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March 1948

SURGICAL APPROACH TO HYPERTENSIVE VASCULAR DISEASE: Technic of Operation, Discussion of Complications and Method of Prevention

Author Affiliations

Dr. Pretty is a diplomate of the American Board of Surgery, a lecturer in surgery at McGill University and associate surgeon, Montreal General Hospital.

Arch Surg. 1948;56(3):357-371. doi:10.1001/archsurg.1948.01240010364006

DILATATION of the capillary bed allows the same volume of blood to flow through larger tubes, with resulting fall in blood pressure. Pressor drugs temporarily reverse the process and cause blood pressure to rise.1 Splanchnicectomy and sympathectomy appear to serve a dual purpose, namely, that of producing vasodilatation of the splanchnic visceral bed and of the capillary bed of the lower limbs and release of sympathetic control to the kidneys and adrenals through the aorticorenal ganglion, which, it is believed, controls the secretion of renin and the emotional internal secretion of epinephrine,2 powerful pressor substances. At present, however, it is felt that the pituitary body, the thalamus and the thyroid are all involved in the condition of hypertensive vascular disease,3 on which our present approach by means of sympathectomy has but slight influence. The surgical procedure is therefore mechanical for the greater part, but it is the