Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease

Abstract

The authors report their experience with the use of saphenous vein bypass grafts for treating advanced occlusive disease in the posterior circulation (77 patients, all of whom had failed medical management and showed severe ischemic symptoms), deteriorating patients with giant aneurysms of the posterior circulation (nine patients), progressive ischemia in the anterior circulation (26 patients, none of whom had a normal examination), and giant aneurysms in the anterior circulation (20 patients, all of whom presented with mass effect or subarachnoid hemorrhage). Graft patency in the first 65 cases treated was 74%. However, after significant technical changes of vein-graft preparation and construction of the proximal anastomosis, patency in the following 67 cases was 94%. Excellent or good results (including relief of deficits existing prior to surgery) were achieved in 71% of patients with advanced occlusive disease in the posterior circulation, 44% of those with giant aneurysms of the posterior circulation, 58% of those with ischemia of the anterior circulation, and 80% of those with giant aneurysms of the anterior circulation. Mean graft blood flow at surgery in the series was 100 ml/min for posterior circulation grafts and 110 ml/min for anterior circulation grafts. Experience to date indicates that this is a useful operation, and is particularly applicable to patients who are neurologically unstable from advanced intracranial occlusive disease in the posterior circulation or with giant aneurysms in the anterior circulation. The risk of hyperfusion breakthrough with intracerebral hematoma restricts the technique in patients with progressing ischemic symptoms in the anterior circulation, and the intolerance of patients with fusiform aneurysms in the posterior circulation to the iatrogenic vertebrobasilar occlusion limits the applicability of this approach to otherwise inoperable lesions in that system.

Graft selection in cerebral revascularization

“…Sundt et al 29 performed bypass surgery using the SVG in 77 patients with posterior circulation occlusive disease, 9 patients with posterior circulation giant aneurysms, 26 patients with anterior circulation ischemia, and 20 patients with anterior circulation giant aneurysms. They determined that graft patency was 74% in their first 65 cases but 94% in the following 67 cases.…”

A Reappraisal of Saphenous Vein Grafting

“…The long SVG was made popular by Sundt et al94 for atheromatous disease and for giant aneurysms involving the anterior and posterior circulation. In a series of 20 patients with internal carotid artery aneurysms unsuitable for clipping or coiling, long venous bypasses were interposed between the internal carotid artery at the neck and the intrapetrous carotid, from the internal carotid artery at the neck to a branch of the middle cerebral artery, or from the external carotid artery to a branch of the middle cerebral artery.…”

Dissecting Basilar Artery Aneurysm Growing During Long-term Follow Up. Case Report.

“…8,12,19,22) Radial artery bypass grafts were used between the intracranial vertebral artery and posterior cerebral artery to treat large basilar artery aneurysms and achieved good results. 8) Therefore, high-flow bypass surgery and proximal occlusion might have been the only option to rescue our patient.…”