Minim Invasive Neurosurg 2003; 46(1): 22-28
DOI: 10.1055/s-2003-37965
Original Article
© Georg Thieme Verlag Stuttgart · New York

End-to-Side Anastomoses in Small Arteries with Partial Lateral Clipping. An Experimental Study

K.  M.  Akay1, 2
  • 1Department of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
  • 2Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
This work has been presented at 2001 AANS Annual meeting, Toronto, Ontario, Canada, April 21 - 26, 2001.
Further Information

Publication History

Publication Date:
17 March 2003 (online)

Abstract

The problem of total therapeutic occlusion of the cranial arteries remains a relatively important area of concern for neurosurgery, neurology, neuroradiology and neuroanesthesia as well as for the patients. Cerebral revascularization procedures require total occlusion of the cranial arteries for a while. End-to-side anastomoses with partial lateral clipping were done in 20 cadaver arteries and then, in one rat common carotid artery. The results of the study were compared with the current cerebrovascular bypass procedures on a theoretical basis and possible clinical implications of the method were suggested. All the anastomoses were found to be open. As conclusions; 1) End-to-side anastomosis with partial lateral clipping and along with this technique the maintenance of blood flow in the target vessel during the anastomosis procedure are experimentally possible. 2) Although the available aneurysm clips may be used in the bigger vessels (> 2.5 mm), currently, the exclusive clips for the technique are not available commercially. 3) Further clinical implications of the technique may be investigated.

