scholarly journals Cervical Vertebral Artery to Facial Branch External Carotid Artery Bypass: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Artery Bypass ◽  
Video Recording ◽  
Distal Segment ◽  
External Carotid Artery ◽  
External Carotid ◽  
Transverse Foramen ◽  
Institutional Review ◽  
V1 Segment

Abstract Posterior circulation ischemia often presents with dizziness, ataxia, visual disturbances, or motor-sensory deficits. The vertebral artery stenosis most frequently involves the V1 segment proximal to the foraminal segment. This patient demonstrated critical stenosis of the left V1 segment of the vertebral artery related to atherosclerotic disease. A left cervical dissection was performed, and the cervical transverse foramen was opened to permit exposure of the vertebral artery in the V2 segment. The vertebral artery was proximally occluded and transected. An endarterectomy was performed, and an end-to-end anastomosis of the facial branch of the external carotid artery to the distal segment of the transected vertebral artery was completed. Indocyanine green angiography was used to confirm patency of the anastomosis. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals A Rare Variantion of Left Vertebral Artery Originating from External Carotid Artery: A Case Report

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Cervical Vertebrae ◽  
External Carotid Artery ◽  
Left Vertebral Artery ◽  
External Carotid ◽  
Transverse Foramen ◽  
Vertebral Arteries ◽  
Tomographic Angiography ◽  
Radiological Procedures

Variations of vertebral arteries are congenital anomalies occurring during the embryonic development. We established a variant left vertebral artery which is a branch of left external carotid artery, by using magnetic resonance angiography and computerized tomographic angiography in a 43-year-old female patient whose vertebral arteries could not be detected in Doppler ultrasonography performed for the evaluation of her dizziness. This vertebral artery was extending up outside the transverse foramina until it entered into the left transverse foramen of the cervical vertebrae at the C1 level. Awareness of such variations of vertebral arteries is important with regard to the prevention of possible cerebrovascular injuries in interventional radiological procedures and vascular surgeries. For this reason, we would like to present this rare case of left vertebral artery showing a different origin and course outside the transverse foramina.

scholarly journals Vertebral Artery to Common Carotid Artery Transposition: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E198-E198
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Video Recording ◽  
Artery Stenosis ◽  
Front Wall ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Steal Syndrome ◽  
V1 Segment

Abstract Vertebral artery (V1 segment) transposition is a useful technique in the treatment of patients with either proximal subclavian artery stenosis with vertebral “steal” syndrome or severe vertebral artery origin stenosis. This patient required extracranial augmentation of right vertebral artery blood flow to treat proximal vertebral artery stenosis. This was achieved through a V1 to common carotid artery end-to-side anastomosis. The end-to-side anastomosis was performed with the first stitch after the heel stich placed to the inside of the vessel, and the back wall was run from the inside. The anastomosis was completed by running along the front wall from the external surface of the arteries. The anastomosis was flushed by temporary removal of the proximal carotid artery clamp. The anastomotic suture was then tied, and clamps were removed. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

External Carotid Artery-to-Middle Cerebral Artery Bypass Using a Saphenous Vein Graft With 3-Vessel Anastomosis for the Treatment of a Large, Ruptured Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kristine Ravina ◽  
Joshua Bakhsheshian ◽  
Joseph N Carey ◽  
Jonathan J Russin
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
External Carotid ◽  
Bifurcation Aneurysm

