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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Cerebral revascularization using cadaveric vein grafts.

Francisco J Mery1, Sepideh Amin-Hanjani, Fady T Charbel

  • 1Department of Neurosurgery, University of Illinois at Chicago, IL 60612-5970, USA.

Surgical Neurology
|July 25, 2009
PubMed
Summary

Cadaveric cryopreserved saphenous vein grafts (CSVGs) show 100% short-term patency in extracranial-intracranial (EC-IC) bypass. This study suggests CSVGs are a viable alternative conduit for patients lacking autologous options.

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Area of Science:

  • Neurosurgery
  • Vascular Surgery
  • Biomaterials

Background:

  • Cadaveric cryopreserved saphenous vein grafts (CSVGs) are used in peripheral and coronary bypass.
  • Autologous conduits like saphenous vein or radial artery are standard for extracranial-intracranial (EC-IC) bypass.
  • Alternative conduits are needed for patients lacking suitable autologous options.

Purpose of the Study:

  • To evaluate the short-term patency of CSVGs used for EC-IC bypass.
  • To assess the feasibility of CSVGs as an alternative conduit in cerebral revascularization.

Main Methods:

  • A preliminary study involving 10 patients undergoing EC-IC bypass using CSVG.
  • Data collected included operative indications, patient demographics, and bypass patency.
  • ABO/Rh blood group compatible CSVGs were utilized.

Main Results:

  • The study included 10 patients (average age 56, equal sex distribution).
  • Indications included giant aneurysms (7), refractory vertebrobasilar ischemia (2), and skull base tumors (1).
  • All grafts demonstrated patency on postoperative angiography, with a mean bypass flow of 109 mL/min via quantitative magnetic resonance angiography in 8 patients.

Conclusions:

  • EC-IC bypass using CSVGs has not been previously reported.
  • The short-term patency rate was 100%, exceeding rates in cardiac and peripheral vascular series.
  • CSVGs show promise as an alternative conduit for EC-IC bypass in select patients, pending long-term follow-up.