Republished: Thrombectomy for late occlusion of high flow extracranial–intracranial saphenous vein bypass graft after 27 years of patency

2018 ◽  
Vol 10 (11) ◽  
pp. e27-e27
Author(s):  
Michael A Silva ◽  
Rodolfo E Alcedo Guardia ◽  
Mohammad Ali Aziz-Sultan ◽  
Nirav J Patel
Keyword(s):  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Bypass Graft ◽  
External Carotid Artery ◽  
High Flow ◽  
Posterior Circulation ◽  
External Carotid ◽  
Vein Bypass ◽  
Basilar Occlusion

High flow extracranial–intracranial (EC-IC) bypass with a saphenous vein graft (SVG) has been used for more than 40 years in patients with giant aneurysms of the posterior circulation refractory to medical management, and has demonstrated high long term patency rates. We report the case of a patient treated with external carotid artery (ECA)–posterior cerebral artery SVG bypass in 1989 who presented 27 years later with paresthesias and confusion, and was found to have partial occlusion of her SVG bypass graft and a basilar occlusion. She was treated with mechanical thrombectomy of the basilar occlusion via the partially thrombosed graft, the first report of such a procedure through a high flow posterior circulation EC-IC SVG, resulting in improvement of the patient’s neurologic examination. At 27 years, this is the longest reported delay in thrombosis of a high flow SVG bypass graft, highlighting the long term patency of these grafts and the feasibility of thrombectomy through occluded bypass grafts.

Giant petrous carotid aneurysm treated by submandibular carotid—saphenous vein bypass

2001 ◽  
Vol 94 (5) ◽  
pp. 806-810 ◽  
Author(s):  
William T. Couldwell ◽  
Joseph Zuback ◽  
Eugenia Onios ◽  
Brij Singh Ahluwalia ◽  
Michael Tenner ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Bypass Graft ◽  
Rapid Onset ◽  
Unique Case ◽  
Temporal Muscle ◽  
Content Type ◽  
Saphenous Vein Bypass ◽  
Vein Bypass

✓ Petrous and cavernous sinus carotid artery (CA) aneurysms that are not amenable to clip ligation or endovascular therapy may be successfully treated by a saphenous vein bypass, thereby preserving the patency of the CA. The authors report the unique case of a 47-year-old man with a giant fusiform aneurysm of the petrous CA, who presented with a rapid onset of a lateral rectus palsy and diplopia. The lesion was treated by trapping the aneurysm and performing a saphenous vein bypass from the cervical to the intracranial CA. The saphenous vein graft was routed beneath the condyle of the mandible to reduce the overall length of the graft, thereby increasing the likelihood of long-term patency and offering protection to the graft by the mandible, temporal muscle zygomatic process, and masseter and temporal muscles. The presentation and technical aspects of the bypass graft in this unique case are discussed.

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.

scholarly journals Saphenous vein graft bypass in the treatment of giant cavernous sinus aneurysms: report of two cases

2000 ◽  
Vol 58 (1) ◽  
pp. 162-168 ◽  
Author(s):  
RICARDO RAMINA ◽  
MURILO S. MENESES ◽  
ARI A PEDROZO ◽  
WALTER O. ARRUDA ◽  
GUILHERME BORGES
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Brain Infarction ◽  
Superficial Temporal Artery ◽  
High Flow ◽  
Low Flow ◽  
External Carotid

Two cases of giant intracavernous aneurysms treated by high flow bypass with saphenous vein graft between the external carotid artery (ECA) and branches of the middle cerebral artery (MCA) are presented. Very often these aneurysms are unclippable because they are fusiform or have a large neck. Occlusion of the internal carotid artery (ICA) is the treatment of choice in many cases. This procedure has however a high risk of brain infarction. Revascularization of the brain by extra-intracranial anastomosis between the superficial temporal artery (STA) and branches of the MCA is frequently performed. This procedure provides however a low flow bypass and brain infarction may occur. We report two cases of giant cavernous sinus aneurysms treated by high flow bypass and endovascular balloon occlusion of the ICA. Immediate high flow revascularization of MCA branches was achieved and the patients showed no ischemic events. Follow-up of 8 and 14 months after operation shows patency of the venous graft and no neurological deficits. Angiographic control examination showed complete aneurysm occlusion in both cases.

EXTERNAL CAROTID ARTERY TO MIDDLE CEREBRAL ARTERY BYPASS WITH THE SAPHENOUS VEIN GRAFT

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_3) ◽  
pp. ONS134-ONS140 ◽  
Author(s):  
Erica F. Bisson ◽  
Agostino J. Visioni ◽  
Bruce Tranmer ◽  
Michael A. Horgan
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
External Carotid Artery ◽  
External Carotid

scholarly journals High flow EC–IC bypass for a giant left MCA aneurysm

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video9
Author(s):  
Eric J. Arias ◽  
Gregory J. Zipfel
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
High Flow ◽  
External Carotid ◽  
Left Middle Cerebral Artery ◽  
Mca Aneurysm ◽  
Cerebral Artery Aneurysm

Giant cerebral aneurysms may be treated through a variety of options, including aneurysm trapping with concurrent bypass. This video describes the case of a large, recurrent, left middle cerebral artery aneurysm that was treated using a high flow, radial artery bypass graft, from the external carotid artery to the left temporal M2 branch. A step-by-step operative description, with emphasis on proper microsurgical technique, is included.The video can be found here: http://youtu.be/9xTMC6InivQ.

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