title: The Valveless Saphenous Vein Graft Technique for EC-IC High-Flow Bypass: Technical Note.
abstract: OBJECTIVE
  Extracranial to intracranial (EC-IC) high-flow bypass using radial artery or saphenous vein (SV) graft has remained vital for complex aneurysms. If an Allen test is positive, the radial artery cannot be harvested because of poor palmer collateral circulation. The valves are thought to be one of causes of SV graft failure. Herein we illustrate the "valveless SV graft technique" as bypass conduits.
  
  
  METHODS
  Between August 2014 and December 2014 at the Department of Neurosurgery at Teishinkai Hospital, 4 patients whose Allen test was positive underwent EC-IC bypass with the valveless SV graft for complex internal carotid artery (ICA) aneurysm. After SV harvesting, we identified the SV valve, cut it, and performed an end-to-end anastomosis using the fish mouth trimming technique. Graft patency was confirmed by computed tomography angiography.
  
  
  RESULTS
  We have not encountered any problems related to graft failure, and all valveless SV grafts were patent during the follow-up period (median, 210 days; interquartile range, 93-287 days).
  
  
  CONCLUSIONS
  The valveless SV graft technique is a useful technique in patients with complex ICA aneurysms who undergo EC-IC high-flow bypass with therapeutic ICA occlusion and whose Allen tests are positive.
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan. Electronic address: nowornever1982@gmail.com.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Matsukawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
mesh_terms: D000714:Anastomosis, Surgical; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D017534:Radial Artery / Q000637:transplantation; D012501:Saphenous Vein / Q000637:transplantation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: EC-IC bypass; Graft; Saphenous vein; Surgical technique