The tandem bypass: Subclavian artery-to-middle cerebral artery bypass with dacron and saphenous vein grafts. Technical case report

Kurtis I. Auguste, Alfredo Quiones-Hinojosa, Michael T. Lawton

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

BACKGROUND: Fusiform or dolichoectatic intracranial aneurysms often cannot be managed with conventional surgical or endovascular techniques, and instead require trapping and revascularization techniques. On rare occasions in elderly patients, extracranial sites used for anastomosing the bypass have been previously repaired with synthetic vascular prostheses. This circumstance in an elderly subarachnoid hemorrhage patient led to a novel bypass procedure, the tandem bypass: a long extracranial-to-intracranial bypass with two grafts of different materials assembled in series. CASE DESCRIPTION: A 71-year-old man with carotid artery atherosclerotic disease and a previous vascular reconstruction (subclavian artery-to-internal carotid artery Dacron interposition graft) presented with a subarachnoid hemorrhage from a dolichoectatic supraclinoid ICA aneurysm. The aneurysm was treated with trapping and distal revascularization. The final construct was a subclavian artery-to-middle cerebral artery bypass, with the graft being the previous Dacron prosthesis and a long saphenous vein. The vein graft was anastomosed end-to-side to the Dacron graft proximally, and end-to side to the middle cerebral artery distally. Subsequently, inflow to the aneurysm was occluded with clips on the Dacron graft beyond the proximal anastomosis of the vein graft, and outflow from the aneurysm was occluded with clips on the supraclinoid ICA. CONCLUSIONS: The tandem bypass, which uses prosthetic graft material and saphenous vein in succession, is a technically straightforward technique in patients who need extracranial-to-intracranial bypasses and who also have pre-existing carotid reconstructions or lack sufficient saphenous vein to complete a long bypass.

Original languageEnglish (US)
Pages (from-to)164-169
Number of pages6
JournalSurgical Neurology
Volume56
Issue number3
DOIs
StatePublished - Oct 20 2001

Keywords

  • Cerebral revascularization
  • Dolichoectatic
  • Fusiform
  • Intracranial aneurysm
  • Subarachnoid hemorrhage
  • Tandem bypass
  • Vascular anastomosis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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