References

  • 1 Yaşargil M G. Microsurgery Applied to Neurosurgery. Stuttgart, New York: Georg Thieme Verlag - Academic Press 1969
  • 2 Acland R D. ed .Microsurgery Practice Manual. St. Louis: CV Mosby 1980
  • 3 Fox J L. Microvascular Anastomosis Technique. The Carotid Artery of the Rat. New Jersey: Sparta Instrument Corp 1976
  • 4 Yonekawa Y, Frick R, Roth P, Taub E, Imhof H-G. Laboratory training in microsurgical techniques and microvascular anastomosis.  Oper Tech Neurosurg. 1999;  2 149-158
  • 5 Dare A O, Chaloupka J C, Putman C M, Fayad P B, Awad I A. Failure of the hypotensive provocative test during temporary balloon test occlusion of the internal carotid artery to predict delayed hemodynamic ischemia after therapeutic carotid occlusion.  Surg Neurol. 1998;  50 147-156
  • 6 Eckert B, Thie A, Carvajal M, Groden C, Zeumer H. Prediction hemodynamic ischemia by transcranial Doppler monitoring during therapeutic balloon occlusion of the internal carotid artery.  AJNR. 1998;  19 577-582
  • 7 Linskey M E, Jungreis C A, Yonas H, Hirsch W L, Sekhar L N, Horton J A, Janosky J E. Stroke risk after abrupt internal carotid artery sacrifice: Accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT.  AJNR. 1994;  15 829-843
  • 8 Mathis J M, Barr J D, Jungreis C A, Yonas H, Sekhar L N, Vincent D, Pentheny S L, Horton J A. Temporary balloon test occlusion of the internal carotid artery: Experience in 500 cases.  AJNR. 1995;  16 749-754
  • 9 Alexander M J, Vishteh A G, Spetzler R F. Bypass surgery in the management of complex aneurysms.  Oper Tech Neurosurg. 1999;  2 123-128
  • 10 Origitano T C, Al-Mefty O, Leonetti J P, DeMonte F, Reichman O H. Vascular considerations and complications in cranial base surgery.  Neurosurgery. 1994;  35 351-363
  • 11 Sekhar L N, Kalavakonda C. Saphenous vein and radial artery grafts in the management of skull base tumors and aneurysms.  Oper Tech Neurosurg. 1999;  2 129-141
  • 12 Sen C, Sekhar L N. Direct vein reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: Lesson learned from 30 cases.  Neurosurgery. 1992;  30 732-743
  • 13 Sundt T M, Whisnant J P, Piepgras D G, Fode N C, Ebersold M J, Marsh W R. Techniques, results, complications and follow-up in superficial temporal artery-to-middle cerebral artery bypass pedicles. In: Meyer FB (ed). Sundt's Occlusive Cerebrovascular Disease, 2nd ed. Philadelphia: WB Saunders 1994: 436-450
  • 14 Vajkoczy P, Horn P, Schmiedek P. Standard superficial temporal artery-middle cerebral artery bypass surgery in hemodynamic cerebral ischemia: indication and technique.  Oper Tech Neurosurg. 1999;  2 106-115
  • 15 Batjer H H, Frankfurt A I, Purdy P D, Smith S S, Samson D S. Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms.  J Neurosurg. 1988;  68 234-240
  • 16 Hoff J T. Cerebral protection.  J Neurosurg. 1986;  65 579-591
  • 17 Al-Mefty O, Khalil N, Elwnay M N, Smith R R. Shunt for bypass graft of the cavernous carotid artery: An anatomical and technical study.  Neurosurgery. 1990;  27 721-728
  • 18 Sekhar L N, Burgess J, Akin O. Anatomical study of the cavernous sinus emphasizing operative approaches and related vascular and neural reconstruction.  Neurosurgery. 1987;  21 806-816
  • 19 Sekhar L N. Comment.  Neurosurgery. 1990;  27 727-728
  • 20 Tulleken C AF, van der Zwan A, van Rooij W JJ, Ramos L M. High-flow bypass using nonocclusive Excimer laser-assisted end-to-side anastomosis of the external carotid artery to the P1 segment of the posterior cerebral artery via the Sylvian route. Technical note.  J Neurosurg. 1998;  88 925-927
  • 21 Tulleken C AF, Verdaasdonk R M, Beck H JM, Mali W P. The modified Excimer laser-assisted high-flow bypass operation.  Surg Neurol. 1996;  46 424-429
  • 22 Tulleken C AF, van der Zwan A, Verdaasdonk R M, Beck H JM, Ramos L MP, Kappelle L J. High-flow Excimer laser-assisted extra-intracranial and intra-intracranial bypass.  Oper Tech Neurosurg. 1999;  2 142-148
  • 23 Tulleken C AF, van Dieren A, Verdaasdonk R M, Berendsen W. End-to-side anastomosis of small vessels using an Nd:YAG laser with a hemispherical contact probe.  J Neurosurg. 1992;  76 546-549
  • 24 Tulleken C AF, Verdaasdonk R M, Berendsen W, Mali W PTM. Use of the Excimer laser in high flow bypass surgery of the brain.  J Neurosurg. 1993;  78 477-480
  • 25 Tulleken C AF, Verdaasdonk R M. First clinical experience with Excimer laser assisted high flow bypass surgery of the brain.  Acta Neurochir (Wien). 1995;  134 66-70
  • 26 DeLacure M D, Kuriakose A, Spies A L. Clinical experience in end to side venous anastomoses with a microvascular anastomotic coupling device in head and neck reconstruction.  Arch Otolaryngol Head Neck Surg. 1999;  125 869-872
  • 27 Newell D W, Dailey A T, Skirboll S L. Intracranial vascular anastomosis using the microanastomotic system. Technical note.  J Neurosurg. 1998;  89 676-681
