Treatment of Giant Intracranial Aneurysms with Saphenous Vein Extracranial-to-Intracranial Bypass Grafting: Indications, Operative Technique, and Results in 29 Patients

Jafar, Jafar J.; Russell, Stephen; Woo, Henry H.; Han, Patrick; Spetzler, Robert F.; Sekhar, Laligam N.; Rak, Ramin; Day, Arthur L.; Lewis, Stephen B.; Batjer, H. Hunt

doi:10.1097/00006123-200207000-00021

Cited by 152 publications

(96 citation statements)

References 19 publications

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“…Obviously, because the goal of any aneurysm treatment is both aneurysm exclusion and blood flow preservation (2-3), when vessels sacrifice or prolonged temporary occlusion are needed, cerebral revascularization is an important management option (2,4,(7)(8)(9). The selection of the ideal bypass procedure (EC-IC vs.…”

Section: Discussionmentioning

confidence: 99%

“…The advantage of "complete trapping" is the immediate exclusion of the aneurysmal lesions and is the recommended option when ever feasible (3)(4)(5). Two types of "complete trapping" strategies are herein described, the "classic" and the "variant" trapping.…”

Section: Discussionmentioning

confidence: 99%

“…Complex cerebral aneurysms include both giant and large/small aneurysms the complexity of which is due to anatomical location, peri-aneurysmal angioanatomy (branch vessels, critical perforators), broad neck, intraluminal thrombosis, atherosclerotic plaques or calcifications of the aneurysmal wall, absence of collateral circulation, and previous treatment (1,4,7,9). These lesions are frequently not amenable to selective clipping or coiling or other endovascular procedures.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Decision-Making for Managing Complex Intracranial Aneurysms

Esposito

Regli

2014

Acta Neurochirurgica Supplement

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The treatment of complex intracranial aneurysms remains a therapeutic challenge. These lesions are frequently not amenable to selective clipping or coiling or other endovascular procedures and surgery still has a predominant role. We illustrate our "surgical decision making" for managing complex intracranial aneurysmal lesions. The best strategy is decided on the basis of pre-operative neuroradiological and intra-operative main determinants such as anatomical location, peri-aneurysmal angioanatomy (branch vessels, critical perforators), broad neck, intraluminal thrombosis, aneurysmal wall atherosclerotic plaques and calcifications, absence of collateral circulation, and previous treatment. The surgical strategy encompasses one of the following treatment possibilities: (1) Direct clip reconstruction; (2) Complete trapping ("classic" or "variant"); (3) Partial trapping (proximal "inflow" or distal "outflow" occlusion). Because the goal of any aneurysm treatment is both (1) aneurysm exclusion and (2) blood flow replacement, cerebral revascularization represents a major management option whenever definitive or temporary vessel occlusion is needed. Cerebral revascularization can therefore be used temporarily as a "protective" bypass, or definitively as a "flow replacement" bypass. Complete and partial trapping strategies are associated with flow "replacement" bypass surgery, to preserve blood flow into the territory supplied by the permanently trapped vessel. The construction of the "ideal" bypass depends on several factors, the most important of which are amount of flow needed, recipient vessel, donor vessel, and microanastomosis technique. The choice between "complete" or "partial" trapping depends on angioanatomical criteria as well. A complete trapping is always favored, as it has the advantage of immediate aneurysm exclusion. When perforating vessels arise from the aneurysmal segment or when the inspection of all the angioanatomy of the aneurysm is considered inadvisable and risky, "partial trapping" strategies are of interest. Partial trapping may consist either of proximal or distal occlusion. We discuss the rationale behind these treatment modalities and illustrate it with a case series of seven patients successfully treated for complex intracranial aneurysmal lesions (location: 1 ICA, 1 ACom, 3 MCA, 2 PICA). ABSTRACTThe treatment of complex intracranial aneurysms still remains a therapeutic challenge. These lesions are frequently not amenable to selective clipping or coiling or other endovascular procedures and surgery still has a predominant role.We illustrate our "surgical decision making" for managing complex intracranial aneurysmal lesions.The best strategy is decided on the basis of pre-operative neuroradiological and intra-operative main determinants such as: anatomical location, peri-aneurysmal angioanatomy (branch vessels, critical perforators), broad neck, intraluminal thrombosis, aneurysmal wall atherosclerotic plaques and calcifications, absence of collateral circulation, and previous t...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Decision-Making for Managing Complex Intracranial Aneurysms

