Conduits for cerebrovascular bypass and lessons learned from the cardiovascular experience.
Direct cerebral revascularization is an important procedure in the treatment of certain complex aneurysms and skull base tumors when acute sacrifice of the internal carotid artery is required. It likely remains an appropriate treatment in a small subgroup of patients with cerebral ischemia refractory to maximal medical management. Similar to cardiovascular surgery, the choice of a graft conduit is critical for a successful outcome. The standard conduits are interposition vein grafts (usually the greater saphenous vein), free arterial grafts (radial artery), and pedicled arterial grafts (superficial temporal artery). The goal of this review is to summarize the conduits commonly used in cerebral revascularization with emphasis on their patency rates and flow characteristics. Comparisons are made with similar data available in the cardiovascular literature.
Liu
James K
JK
Department of Neurosurgery, and Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Kan
Peter
P
Karwande
S V
SV
Couldwell
William T
WT
D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods / Q000706:statistics & numerical data; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D017534:Radial Artery / Q000637:transplantation*; D012501:Saphenous Vein / Q000637:transplantation*; D013699:Temporal Arteries / Q000637:transplantation*; D014654:Vascular Patency