[Intravascular blood aspiration in large and giant parawedge aneurysm surgery]

The efficiency of a procedure of intravascular blood aspiration (IVBA) in patients with large and giant parawedge aneurysms of the internal carotid. The study was based on the analysis of clinical data and outcomes of surgical treatment in 20 patients with the aneurysms. The paper presents different procedures for IVBA, a complex of methods for preoperative examination of patients and intraoperative prediction of possible ischemic complications and defines indications for the IVBA procedure. Complete and partial aneurysm exclusion was achieved in 15 (75%) and 2 (10%) patients; the neck and walls of aneurysm were strengthened with surgical gauze in 2 (10%) patients. Incompetent clipping was observed in one case. There was recovery in 17 (85%), improvement in 2 (10%), 1 (5%) patients. No deaths occurred. The IVBA procedure for aneurysm is indicated for large and giant thin-walled non-thrombotic aneurysms of the parawedge carotid segment. It permit effective proximal monitoring of carotid blood flow and creates favourable conditions for preparing and excluding aneurysm, and, if necessary, forming a carotid lumen. Intraoperative monitoring of brain function is highly important and obligatory for early prediction and prevention of ischemic complications. Under intraoperative monitoring of brain function, fractional IVBA makes it effective even if collateral circulation is inadequate.