Extra-intracranial bypass procedure with saphenous vein grafts

This study reports on 13 cases of extra-intracranial bypass procedures using saphenous vein grafts. Ten patients had arteriosclerotic occlusive vascular disease, one patient had a giant aneurysm of the internal carotid artery, another 2 females, 18 and 28 years of age, respectively, suffered from Takayasu's disease. Preoperatively all patients had severe neurological symptoms. To keep the venous graft as short as possible, as a first choice the carotid artery, in case of occlusive disease of the latter as a second choice the ipsilateral subclavian artery, or as a third choice the ascending aorta, were used as donor vessels. Perioperatively, one patient sustained an intracerebral/intraventricular hemorrhage and, despite immediate reoperation, died in a vegetative state early postoperatively. Another patient had a minor perioperative cerebral stroke with complete recovery. None of the other patients had any additional neurological deficit perioperatively, and they had complete relief from ischemic attacks postoperatively. There was one early occlusion due to high competitive collateral flow, and one late occlusion due to technical problems. The overall patency rate of surviving patients was 83.3% (follow-up 3 to 23 months).