Traumatic Aneurysm

The essential feature of a traumatic aneurysm is that it is produced by some form of injury which divides all the coats of the artery. The walls of the injured vessel are presumably healthy, but they form no part of the sac of the aneurysm. The sac consists of the condensed and thickened tissues around the artery.

The injury to the artery may be a subcutaneous one such as a tear by a fragment of bone: much more commonly it is a punctured wound from a stab or from a bullet.

The aneurysm usually forms soon after the injury is inflicted; the blood slowly escapes into the surrounding tissues, gradually displacing and condensing them, until they form a sac enclosing the effused blood.

Less frequently a traumatic aneurysm forms some considerable time after the injury, from gradual stretching of the fibrous cicatrix by which the wound in the wall of the artery has been closed. The gradual stretching of this cicatrix results in condensation of the surrounding structures which form the sac, on the inner aspect of which laminated clot is deposited.

A traumatic aneurysm is almost always sacculated, and, so long as it remains circumscribed, has the same characters as a pathological sacculated aneurysm, with the addition that there is a scar in the overlying skin. A traumatic aneurysm is liable to become diffuse—a change which, although attended with considerable risk of gangrene, has sometimes been the means of bringing about a cure.

The treatment is governed by the same principles as apply to the pathological varieties, but as the walls of the artery are not diseased, operative measures dealing with the sac and the adjacent segment of the affected artery are to be preferred.