Short vein grafts for cerebral revascularization

Experience with the use of a short saphenous vein bypass graft for cerebral revascularization is reviewed. Twenty patients with symptomatic atherosclerotic occlusive disease underwent a total of 21 bypass procedures. Cerebral revascularization was performed using a short (5 to 10 cm) saphenous vein graft (SVG) extending from the superficial temporal artery (STA) trunk anterior to the ear in 19 bypasses, or from the occipital artery (OA) immediately behind the mastoid process to the posterior temporal or angular branch of the middle cerebral artery (MCA) in two bypasses. The early patency rate for the SVG bypasses was 90%. Two of the four patients with SVG occlusion were found to have substantial resolution of a severe inaccessible internal carotid artery stenosis that was present preoperatively. Filling of multiple major branches of the MCA through the SVG was seen in 90% of patients on late postoperative conventional angiography. The STA trunk or proximal OA was consistently found to be enlarged on the late studies. None of the patients had recurrence of cerebral transient ischemic attacks. The procedure may be useful as a primary means of cerebral revascularization or as an alternative approach when a scalp artery cannot be used because of its small size, severity of arteriosclerotic changes (a common occurrence), or damage during its dissection. Cerebral blood flow studies suggest that the use of a short SVG has a more favorable effect upon the cerebral circulation than the conventional bypass procedure.