Esposito

Regli

2014

Acta Neurochirurgica Supplement

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“…This surgical technique was then employed widely in the treatment of giant intracranial aneurysms 91. When the middle cerebral artery is not suitable for intracranial anastomosis, the supraclinoid internal carotid artery can be a recipient vessel.…”

Section: Neurosurgerymentioning

confidence: 99%

A Reappraisal of Saphenous Vein Grafting

Yuan

Hua

2011

Annals of Saudi Medicine

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Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.

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“…If preservation of the internal carotid artery itself is considered difficult due to disorders such as a giant aneurysm, therapeutic options include surgical occlusion of the internal carotid artery after bypass surgery, [1][2][3] and stent-assisted intracranial endovascular treatment preserving the internal carotid artery. 4) Although the use of neck bridge stents and flow diverters for the treatment of wide-necked aneurysms has also become possible in Japan, securing of the distal area may be difficult even by concomitant stenting depending on the shape of the aneurysm, and radical cure is still impossible in some lesions.…”

Section: Introductionmentioning

confidence: 99%

Long-term Results of Therapeutic Parent Artery Occlusion without Bypass Surgery for Internal Carotid Artery Aneurysms

Kuramoto

Imamura

Sakai

et al. 2017

JNET

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Objective: When internal carotid artery occlusion is performed for the treatment of an aneurysm, it is important to judge whether or not bypass surgery should be performed for the prevention of complications by the balloon occlusion test (BOT), but there are no clear criteria for the judgment. In this study, we evaluated the long-term results in patients who underwent internal carotid artery occlusion without bypass surgery. Methods:In all, 33 patients with 34 aneurysms who showed no symptoms, a venous phase delay of within 2 seconds, and a mean stump pressure of ≥40 mmHg on a 20-minute BOT between April 2001 and March 2015 and were treated by endovascular internal carotid artery occlusion under local anesthesia without bypass surgery were evaluated.Results: There were no periprocedural deaths, periprocedural ischemic complications were observed in four patients (12%), and they persisted in two patients (6%). On postprocedural diffusion-weighted magnetic resonance (MR) imaging, high intensity signal areas were observed in 25 patients (75%). In all, 30 patients could be followed up on an outpatient basis, and symptomatic cerebral infarction, which was cardiogenic, was noted in one patient (3.3%) during a mean follow-up period of 65.3 months. The final evaluation using DSA or MRA, which was performed after a mean of 63.7 months, revealed aneurysm recurrence in one patient and de novo aneurysm formation in one patient. Conclusion:With judgment of whether or not bypass surgery should be performed according to the results of the BOT, endovascular internal carotid artery occlusion is a safe treatment with a favorable long-term outcome.Keywords▶ internal carotid aneurysm, parent artery occlusion, balloon occlusion test, endovascular treatment

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Treatment of Giant Intracranial Aneurysms with Saphenous Vein Extracranial-to-Intracranial Bypass Grafting: Indications, Operative Technique, and Results in 29 Patients

Cited by 152 publications

References 19 publications

Surgical Decision-Making for Managing Complex Intracranial Aneurysms

Surgical Decision-Making for Managing Complex Intracranial Aneurysms

A Reappraisal of Saphenous Vein Grafting

Long-term Results of Therapeutic Parent Artery Occlusion without Bypass Surgery for Internal Carotid Artery Aneurysms

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