Repair of a tear at the base of a blister-like aneurysm with suturing and an encircling clip: technical note.
OBJECTIVE
An aneurysm can produce large defects in the parent vessel if the aneurysm tears at the neck of the vessel. The authors present a technique to repair a tear at the base of a blister-like aneurysm encountered during microsurgical clipping of an anterior wall aneurysm of the internal carotid artery.


METHODS
The repair technique involved suturing and covering the aneurysm with an encircling aneurysm clip. A large tear had destroyed the vessel's tubular structure, and repair was not sufficient using an encircling clip alone. Two microsuture stitches were placed on the tear, so that a split artery re-formed a tubular structure. The lesion was then covered with Surgicel (Ethicon, Inc., Somerville, NJ) and fibrin glue. When the Surgicel and fibrin glue were applied, the temporary clip on the distal internal carotid artery was removed for a moment, allowing retrograde blood flow to provide the counterforce necessary to maintain the vessel's tubular structure. An encircling clip was then applied to cover the entire circumference of the lesion.


RESULTS
This method required only a short occlusion time for arterial repair, thus helping avoid ischemic complications. The patient awoke with transient hemiparesis, but recovery was prompt.


CONCLUSIONS
This technique is useful for repairing an aneurysmal tear at its base, especially if the tear is large.
Yanaka
Kiyoyuki
K
Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan. kyanaka@md.tsukuba.ac.jp
Meguro
Kotoo
K
Nose
Tadao
T
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D013525:Surgical Instruments; D013536:Suture Techniques