  • 28 Padubidri A N, Browne E, Kononov A. Fibrin glue assisted end-to-side anastomosis of rat femoral vessels. Comparison with conventional suture method.  Ann Plast Surg. 1996;  37 41-47
  • 29 Tellioglu A T. End-on-side microvascular anastomosis: An experimental study.  Ann Plast Surg. 1997;  39 137-140
  • 30 Tulleken C AF, Schilte G FAJ, Berendsen W, van Dieren A. A new type of end-to-side anastomosis for small arteries. A technical and scanning electron microscopic study in rats.  Neurosurgery. 1988;  22 604-608
  • 31 Wheatley M J, Mathes S J, Hassett C. Comparison of continuous and interrupted suture in microvascular end-to-side anastomosis.  J Reconstr Microsurg. 1986;  2 93-96
  • 32 Hayhurst J W, O'Brien B McM. An experimental study of microvascular technique, patency rates and related factors.  Brit J Plast Surg. 1975;  28 128-132
  • 33 Nishikawa M, Hashi K, Miyake H, Ozaki T, Suzuki H. Endothelial damage in microvascular anastomosis: to splint or not to splint?.  Surg Neurol. 1979;  12 433-440
  • 34 Rosenbaum T J, Sundt Jr T M. Thrombus formation and endothelial alterations in microarterial anastomoses.  J Neurosurg. 1977;  47 430-441
  • 35 Polin S G, Hershey F B. Technic of shunt removal from the carotid artery without interruption of blood flow.  Am J Surg. 1966;  111 296-297
  • 36 Berguer R, Kieffer E. Surgery of the arteries to the head. New York: Springer-Verlag 1992
  • 37 Ouriel K, Rutherford R B. Atlas of vascular surgery: Operative procedures. Philadelphia: WB Saunders 1998
  • 38 Stoney R J, Effeney D J. Wylie's atlas of vascular surgery: Basic considerations and techniques. Philadelphia: JB Lippincott 1992
  • 39 Belghiti J, Panis Y, Sauvanet A, Gayet B, Fekete F. A new technique of side to side caval anastomosis during orthotopic hepatic transplantation without inferior vena caval occlusion.  Surg Gyne Obst. 1992;  175 270-272
  • 40 Cherqui D, Lauzet J, Rotman N, Duvoux C, Dhumeaux D, Julien M, Fagniez P. Orthotopic liver transplantation with preservation of the caval and portal flows.  Transplantation. 1994;  58 793-796
  • 41 Baxter T J, O'Brien B McM, Henderson P N, Bennet R C. The histopathology of small vessels following microvascular repair.  Brit J Surg. 1972;  59 617-622
  • 42 Mann F C, Herrick J F, Essex H E, Baldes E J. The effect on blood flow of decreasing the lumen of a blood vessel.  Surgery. 1938;  4 249-252
  • 43 Berguer R, Hwang N HC. Critical arterial stenosis: A theoretical and experimental solution.  Ann Surg. 1974;  180 39-50
  • 44 May A G, de Weese J A, Rob C G. Hemodynamic effects of arterial stenosis.  Surgery. 1963;  53 513-524
  • 45 May A G, van de Berg L, de Weese J A, Rob C G. Critical arterial stenosis.  Surgery. 1963;  54 250-259
  • 46 Moore W S, Malone J M. Effect of flow rate and vessel caliber on critical arterial stenosis.  J Surg Res. 1979;  26 1-9
  • 47 Vonruden W J, Blaisdell F W, Hall A D, Thomas A N. Multiple arterial stenosis: Effect on blood flow.  Arch Surg. 1964;  89 307-315
  • 48 Hsia D C, Moscoe L M, Krushat W M. Epidemiology of carotid endarterectomy among Medicare beneficiaries. 1985 - 1996 update.  Stroke. 1998;  29 346-350
  • 49 Lie J T. Pathology of occlusive disease of the extracranial arteries. In: Meyer FB (ed). Sundt's occlusive cerebrovascular disease, 2nd ed. Philadelphia: WB Saunders 1994: 25-44
  • 50 Astrup I, Siesjo B K, Simon L. Threshold in cerebral ischemia: the ischemic penumbra.  Stroke. 1981;  12 723-725
  • 51 Hakim A M. The cerebral ischemic penumbra.  Can J Neurol Sci. 1987;  14 557-559
  • 52 Hossmann K A. Viability threshold and the penumbra of focal ischemia.  Ann Neurol. 1994;  36 557-565
  • 53 Kety S S, Schmidt C F. The nitrous oxide method for the quantitative determination of cerebral blood flow in man: Theory, procedure and normal values.  J Clin Invest. 1948;  27 476-483
  • 54 Yonas H, Darby J M, Marks E C, Durham S R, Maxwell C. CBF measured by Xe-CT: an approach to analysis and normal values.  J Cereb Blood Flow Metab. 1991;  11 716-725
  • 55 Bowles A P, Al-Mefty O. The cavernous carotid artery: Preservation is the best means of reconstruction.  Clin Neurosurg. 1995;  42 154-170
  • 56 Diaz F G, Ausman J I, Pearce J. Ischemic complications after combined internal carotid artery occlusion and extracranial-intracranial anastomosis.  Neurosurgery. 1982;  10 563-570
  • 57 Hashi K, Nin K. Incidence of ischemic complications after carotid ligation combined with EC-IC bypass: A multicenter study. In: Spetzler RF et al. (eds). Cerebral revascularisation for stroke. New York: Thieme-Stratton 1985: 570-577

K. M. Akay,M. D. 

Mercimek Sokak 10/3

Etlik, Ankara, 06010

Turkey

Phone: +90-312-325-0224

Fax: +90-312-287-5661

Email: kmakay45@hotmail.com

    >