Skeletonized Radial Artery Graft Prepared with Phosphodiesterase-III Inhibitors Indicates Favorable Results Compared with Pedicled Radial Artery Graft in Angiographic Studies

2006 ◽  
Vol 1 (5) ◽  
pp. 251-254 ◽  
Author(s):  
Shohjiro Yamaguchi ◽  
Go Watanabe ◽  
Kohichi Higasidani ◽  
Shigeyuki Tomita ◽  
Kenji Iino ◽  
...  
Keyword(s):  
Radial Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Phosphodiesterase Iii Inhibitor ◽  
The Mean ◽  
Phosphodiesterase Iii Inhibitors ◽  
Phosphodiesterase Iii

Objectives The technique used to harvest the radial artery was modified, with improved results. Skeletonized radial artery conduits prepared with phosphodiesterase-III inhibitor were compared with pedicled conduits by angiography. Methods Isolated coronary artery bypass graft surgery that used the radial artery for conduits was performed on 83 consecutive occasions from March 2003 to February 2004. The mean age of the patients was 68 ± 7 years; 65% were male. The radial arteries were harvested randomly for skeletonized (group SPD and group SPa) or pedicled (group PPD). A phosphodiesterase-III inhibitor, olprinone hydrochloride, was used as an antispastic agent during harvesting of the radial artery for both in groups SPD and PPD. Papaverine was used in group SPa. Postoperative angiograms were performed within 1 month. Diameters of the radial artery were scaled at proximal, mid, and distal sections and averaged. Optical stenosis was measured as a percent stenosis value. Results There were no significant differences among groups SPD, SPa, and PPD in morbidity or mortality rates. Graft patency rates were 97.4% in group SPD, 98.6% in group SPa, and 95.4% in group PPD (P = 0.67). Diameters of the radial artery conduits were significantly wider in group SPD compared with group PPD (P < 0.001). Spasm and stenosis were less frequent in group PPD (P < 0.05). Conclusions Skeletonized radial artery grafting prepared with a phosphodiesterase-III inhibitor indicated favorable results in angiographic studies.

Endovascular Management of Symptomatic Spasm of Radial Artery Bypass Graft

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 794-798 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Erik F. Hauck ◽  
L. Nelson Hopkins ◽  
Elad I. Levy ◽  
Adnan H. Siddiqui
Keyword(s):  
Radial Artery ◽  
Moyamoya Disease ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Occipital Artery ◽  
Artery Bypass Graft ◽  
Perfusion Deficit ◽  
Radial Artery Graft ◽  
Symptomatic Vasospasm ◽  
Artery Graft

Abstract OBJECTIVE To describe the technique of endovascular access for treatment of vasospasm of a radial artery bypass graft from the occipital artery to the M3 branch of the middle cerebral artery (MCA) in a patient with moyamoya disease. CLINICAL PRESENTATION A 32-year-old woman presented with recurrent right-sided ischemic symptoms in the territory of a previous stroke. Angiographic findings were consistent with moyamoya disease, and a perfusion deficit was identified on computed tomography (CT) perfusion imaging. TECHNIQUE The patient underwent a left MCA bypass graft for flow augmentation. She returned with an occluded bypass graft, collateralization of the anterior MCA territory through a spontaneous synangiosis, and a severe perfusion deficit in the posterior MCA territory. She underwent a revision bypass graft procedure with the radial artery from the occipital artery stump to the MCA-M3 branch. She developed repeated symptomatic vasospasm of the radial artery graft postoperatively. After systemic anticoagulation, the graft was accessed through the occipital artery, and intra-arterial verapamil was injected. When this failed to resolve the graft spasm, the radial artery graft was accessed with a 0.14-inch Synchro-2 microwire (Boston Scientific, Natick Massachusetts), and sequential angioplasties were performed using over-the-wire balloons from the proximal to distal anastomosis and in the occipital artery stump. A nitroglycerin patch was applied cutaneously over the graft to relieve the vasospasm. RESULTS No complications occurred. Graft patency with robust flow was observed on the 5-month follow-up angiogram. CONCLUSION Endovascular techniques can be safely used for salvage of spastic extracranial-intracranial grafts.

