Cerebral revascularization using cadaveric vein grafts

Abstract 

Background

Use of cadaveric cryopreserved saphenous vein grafts (CSVGs) has been described for peripheral vascular and coronary revascularization. The aim of this study is to recognize CSVGs as a potential alternative to autologous conduits for extracranial-intracranial (EC-IC) bypass in patients without available or suitable saphenous vein graft or radial artery. We report the short-term patency rate of CSVGs in EC-IC bypass.

Methods

We present our preliminary experience in 10 patients using CSVG for cerebral revascularization. Data regarding operative indications, patient demographics, and bypass patency were collected.

Results

The average age was 56 years old with equal sex distribution. The indications for the procedure were giant aneurysms in 7 patients, medically refractory vertebrobasilar ischemia in 2, and a skull base tumor in 1. ABO/Rh blood group compatible CSVG was used in each case. Postoperative angiography demonstrated patency in all cases. Quantitative magnetic resonance angiography was performed in 8 patients, demonstrating a mean bypass flow of 109 mL/min ± 19 mL/min (mean ± SE).

Conclusions

Use of CSVG for EC-IC bypass has not previously been reported. In our series, the short-term patency rate was 100%, better than that found in cardiac and peripheral vascular series, possibly because of the higher flow in EC-IC bypasses. Our preliminary experience suggests that CSVGs may be an option in patients without available autologous conduits, although longer follow-up is needed to assess long-term patency.

Abbreviations: CABG, coronary artery bypass graft, CAD, Coronary artery disease, CSVG, cadaveric saphenous vein graft, DMSO, dimethyl sulfoxide, ECA, external carotid artery, EC-IC, extracranial-intracranial, ICA, internal carotid artery, MCA, middle cerebral artery, PCA, posterior cerebral artery, QMRA, quantitative magnetic resonance angiography, RA, radial artery, STA, superficial temporal artery, SVG, saphenous vein graft, TIA, transient ischemic attack

Keywords: Aneurysm, Cadaveric vein grafts, Cerebral revascularization, Extracranial-intracranial bypass