Long saphenous-vein grafts for extracranial and intracranial internal carotid aneurysms amenable neither to clipping nor to endovascular treatment.
BACKGROUND
In the treatment of patients with unclippable, uncoilable internal carotid artery aneurysms it may be necessary to use high-flow bypass grafts. The indications, surgical techniques and complications are discussed.


METHODS
During a 12- year period, 20 saphenous vein grafts were performed in 20 patients. The 20 aneurysms were located in the prepetrous or intrapetrous internal carotid artery in 7 cases, the intracavernous in 9 and intracranial internal carotid artery in 4. All aneurysms were symptomatic. The vein graft was 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 and a branch of the middle cerebral artery, according to the collateral circulation assessed with a 30-minute the balloon test occlusion during electroencephalographic recording.


RESULTS
Only one of the 20 grafts occluded. One patient died from a large postoperative cerebral infarction. One patient had cerebral ischemia with transient hemiparesis; and three patients had mixed aphasia that resolved completely within two weeks. Radiological follow-up monitoring was by magnetic resonance imaging, magnetic resonance angiography or digital angiography. Postoperative follow-up ranged from 1 to 12 years (mean 3.7 years).


CONCLUSIONS
Our experience in this series suggests that the indications for cerebral revascularization should be widened, even to include patients with adequate collateral circulation, particularly those who have a long life expectancy.
Santoro
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Dipartimento di Scienze Neurologiche, Università degli Studi La Sapienza, Roma.
Guidetti
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Dazzi
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Cantore
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D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000637:transplantation*; D013525:Surgical Instruments / Q000009:adverse effects; D016378:Tissue Transplantation / Q000379:methods*; D016896:Treatment Outcome