Radial Artery Graft for Bypass of the Maxillary to Proximal Middle Cerebral Artery: An Anatomic and Technical Study

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 667-671 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Mustafa Büyükmumcu ◽  
Cagatay Han Ulku ◽  
Aynur Emine Cicekcibasi ◽  
Hamdi Arbag
Keyword(s):  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Proximal Middle Cerebral Artery ◽  
The Mean ◽  
Artery Branch

Abstract OBJECTIVE In this study, we aimed to investigate the use of a radial artery graft for bypass of the maxillary artery (MA) to the proximal middle cerebral artery (MCA) as an alternative to superficial temporal artery-to-MCA anastomosis or extracranial carotid-to-MCA bypass using long grafts. METHODS Five adult cadavers were used bilaterally. After a frontotemporal craniotomy and a zygomatic arch osteotomy, the MA was found easily 1 to 2 cm inferior to the infratemporal crest. A hole was created with a 4-mm-tip drill in the sphenoid bone 2 to 3 mm lateral to the foramen rotundum extradurally, and the dura over the hole was opened. After the carotid and sylvian cisterns had been opened, the M2 segment of the MCA was exposed. The graft was passed through the hole to reach the M2 segment. Then, the MA was freed from the surrounding tissue and was transected before the infraorbital artery branch. The radial artery graft was anastomosed end-to-end to the MA proximally and end-to-side to the M2 segment of the MCA distally. RESULTS The mean thickness of the MA before the infraorbital artery branch was 2.6 ± 0.3 mm. The mean thickness of the largest trunk of the MCA was 2.3 ± 0.3 mm. The average length of the graft was 36 ± 5.5 mm. CONCLUSION MA-to-MCA bypass is as feasible as proximal MCA revascularization using long vein grafts. The thickness of the MA provides sufficient flow; the length of the graft is short, and it has a straight course. MA-to-proximal MCA bypass may be an alternative to superficial temporal artery-to-MCA as well as extracranial carotid-to-MCA bypasses.

The azygos anterior cerebral artery bypass: double reimplantation technique for giant anterior communicating artery aneurysms

2011 ◽  
Vol 114 (4) ◽  
pp. 1154-1158 ◽  
Author(s):  
Zaman Mirzadeh ◽  
Nader Sanai ◽  
Michael T. Lawton
Keyword(s):  
Radial Artery ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Bypass ◽  
Anterior Communicating Artery ◽  
Retrograde Flow ◽  
Radial Artery Graft ◽  
Pterional Craniotomy ◽  
Artery Graft ◽  
Interhemispheric Fissure

The authors introduce the azygos anterior cerebral artery (ACA) bypass as an option for revascularizing distal ACA territories, as part of a strategy to trap giant anterior communicating artery (ACoA) aneurysms. In this procedure, the aneurysm is exposed with an orbitozygomatic-pterional craniotomy and distal ACA vessels are exposed with a bifrontal craniotomy. The uninvolved contralateral A2 segment of the ACA serves as a donor vessel for a short radial artery graft. The contralateral pericallosal artery (PcaA) and the callosomarginal artery (CmaA) are connected to the graft in the interhemispheric fissure using the double reimplantation technique. Three anastomoses create an azygos system supplying the entire ACA territory, enabling the surgeon to trap the aneurysm incompletely. Retrograde flow from the CmaA supplies the ipsilateral recurrent artery of Heubner, and the aneurysm lumen thromboses. The azygos bypass was successfully performed to treat a 47-year-old woman with a giant, thrombotic ACoA aneurysm supplied by the A1 segment of the left ACA, with left PcaA and CmaA originating from the aneurysm base. The authors conclude that the azygos ACA bypass is a novel option for revascularizing PcaA and CmaA, as part of the overall treatment of giant ACoA aneurysms.

scholarly journals Surgical Treatment of Coronary Artery Aneurysm with Calcification and Stenosis: A Case Report and Review of the Literature

2020 ◽  
Author(s):  
He Sun ◽  
Mingkui Zhang ◽  
Qingyu Wu ◽  
Hui Xue ◽  
Yongqiang Jin
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Aneurysm ◽  
Causative Factor ◽  
Review Of The Literature ◽  
Radial Artery Graft ◽  
Artery Graft

Abstract Coronary artery aneurysm (CAA) has been increasingly reported in recent years. The symptoms are related to myocardial ischemia, such as angina pectoris, myocardial infarction, sudden death and congestive heart failure. This report describes a case of a giant CAA with calcification and stenosis involving two coronary arteries, and the patient underwent a complete arterialized coronary artery bypass graft. After 3 months of follow-up, it was found that the radial artery graft was occluded. In this report, all cases related to CAA with calcification and stenosis are summarized. According to the data, the following conclusions can be drawn: CAA seem to be more common in men; Kawasaki disease is likely to be a causative factor in some patients with asymptomatic CAA involving calcification and stenosis; CABG is a feasible treatment option for CAA with calcification and stenosis.

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