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CASE STUDY
Year : 2014  |  Volume : 35  |  Issue : 3  |  Page : 300-302  

Multiple aneurism (Siraja Granthi) observed during cadaveric dissection


Department of Shareera Rachana, SDM College of Ayurveda, Udupi, Karnataka, India

Date of Web Publication20-Mar-2015

Correspondence Address:
Pralhad D Subbannavar
Asso. Prof., Dept. of Shareera Rachana, SDM College of Ayurveda, Kuthpady, Udupi - 574 118, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.153749

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   Abstract 

Acharya Sushruta has emphasized the method and importance of dissection to study anatomy practically. Perfect knowledge of anatomy is vital for practicing surgeons and hence training of dissecting the dead body was considered as mandatory for surgeons. Though dissection techniques may give the perception of the structure of organs, the pervading and subtle consciousness in the body can be experienced with the eyes of knowledge and penance only . Though standard anatomy is defined based on statistical inferences on comparing large number of subjects, individual variations and exceptional structural specialties tend to occur quite frequently. Proper recording and publication of such instances would strengthen the knowledge base of the science. During the routine cadaveric dissection in the anatomy lab, multiple aneurisms (Siraja Granthi) in the abdominal aorta and femoral artery of 55-year-old male cadaver were observed. Such pathological variations are uncommon but clinically significant. Rupture of aneurysms or clot formation inside the lumen can produce serious complications in living condition. Enhancing size of the aneurysm producing pressure effect on the nearby structures can be the other reason for the surgical intervention. A good number of these can remain asymptomatic for a considerable period. As the clinical consequences are wide varying, the disease is of interest to physicians, as well as surgeons.

Keywords: Anatomical anomalies, aneurysm, cadaveric dissection, Siraja Granthi


How to cite this article:
Subbannavar PD. Multiple aneurism (Siraja Granthi) observed during cadaveric dissection. AYU 2014;35:300-2

How to cite this URL:
Subbannavar PD. Multiple aneurism (Siraja Granthi) observed during cadaveric dissection. AYU [serial online] 2014 [cited 2019 Dec 13];35:300-2. Available from: http://www.ayujournal.org/text.asp?2014/35/3/300/153749


   Introduction Top


Dilatation of a localized segment of the arterial system is known as aneurysm. Usually, it happens in the aorta but can also be occur in the peripheral vessels, including femoral artery (FA). Patients rarely have any symptoms due to FA aneurysm. Usually aneurysm is discovered on routine physical examination by a physician. But as the size of an aneurysm increases, the risk of rupture increases. Rupture aneurysm results in concealed hemorrhage that may prove fatal even. A clot in the FA may be the cause of ischemia in the limb and consequent loss of the limb. Compression of femoral nerve and femoral vein may result in neurovascular complications. The cause of FA aneurysms is unknown but most likely it tend to occur in older men and women and generally bilateral.

Though dissection techniques may give the perception of the structure of organs, the pervading and subtle consciousness in the body can be experienced with the eyes of knowledge and penance only . [1] Sushruta Samhita describes cadaveric dissection of the body for studying anatomy. [2] Technique explained for dissection in classics were to keep the body covered with grass, in flowing water for a week and to dissect the tissue with a brush. Naturally, in such condition minute details of the vessels and branches might not have been visible.

Sushruta Samhita describes a disease named as Siraja Granthi akin to the aneurysm. It is explained as the vitiation of Vata and with other Niadanas, and the Sira will become Sampeeda and Sankocha and that leads to Vruttakar Granthi. [3]

Classification

True aneurysm involves all the three layers of the arterial wall whereas false aneurysm has only single layer of fibrous tissue as the covering of sac and does not contain all the three layers of the arterial wall. (2) As per morphology - it is commonly described as fusiform, saccular and dissecting aneurysm. (3) As per etiology, some of the underlying causes found are atherosclerosis, mycotic aneurysm (due to fungal infection), syphilis (due to the loss of vasa-vasorum in the tunica adventitia, etc.) [4]


   Case Report Top


A 55-year-old aged male cadaver was dissected in the anatomy laboratory where multiple aneurysms in the abdominal aorta and FA were seen. Aneurysm of the abdominal aorta was located at the level of L4. FA aneurysm was bilaterally situated at mid-inguinal point at the beginning of FA behind the inguinal ligament [Figure 1] [Figure 2] [Figure 3] [Figure 4].
Figure 1: Bilateral femoral artery aneurysm. LFAA: Left femoral artery aneurysm; RFAA: Right femoral artery aneurysm

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Figure 2: Aneurysm in the abdominal aorta. AAA: Abdominal aorta aneurysm; RK: Right kidney; RU: Right ureter

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Figure 3: Aneurysm in the right femoral artery

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Figure 4: Aneurysm in the left femoral artery. IL: Inguinal ligament; LFAA: Left femoral artery aneurysm; FA: Femoral artery; SM: Sartorius muscle

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Abdominal aortic aneurysm is the most common type of large vessel aneurysm and is found in about 2% of population at autopsy in which 0.95% found to be associated with atheromatous degeneration and 95% cases occur below the level of renal arteries. True aneurysm of FA is uncommon, and complications occur in less than 3% of cases.

The FA aneurysm can cause trouble to a patient if they rupture and cause bleeding into the thigh, or when blood clot builds up inside the FA aneurysm along the walls of the aneurysm and then travels down the artery and into the lower leg. Either of these two events can potentially lead to the need for amputation of the lower leg.


   Conclusion Top


Many of the anomalies may remain unidentified throughout the life of a human being. They may be identified only during the cadaveric dissection. Proper documentation and reporting of such anomalies help in the progression of science of anatomy. Detailed documentation of such studies will help the surgeons for the conduction of respective surgeries and their prognosis.

 
   References Top

1.
Sushruta, Sushruta Samhita, Sharira Sthana, Sharira Sankhya Vyakaran Adhyaya, 5/51, edited by Vaidya Jadaji Trikamji Acharya, 9 th ed. Chaukhambha Orientalia, Varanasi, 2007; 369.  Back to cited text no. 1
    
2.
Ibidem. Sushruta Samhita, Sharira Sthana, Sharira Sankhya Vyakaran Adhyaya, 5/47-49; 369.  Back to cited text no. 2
    
3.
Ibidem. Sushruta Samhita, Nidanda Sthana, Granthi-Apachi-Arbud-Galganda Nidanadhyaya, 11/8; 311.  Back to cited text no. 3
    
4.
Williams NS, Bulstrode JK, Ronan O'Connell P, editors. Bailey and Love's - Short Practice of Surgery. 2 5th ed. London: Hodder Arnold; 2008. p . 918.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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