• SCVS Home
• President's Message
• Council
• Commitees
• Annual Meeting
• 37th Annual Symposium
• 36th Annual Symposium
• 35th Annual Symposium
• 34th Annual Symposium
• 33rd Annual Symposium
• Membership
• Join SCVS
• Members Only Area
• Find a Vascular Specialist
• Newsletters
• Journal
• History
• Mission Statement
• Bylaws
• Contact Us
• 37th Annual Symposium
• 36th Annual Symposium
• 35th Annual Symposium
• 34th Annual Symposium
• 33rd Annual Symposium
• Join SCVS
• Members Only Area
• Find a Vascular Specialist

Extracranial-Intracranial Bypass: Resurrection of a Nearly Extinct Operation

OBJECTIVES:
Extracranial to intracranial (EC-IC) artery bypass is a well described treatment for giant intracranial artery aneurysms (IAA). We evaluated the outcomes of patients treated with a high flow bypass using either saphenous vein graft (SVG) or radial artery graft (RAG) for giant IAA.
METHODS:
A retrospective review of patients treated from 1990 - 2007 was performed. A total of 34 patients (13 males, 21 females) underwent 35 EC-IC bypasses (33 SVG, 2 RAG). Mean age and follow up time were 57 years and 54 months, respectively. Either SVG or RAG was harvested and the proximal anastomosis was performed in end-to-side manner using 7-0 monofilament nylon sutures to the external carotid artery. The distal anastomosis was also performed in an end-to side manner using 8-0 or 9-0 monofilament nylon suture to the middle cerebral artery when possible. All proximal anastomoses were performed by single vascular surgeon (MA), and all distal anastomoses were performed by a sole neurosurgeon (JJ). Parent artery vessel occlusion was performed for all aneurysms after EC-IC bypass. Intraoperative cerebral angiogram was performed to assess graft patency and aneurysm obliteration. Follow up consisted of serial cerebral or magnetic resonance angiograms.
RESULTS: All 35 aneurysms were excluded from the cerebral circulation with 31 grafts remaining patent. 88% (29/33) of SVG and 100% of RAG (2/2) remained patent at follow up. Three graft occlusions occurred secondary to poor distal runoff, and the fourth occurred secondary to misplacement of a cranial pin. There were two deaths secondary to a subarachnoid hemorrhage in one patient and a large cerebral infarction in another. Other complications included homonymous hemianopsia in one patient and temporary hemiparesis in another. There were no graft occlusions or complications as a result of the proximal anastomosis in this study.
CONCLUSIONS:
EC-IC artery bypass is an effective method for treating giant IAA with excellent graft patency regardless of type of graft chosen and must be maintained in the technical armamentarium of the vascular surgeon.