A NEW PRINCIPLE IN THE SURGERY OF THE LARGE VESSELS

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Abstract
The age-old operation of ligation of an artery has within recent years undergone an important modification following recognition of the principle that the companion vein must also be occluded whenever injury or disease requires ligation of the main artery to an extremity. It is largely through the experiences and writings of Sir George Makins1that this development in a simple operation has become universally adopted. The clinical experiences of a lessened incidence of gangrene following its adoption have been corroborated experimentally by Drummond2and by Brooks and Martin.3 Additional experimental evidence is now available in support of a further modification of the operation, which requires that under certain circumstances the ligation of the vein be performed at a considerable distance proximal to the site of ligation of the artery. The principle is particularly applicable to the ligation of the femoral and popliteal vessels, following which, as the

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