Najib E El Tecle1, Samer G Zammar2, Youssef J Hamade3, Tarek Y El Ahmadieh4, Rami James N Aoun3, Allan D Nanney2, Hunt H Batjer4, Gregory A Dumanian5, Bernard R Bendok6. 1. Department of Neurological Surgery, Saint Louis University, St. Louis, MO, United States. 2. Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, IL, United States. 3. Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, United States. 4. Department of Neurological Surgery, University of Texas Southwestern, Dallas, TX, United States. 5. Department of Plastic Surgery, Northwestern Memorial Hospital, Chicago, IL, United States. 6. Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, United States. Electronic address: bendok.bernard@mayo.edu.
Abstract
BACKGROUND AND SIGNIFICANCE: The vessels of choice for cerebrovascular high-flow direct bypass procedures are the radial artery and the saphenous vein. Radial artery grafts have become favored over saphenous vein grafts because of higher patency rates and better size matching to appropriate recipient vessels. Radial grafts are prone to spasm however, and this may be seen in 4-10% of cases and can be associated with ischemic sequelae. The standard technique for radial artery harvest calls for complete separation of the artery from its adventitial attachments and associated venous network. There is reason to believe that this could contribute to spasm risk and possibly even thrombosis. Radial graft outcomes appear to be improved when the vena comitantes is preserved in cardiac and peripheral applications. We report the novel use of a harvested radial artery graft with preservation of its venae comitantes for extracranial to intracranial bypass. CLINICAL PRESENTATION: The patient is a 59-year-old male who had a blunt head trauma with associated loss of consciousness and who was led to the incidental discovery of a large fusiform middle cerebral artery (MCA) aneurysm. CONCLUSION: Preservation of the vena comitantes when harvesting a radial arterial graft for bypass, along with dual (arterial and venous) anastomoses, and concomitant use of intra-operative vaso-dilatory maneuvers to prevent spasm, may improve overall graft patency and patient outcome.
BACKGROUND AND SIGNIFICANCE: The vessels of choice for cerebrovascular high-flow direct bypass procedures are the radial artery and the saphenous vein. Radial artery grafts have become favored over saphenous vein grafts because of higher patency rates and better size matching to appropriate recipient vessels. Radial grafts are prone to spasm however, and this may be seen in 4-10% of cases and can be associated with ischemic sequelae. The standard technique for radial artery harvest calls for complete separation of the artery from its adventitial attachments and associated venous network. There is reason to believe that this could contribute to spasm risk and possibly even thrombosis. Radial graft outcomes appear to be improved when the vena comitantes is preserved in cardiac and peripheral applications. We report the novel use of a harvested radial artery graft with preservation of its venae comitantes for extracranial to intracranial bypass. CLINICAL PRESENTATION: The patient is a 59-year-old male who had a blunt head trauma with associated loss of consciousness and who was led to the incidental discovery of a large fusiform middle cerebral artery (MCA) aneurysm. CONCLUSION: Preservation of the vena comitantes when harvesting a radial arterial graft for bypass, along with dual (arterial and venous) anastomoses, and concomitant use of intra-operative vaso-dilatory maneuvers to prevent spasm, may improve overall graft patency and patient outcome.
Authors: Alba Scerrati; Giovanni Sabatino; Giuseppe Maria Della Pepa; Alessio Albanese; Enrico Marchese; Alfredo Puca; Alessandro Olivi; Carmelo Lucio Sturiale Journal: Neurosurg Rev Date: 2018-05-22 Impact factor: 3.042