cava.
46. (Case 2) A and B. Aneurysm of left caroticartery 8 weeks afterinjury. C. Five months later apparent spontaneous cure of lesion.
47. (Case 9.) Right axillary aneurysm 3 monthsafter injury.
48. (Case 9.) Drawing of condition foundat operation.
49. Traumatic aneurysm excised 11 years afterits origin.
50. Poorly organized thrombus from a largebrachial aneurysm of 2months duration.
51. Typical digital symcope in patient withRaynaud's disease onexposure to cold.
52. A. Patient with longstanding Raynaud'sdisease showing bilateralsuperficial gangrene in fingertips. B. Complete healing of ulcerativeareas shortly after bilateral doral sympathectomy.
53. A. Marked livido reticularis of lowerextremities in patient withRaynaud's symdrome. B. Appearance of feet following bilateral lumbarsympathectomy.
54. A. Massive edema of right hand in patientwith vasomotor disorderfollowing trauma. B. Disappearance of edema several weeks afterinstitution of intensive active exercise and physical therapy.
55. A. Massive edema and ulceration of left footand lower leg inpatient with post tramatic vasomotor disorder and resistant infection.
56. A. Edema of left foot in patient withpost-traumatic vasomotordisorder and hysteria 11 months after injury.
Tables
1. Combined diagnostic analysis report Ashford General HospitalVascular Center.
Combined diagnostic analysisreport Ashford GeneralHospital Vascular Center (Continued)
Combineddiagnostic analysisreport Ashford General Hospital Vasuclar Center (Continued)
2. Combined operative analysis report AshfordGeneral Hospital VascularCenter
Combined operative analysisreport Ashford GeneralHospital Vascular Center (Continued)
Combined operative analysisreport Ashford GeneralHospital Vascular Center (Continued)
3. Comparative distribution of arterialinjuries among World WarI (British) and World War II (American) casualties.
4. Indications for amputation in 189 cases ofvascular injury.
5. Special laboratory studies (Case 8)
6. Distribution of 814 arterial aneurysms andarteriovenous fistulas.
Distribution of 814 arterialaneuryms andarteriovenous fistulas (Continued)
7. Oscillometric variations in the two arms atdifferent positionsduring normal breathing and deep inspiration.
8. Techniques of operative treatment in 209arterial aneurysms.
9. Techniques of operative treatment in 585arteriovenous fistulas.
10. Associated injuries in 159 arterial aneurysms.
11. Associated injuries in 288 arteriovenousfistulas.
12. Distribution of multiple aneurysms andarteriovenous fistulas among20 patients with 46 lesions.
13. Preoperative and postoperativeballistocardiographic observation in47 patients with arteriovenous fistulas.
14. Preoperative and postoperative blood volumestudies in 41 patientswith arteriovenous fistulas.
15. Preoperative and postoperative studies ofeffects of temporaryocclusions in 25 patients with arteriovenous fistulas.
16. Preoperative studies of effects of temporaryocculsion with andwithout atropinization in 5 ptients with arteriovenous fistulas.
17. Location of lesion and age distribution.
18 Interval in months between injury andpreoperative roentgenogrambetween injury and operation, and between operation and post operativeroentgenogram.
19. Proportionate distribution of preoperativemeasurements of thecardiac frontal area.
20. Proportionate distribution of postoperativemeasurements of thecarida frontal area.
21. Proportionate distribution of postoperativealterations in cardiacfrontal area.
22. Proportionate distibution of cardiacenlargement in relation tosize of fistula in patients with popliteal and femoral arteriovousfistulas.
23. Proportionate Distribution of Preoperative Cardiac Frontal Area in VariouslyLocated Fistulas 7 Millimeters or More in Diameter and from 3.1 to 6.5 MonthsDuration
24. Relationship of duration and size of fistulato preoperativecardiac frontal area.
25. Relationship of duration of fistula topreoperative cardiac frontalarea in patients with popliteal and femoral fistulas of large size(diameter of 7 mm.+)
26.Comparison of cardiac frontal area in patientsin whom more than onemeasurement was made before operation.
27. Comparison of cardiac frontal area inpatients in whom more thanone measurement was made after operation.
28. Analysis of results of various operativeprocedures in patientswith innominate aneurysms and arteriovenous fistulas.
29. Ligation and transfixion of fistula - data on13 patients witharteriovenous fistulas.
30. Lateral arteriorrhaphy-data on 5 patientswith aneurysms andarteriovenous fistulas.
31. End-to-end suture data on 10 patients witharterial aneurysms andarteriovenous fistulas.
32. Vein transplant - data on 6 patients witharterial aneurysms andarteriovenous fistulas.
33. Oscillometric studies following arterialrepair in 28 patients.
34. Chemical constituents of blood.
35. Sympathectomy performed before or at the timeof operation foraneurysm or arteriovenous fistula.
36. Sympathectomy performed before operation foraneurysm or fistula.
Sympathectomyperformed before operationfor aneurysm or fistula (Continued)
37. Sympathectomy performed before operation foraneurysm or fistula.
Sympathectomyperformed before operationfor aneurysm or fistula (Continued)
38. Sympathectomy performed before operation foraneurysm or fistula.
Sympathectomyperformed before operationfor aneurysm or fistula (Continued)
39. Symptathectomy performed before operation foraneurysm or fistula.
40. Sympathectomy performed before operation foraneurysm or fistula.
41. Sympathectomy performed before operation foraneurysm or fistula.
42. Sympathectomy performed at the time ofoperation for aneurysm orfistula.
Sympathectomyperformed at the time ofoperation for aneurysm or fistula (Continued)
43. Incidence of sympathectomy in patients witharterial aneurysm andarteriovenous fistula.
44. Sympathectomy performed after operation foraneurysm andarteriovenous fistula.
Sympathectomyperformed after operationfor aneurysm and arteriovenous fistula (Continued)
45. Sympathectomy performed after operation foraneurysm andarteriovenous fistula.
46. Sympathectomy performed after operation foraneurysm andarteriovenous fistula.
47. Sympathectomy performed after operation foraneurysm andarteriovenous fistula.
Sympathectomy performedafter operationfor aneurysm and arteriovenous fistula.
48. Symptoms and signs in post-traumaticvasomotor disorders.
49. Sympathectomy in post-traumatic vasomotordisorders.
50. Sympathectomy in post-traumatic vasomotordisorders.
Sympathectomy in post-traumatic vasomotordisorders (Continued).
51. Sympathectomy in post-traumatic vasomotordisorders.
Sympathectomy inpost-traumatic vasomotor disorders (Continued).
52. Sympathectomy in post-traumatic vasomotordisorders.
