High-flow bypass grafts in the management of complex intracranial aneurysms

The majority of intracranial aneurysms can be treated by either endovascular coiling or microsurgical clipping. A small group of aneurysms may require vascular bypass or reconstruction for their management. A variety of vascular reconstruction techniques are available, including direct suture, patch grafting, local reimplantations, side to side anastomosis, and bypass grafts. Bypass grafts may include low-flow (superficial temporal to middle cerebral) and high-flow bypass grafts using either the radial artery or saphenous vein. In this article, the indications and techniques of high-flow bypasses and concurrent aneurysm management are discussed. Troubleshooting of these bypasses is also illustrated. Seven intraoperative videos have been provided to demonstrate the various techniques of radial artery graft harvesting, cervical exposure of carotid vessels, bypasses, and concurrent aneurysm management.