- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
DOI:10.4103/2152-7806.134522Copyright: © 2014 Horiuchi T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Horiuchi T, Tsutsumi K, Hasegawa T, Hongo K. Rescue revision techniques for end-to-side anastomosis: Technical note. Surg Neurol Int 13-Jun-2014;5:94
How to cite this URL: Horiuchi T, Tsutsumi K, Hasegawa T, Hongo K. Rescue revision techniques for end-to-side anastomosis: Technical note. Surg Neurol Int 13-Jun-2014;5:94. Available from: http://sni.wpengine.com/surgicalint_articles/rescue-revision-techniques-for-end-to-side-anastomosis-technical-note/
Background:Extracranial-intracranial bypass operation is an essential procedure for cerebrovascular surgeons. Proper procedure of the bypass requires special skills, selected instruments, and training in the microsurgical laboratory. In spite of the high success rate for extracranial-intracranial bypass, a potential pitfall while performing an end-to-side anastomosis is poor blood flow or occlusion at the anastomotic site during surgery. If this happens, revision procedure is necessary.
Methods:We introduce our salvage techniques for anastomosis revision with or without recipient artery occlusion.
Results:With this method, ischemic complication related to revision procedure minimizes ischemic complications.
Conclusions:The present technique is a simple method for anastomosis revision.
Keywords: Anastomosis, bypass, occlusion, revision, surgery
Superficial temporal artery-middle cerebral artery (STA-MCA) bypass has been used in the management of selected atherosclerotic cerebrovascular occlusive disease, moyamoya disease, artery involved tumors, and unclippable aneurysms.[
Illustrations of traditional and present anastomosis revisions. The uppermost image shows the end-to-side anastomosis before revision. (a) Traditional revision technique. (b) One of the present revision techniques in case of the donor and recipient occlusions. (c) The new revision technique for the donor occlusion without additional parent artery occlusion
In this technical note, we introduce salvage techniques if immediate occlusion happens at the end-to-side anastomotic site.
End-to-side anastomosis is performed in the standard manner as described elsewhere.[
A 13-year-old boy complained of a transient ischemic attack and he was diagnosed as having a moyamoya disease. He underwent the direct and indirect revascularization surgery in both sides. During the right-sided surgery, ICG videoangiography showed donor occlusion after anastomosis [Figure
(a) An end-to side anastomosis between the parietal branch and the frontal cortical artery. (b) Indocyanine green (ICG) videoangiography showing the donor occlusion (black arrowheads). (c) A simple closure of the linear arteriotomy after detachment of the donor artery. (d) Follow-up ICG showing the patency of the recipient and the stenosis (open circle). (e) The new end-to-side anastomosis at the remote artery. (f) Final ICG showing the patency of the new anastomosis
A 78-year-old man presented with a minor cerebral infarction caused by the left internal carotid artery occlusion. Cerebral blood flow study demonstrated the misery perfusion in the left MCA territory. STA-MCA bypass was scheduled. The parietal branch of STA was anastomosed to the cortical branch [
Intraoperative bypass occlusion may potentially lead to cerebral ischemia. Therefore, reliable rescue techniques for failure of the end-to-side anastomosis may decrease the surgical morbidity associated with bypass surgery. Salvage techniques are rarely cited in literatures describing how to perform the anastomosis revision. If the anastomosis is not patent, traditional rescue procedure would be the re-opening of the anastomotic site followed by the re-suture after careful inspection.[
Although immediate bypass site occlusion during surgery rarely happens, the vascular surgeon should know revision techniques. The technique described here minimizes ischemic complications related to the end-to-side anastomosis and is a simple method for anastomosis revision.
This study was partly supported by JSPS KAKENHI grant number 25462251.
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