Urgent A3A3 Anastomosis for Intraoperative Arterial Injury During Surgery for an Unruptured Anterior Communicating Artery Aneurysm: A Case Report

Abstract

Summary:It is clearly important to avoid damage to the major arterial trunk during surgery.However, it is also useful to consider how to address problems associated with an unexpected arterial injury. We report a case in which a left proximal A2 occlusion and urgent A3A3 anastomosis were performed for arterial injury during surgery for an unruptured anterior communicating artery aneurysm. When an arterial injury occurs, closing of the arterial defect should first be attempted by stitching or clipping. If this is impossible, it might be necessary to occlude the artery and perform vascular reconstruction. However, there are 2 major problems in a case requiring urgent vascular reconstruction such as A3A3 anastomosis: the difficulty of suturing vessels in a deep and narrow field, and the requirement for further preparation of vascular components to make them adequate for vascular reconstruction.Good judgment and prompt performance of the procedure is required to avoid ischemic complications.