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Extracranial-intracranial bypass: Resurrection of a nearly extinct operation.
MedLine Citation:
PMID:  22819751     Owner:  NLM     Status:  Publisher    
BACKGROUND: Giant intracranial artery aneurysms (GIAAs) are often not amenable to neurosurgical clipping or endovascular coiling. Extracranial-intracranial (EC-IC) bypass, a procedure that has been essentially abandoned for the treatment of intracranial ischemic disease, followed by parent vessel occlusion, is often successful in treating these aneurysms. Vascular surgeons should be familiar with this operation, especially in centers with neurosurgical capability. METHODS: A retrospective review of patients treated from 1990 to 2010 at New York University Medical Center was performed. Office and hospital records of all patients identified were reviewed with attention to the age and sex of the patient, presenting symptoms, preoperative testing, procedure performed, type of bypass conduit, graft patency, intraoperative and postoperative complications, length of follow-up, and overall outcome. EC-IC bypass was performed using a graft of great saphenous vein (GSV) or radial artery (RA). The vascular surgeon harvested the vascular conduit, tunneled the graft, and performed the extracranial anastomosis, and the intracranial anastomosis was performed by the neurosurgeon. RESULTS: A total of 36 patients (14 men, 22 women) underwent 37 EC-IC bypasses with 34 GSV and three RA grafts. The median age was 57 years (interquartile range, 49-66 years), and the median follow-up was 53 months (interquartile range, 29-77 months). Aneurysm location was the internal carotid artery in 30 patients, the basilar artery in three, and the middle cerebral artery in four. All 37 aneurysms were excluded from the cerebral circulation, with 33 grafts remaining patent at follow-up, as determined by serial cerebral or magnetic resonance angiogram. At follow-up, 33 of 34 of the GSV grafts (88%) and three of three (100%) of the RA grafts were patent. There were two deaths (5.6%), despite patent grafts. Postoperative graft occlusion led to homonymous hemianopsia in one patient and temporary hemiparesis in another (5.6%). Graft occlusions were asymptomatic in two patients. CONCLUSIONS: EC-IC bypass is a safe and effective treatment for GIAAs, with acceptable rates of morbidity (5.6%), mortality (5.6%), and graft patency (89.2%). We suggest that the technique described in this report should be routinely used for treatment of GIAAs in centers where neurosurgery and vascular surgery services are available and should be considered a standard procedure in the armamentarium of the vascular surgeon.
Ryan M Gobble; Han Hoang; Jafar Jafar; Mark Adelman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-21
Journal Detail:
Title:  Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter     Volume:  -     ISSN:  1097-6809     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Department of Surgery, New York University, Langone Medical Center, New York, NY.
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