Radial Artery Fascial Flow-Through Free Flap for Complex Cerebral Revascularization: Technical Notes and Long-Term Neurologic and Radiographic Outcomes

Abstract

The RAFF and RAFCF are versatile grafts for complex cerebral revascularizations.

Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series

“…Although the 1 patient in this series who experienced any new clinically significant ischemia had vasospasm-related strokes after aneurysmal SAH, previous data suggest that acceptable outcomes with bypass in such patients can be achieved and that revascularization followed by deconstructive aneurysm treatment can be considered in the absence of other viable management options. 27,28 The 1 surgical complication involved an operative site hematoma and venous congestion within the RAFF graft (used for direct bilateral ACA and indirect MCA revascularization), 5 which required hematoma evacuation and flap debridement due to local mass effect but did not affect bypass patency or negatively affect the patient's neurological outcome at discharge. Excluding the patient who died from medical complications of his pre-existing stroke/hemiplegia (and who was at his neurological baseline at the time of hospital discharge), the functional and neurological outcomes in the remaining patients were stable or improved as compared with preoperative baselines.…”

“…A radial artery fascial flow-through free flap (RAFF; consisting of a RA interposition graft for direct, high-flow bypass with an attached fascial pedicle and venous outflow for additional indirect bypass) was considered when revascularization of a third territory was planned. 5 All patients were maintained on daily oral aspirin in the perioperative and postoperative period to facilitate graft patency. Perioperative anesthesia protocols ensured a strict maintenance of cerebral perfusion above baseline in patients undergoing flow augmentation and burst suppression anesthesia in all patients during temporary clip times.…”

“…Cerebral revascularization remains a critical treatment for selected patients with complex aneurysms, tumors, and ischemic disease. 1,2 In cases where revascularization of multiple territories is required, traditional strategies require either combined direct and indirect approaches, multiple graft/donor constructs, or serial anastomoses, 3-13 which can limit flow potential in selected territories and increase the surgical footprint and total occlusion times.…”

Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series

“…Surgical details on anterior and posterior circulation revascularization with interposition grafts are previously reported. 12,20,21 PROCESS guidelines were followed in data reporting. 22 This study was approved by the IRB and performed in compliance with Health Insurance Portability and Accountability Act regulations.…”

Anatomic Feasibility of a Superficial Temporal Artery to Distal Anterior Cerebral Artery Bypass With a Parietal Branch Interposition Graft: The Superficial Temporal Artery Telescope Bypass

“…2 Progressive occlusive vasculopathy affecting the ACA territory with insufficient compensatory supply from leptomeningeal collaterals may require a direct bypass to the ACA territory, and patients may undergo a combined direct and indirect revascularization technique such as a radial or tibial flow-through free flap. 6 The surgical technique for revascularizing the distal ACA remains suboptimal, without distinct superiority of 1 technique. An extracranial-intracranial bypass to the ACA requires harvesting ABBREVIATIONS: CmaA, callosomarginal artery; fSTA, frontal branch of the STA; MIFA, middle internal frontal artery; pSTA, parietal branch of the STA; STA, superficial temporal artery.…”