Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery

OBJECTIVECerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up.METHODSAll intracranial bypass procedures performed between 2001 and 2018 were reviewed. Demographic, clinical, angiographic, and operative data were recorded and then analyzed according to SVG type.RESULTSA total of 308 consecutive intracranial bypasses were performed during the study period, 53 (17.2%) of which were bypasses with an interposition SVG (38 autologous, 15 cadaveric). At a median follow-up of 2.2 months (IQR 0.2–29.1), 39 (73.6%) bypasses were patent (26 [68.4%] autologous, 13 [86.7%] cadaveric, p = 0.30). Comparing autologous and cadaveric SVG recipients, there were no statistically significant differences in age (p = 0.50), sex (p > 0.99), history of smoking (p = 0.75), hypertension (p > 0.99), diabetes mellitus (p = 0.13), indication for bypass (p = 0.27), or SVG diameter (p = 0.65). While there were higher intraoperative (autologous, 100.0 ml/min, IQR 84.3–147.5; cadaveric, 80.0 ml/min, IQR 47.3–107.8; p = 0.11) and postoperative (autologous, 142.2 ml/min, IQR 76.8–160.8; cadaveric, 92.0 ml/min, IQR 69.2–132.2; p = 0.42) volumetric flow rates in the autologous SVGs compared to those in the cadaveric SVGs, the difference between the two groups did not reach statistical significance. In addition, the blood flow index, or ratio of postoperative to intraoperative blood flow, for each bypass was similar between the groups (autologous, 1.3, IQR 0.9–1.6; cadaveric, 1.5, IQR 1.0–2.3; p = 0.37). Kaplan-Meier estimates showed no difference in bypass patency rates over time between autologous and cadaveric SVGs (p = 0.58).CONCLUSIONSCadaveric SVGs are a reasonable interposition graft option in cerebral revascularization surgery when autologous grafts are not available.

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Cerebral Revascularization for Aneurysms and Tumors

Neurosurgery ◽

10.1097/00006123-200202000-00014 ◽

2002 ◽

Vol 50 (2) ◽

pp. 321-331 ◽

Cited By ~ 12

Author(s):

Laligam N. Sekhar ◽

Chandrasekar Kalavakonda

Keyword(s):

Scale Score ◽

Radial Artery ◽

Saphenous Vein ◽

Glasgow Outcome Scale ◽

Cranial Base ◽

Cerebral Revascularization ◽

Vein Grafts ◽

Saphenous Vein Grafts ◽

Revascularization Procedures

ABSTRACT OBJECTIVE To discuss the indications, techniques, pitfalls, complication avoidance, and management of cerebral revascularization techniques for the treatment of aneurysms and cranial base tumors. METHODS The indications for cerebral revascularization procedures included microsurgical occlusion of a parent vessel during the treatment of aneurysms and occlusion of a major vessel during the treatment of basal tumors. The techniques discussed include arterial patch grafting, end-to-end anastomosis, side-to-side anastomosis, arterial interposition grafting, and extracranial-to-intracranial bypass grafting, using radial artery grafts or saphenous vein grafts. RESULTS During the 15-year period between 1985 and 2000, the senior author performed 24 radial artery grafts, 105 saphenous vein grafts, and 8 other revascularization procedures, among 50 patients with aneurysms and 83 patients with cranial base tumors. The overall patency rate was 95.6%. Twenty-three patients experienced a cerebral infarction; among those patients, 17 (12.5%) exhibited symptoms but the majority demonstrated considerable recovery during the follow-up period. One hundred one patients recovered to an excellent (Glasgow Outcome Scale score of 5) or good (Glasgow Outcome Scale score of 4) condition. Fifteen patients died as a result of recurrence or progression of tumors during the follow-up period. There were five perioperative deaths. For the last 35 patients, the surgical mortality rate was 0%, with all patients returning to an excellent or good condition. CONCLUSION Although highly specialized, these sophisticated cerebral revascularization techniques should be learned and practiced by all neurosurgeons who wish to microsurgically treat intracranial aneurysms or cranial base tumors.

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