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Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series
Erik M Wolfswinkel1, Kristine Ravina2, Robert C Rennert3
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Insights
The descending branch of the lateral circumflex femoral artery (DLCFA) is a versatile graft for cerebrovascular bypass, showing good outcomes and minimal harvest site morbidity in a recent institutional review. This study highlights its effectiveness in complex cerebral revascularization procedures.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Microsurgery
Background:
- Donor vessel selection is critical for extracranial to intracranial (EC-IC) and intracranial to intracranial (IC-IC) bypass surgery.
- The descending branch of the lateral circumflex femoral artery (DLCFA) presents as a promising conduit for cerebrovascular bypass due to its characteristics.
Purpose of the Study:
- To evaluate the institutional experience with using DLCFA grafts for cerebral revascularization.
- To assess the outcomes and complications associated with DLCFA grafts in bypass surgery.
Main Methods:
- A retrospective review of 20 consecutive patients undergoing cerebrovascular bypass using DLCFA grafts between 2016 and 2019.
- Data collected included perioperative details, bypass indications, graft patency, and functional outcomes (modified Rankin Scale).
Main Results:
- DLCFA grafts were used for various indications, including intracranial aneurysms (65%) and large artery occlusions (20%).
- Most patients achieved good functional outcomes (mRS ≤2), with a median mRS of 1.5.
- Complications included graft spasm (2 cases), asymptomatic occlusion (1 case), and bypass surgery-related ischemia (3 cases). Donor site hematoma occurred in one case.
Conclusions:
- The DLCFA is a versatile and effective graft for cerebral revascularization.
- It offers good functional outcomes with acceptable graft patency and minimal donor site morbidity.
Background:
When performing extracranial to intracranial (EC-IC) and intracranial to intracranial (IC-IC) bypass, the choice of donor vessel and interposition graft depends on several factors: vessel size and accessibility, desired blood flow augmentation, revascularization site anatomy, and pathology. The descending branch of the lateral circumflex femoral artery (DLCFA) is an attractive conduit for cerebrovascular bypass.
Objective:
To present our institutional experience using DLCFA grafts for cerebral revascularization.
Methods:
Retrospective review of perioperative data and outcomes for patients undergoing cerebrovascular bypass surgery using a DLCFA graft from 2016 to 2019.
Results:
Twenty consecutive patients underwent EC-IC bypass using a DLCFA interposition graft. Bypass indications included 13 (65%) intracranial aneurysms, 4 (20%) medically refractory atherosclerotic large artery occlusions (internal carotid artery or middle cerebral artery), 2 (10%) internal carotid artery dissections, and 1 (5%) patient with moyamoya disease. Most commonly, a donor superior temporal artery was bypassed to a recipient middle cerebral artery (14 of 20; 70%). Two cases demonstrated graft spasm. Graft occlusion occurred in one patient and was asymptomatic. Perioperative bypass surgery-related ischemia occurred in 3 patients: 1 patient with insufficient bypass flow, 1 patient with graft stenosis because of an adventitial band, and 1 patient with focal status epilepticus in the bypassed territory resulting in cortical ischemia. One donor site hematoma occurred. The median (range) modified Rankin scale (mRS) score on follow-up was 1.5 (1-4) at 7.8 (1-27) months, with most patients achieving good functional outcomes (mRS ≤2).
Conclusion:
The DLCFA is a versatile graft for cerebral revascularization surgery, demonstrating good outcomes with minimal graft harvest site morbidity and an acceptable graft patency rate.