Abstract Cerebral revascularization is the treatment of choice for select complex intracranial aneurysms unamenable to traditional approaches.1 Complex middle cerebral artery (MCA) bifurcation aneurysms can include the origins of 1 or both M2 branches and may benefit from a revascularization strategy.2,3 A novel 3-vessel anastomosis technique combining side-to-side and end-to-side anastomoses, allowing for bihemispheric anterior cerebral artery revascularization, was recently reported.4  This 2-dimensional operative video presents the case of a 73-yr-old woman who presented as a Hunt-Hess grade 4 subarachnoid hemorrhage due to the rupture of a large right MCA bifurcation aneurysm. The aneurysm incorporated the origins of the frontal and temporal M2 branches and was deemed unfavorable for endovascular treatment. A strategy using a high-flow bypass from the external carotid artery to the MCA with a saphenous vein (SV) graft was planned to revascularize both M2 branches simultaneously, followed by clip-trapping of the aneurysm. Intraoperatively, the back walls of both M2 segments distal to the aneurysm were connected with a standard running suture, and the SV graft was then attached to the side-to-side construct in an end-to-side fashion. Catheter angiograms on postoperative days 1 and 6 demonstrated sustained patency of the anastomosis and good filling through the bypass. The patient's clinical course was complicated by vasospasm-related right MCA territory strokes, resulting in left-sided weakness, which significantly improved upon 3-mo follow-up with no new ischemia.  The patient consented for inclusion in a prospective Institutional Review Board (IRB)-approved database from which this IRB-approved retrospective report was created.

Cerebral Protection with a Temporary Ascending Aorta–External Carotid Artery Bypass during Common Carotid Artery Revascularization

2018 ◽  
Vol 46 ◽  
pp. 368.e13-368.e17
Author(s):  
Murat Ugurlucan ◽  
Yilmaz Onal ◽  
Didem Melis Oztas ◽  
Cagla Canbay ◽  
Ibrahim Demir ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Artery Bypass ◽  
External Carotid Artery ◽  
Ascending Aorta ◽  
Cerebral Protection ◽  
External Carotid

Cerebral Protection With a Crossover External Carotid Artery Bypass During Arch Debranching

2015 ◽  
Vol 99 (2) ◽  
pp. 725-727 ◽  
Author(s):  
Murat Ugurlucan ◽  
Omer Ali Sayin ◽  
Mehmet Akif Onalan ◽  
Nijat Alishev ◽  
Murat Basaran ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Bypass ◽  
External Carotid Artery ◽  
Cerebral Protection ◽  
External Carotid

Subclavian-External Carotid Artery Bypass Graft

AORN Journal ◽  
1989 ◽  
Vol 50 (2) ◽  
pp. 361-368
Author(s):  
Jon Senkowsky ◽  
Florence L. Smith ◽  
Morris D. Kerstein
Keyword(s):  
Carotid Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
External Carotid Artery ◽  
External Carotid ◽  
Artery Bypass Graft

Suspicious Extracranial Duplex Examination: A Predictor of Intracranial Disease?

2009 ◽  
Vol 33 (1) ◽  
pp. 31-35
Author(s):  
Esther Collado ◽  
Megan Hodge ◽  
Charles McCollum ◽  
George Noon ◽  
Ruth L. Bush ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Moyamoya Disease ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
Left Vertebral Artery ◽  
External Carotid ◽  
Carotid Duplex ◽  
Doppler Signals

Introduction Moyamoya disease is a rare and progressive condition with poor long-term prognosis. A meticulous evaluation during an extracranial carotid duplex exam, with attention to subtle changes in anatomy and Doppler signals, can alert the sonographer to pathology in the intracranial circulation, which may suggest this diagnosis. Case Report A 45-year-old woman presented to our vascular lab with an episode of slurred speech, right arm weakness, right-sided numbness, and generalized weakness that lasted 15 – 20 min, with total resolution of symptoms. A carotid duplex examination was ordered and demonstrated no evidence of extracranial carotid disease; however, bilaterally the external carotid artery was larger in size than the internal carotid artery, multiple prominent external carotid artery branches were noted, the internal carotid artery and vertebral artery Doppler signals demonstrated low-resistance waveforms with high diastolic flow velocity, and the left vertebral artery was enlarged. Magnetic resonance imaging with angiography demonstrated multiple intracranial abnormalities, and conventional angiography was compatible with Moyamoya disease. A superficial temporal artery-to-middle cerebral artery bypass was performed with an uneventful postoperative course and no recurrence of symptoms. Conclusions Subtle changes in anatomy and Doppler signals observed during an extracranial carotid duplex examination can be important indicators of pathology in a location that is not under direct visualization and interrogation. It is important for the sonographer to note these changes and report them to the physician for further evaluation by more direct methods of testing. This case provides an example of the use of such indirect sonographic evidence.

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