title: Use of a harvested radial artery graft with preservation of the vena comitantes to reduce spasm risk and improve graft patency for extracranial to intracranial bypass: Technical note.
abstract: BACKGROUND
  The vessels of choice for cerebrovascular high-flow direct bypass procedures are the radial artery and the saphenous vein. Radial artery grafts have become favored over saphenous vein grafts because of higher patency rates and better size matching to appropriate recipient vessels. Radial grafts are prone to spasm however, and this may be seen in 4-10% of cases and can be associated with ischemic sequelae. The standard technique for radial artery harvest calls for complete separation of the artery from its adventitial attachments and associated venous network. There is reason to believe that this could contribute to spasm risk and possibly even thrombosis. Radial graft outcomes appear to be improved when the vena comitantes is preserved in cardiac and peripheral applications. We report the novel use of a harvested radial artery graft with preservation of its venae comitantes for extracranial to intracranial bypass.
  
  
  METHODS
  The patient is a 59-year-old male who had a blunt head trauma with associated loss of consciousness and who was led to the incidental discovery of a large fusiform middle cerebral artery (MCA) aneurysm.
  
  
  CONCLUSIONS
  Preservation of the vena comitantes when harvesting a radial arterial graft for bypass, along with dual (arterial and venous) anastomoses, and concomitant use of intra-operative vaso-dilatory maneuvers to prevent spasm, may improve overall graft patency and patient outcome.
authors.affiliation: Department of Neurological Surgery, Saint Louis University, St. Louis, MO, United States.
authors.forename: Najib E El
authors.initials: NEE
authors.lastname: Tecle
authors.affiliation: Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, IL, United States.
authors.forename: Samer G
authors.initials: SG
authors.lastname: Zammar
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, United States.
authors.forename: Youssef J
authors.initials: YJ
authors.lastname: Hamade
authors.affiliation: Department of Neurological Surgery, University of Texas Southwestern, Dallas, TX, United States.
authors.forename: Tarek Y
authors.initials: TY
authors.lastname: El Ahmadieh
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, United States.
authors.forename: Rami James N
authors.initials: RJN
authors.lastname: Aoun
authors.affiliation: Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, IL, United States.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Nanney
authors.affiliation: Department of Neurological Surgery, University of Texas Southwestern, Dallas, TX, United States.
authors.forename: Hunt H
authors.initials: HH
authors.lastname: Batjer
authors.affiliation: Department of Plastic Surgery, Northwestern Memorial Hospital, Chicago, IL, United States.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, United States. Electronic address: bendok.bernard@mayo.edu.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
mesh_terms: D002548:Cerebral Revascularization / Q000379:methods; D002550:Cerebral Veins / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D017534:Radial Artery / Q000637:transplantation*; D012306:Risk; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: EC–IC bypass; MCA aneurysm; Radial artery graft; Vasospasm; Venae comitantes