Abstract
Background Temporary occlusion of the proximal vessel is being increasingly used as an adjunct
during aneurysm surgery for safer dissection, evacuation of the aneurysm, and to prevent
intraoperative rupture. The guidelines regarding its practice are ambiguous. One of
the major concerns is the safe time limit for temporary occlusion. Studies done so
far have failed to reach a consensus on this issue. This study is an attempt to provide
a practical, safe time period of intermittent occlusion of an artery in the anterior
circulation, irrespective of vascular territory.
Patients and Methods A total of 68 patients in whom elective, intermittent, temporary clipping of the
proximal vessel was employed during aneurysm surgery were prospectively studied. They
were divided into two groups, Group I with an occlusion period of less than 7 minutes
and Group II with occlusion period of 10 minutes and above per episode. The incidence
of complications in both groups, their relationship to the number of intermittent
clippings, and the total duration of clipping were analyzed.
Results The incidence of complications was more in Group II (23.5 vs. 8.8%). There was a
reduction in the incidence of complications when the duration of occlusion per episode
was reduced; this, however, was not reflected statistically (p = 0.1). The total duration of temporary occlusion, when compared, was significantly
longer in Group II (p = 0.000). The total duration of clipping, however, was not significantly different
between those who developed complications and those who did not (p = 0.86). The occurrence of complications did not correlate with the vascular territory,
number of intermittent clippings, or the total duration of occlusion within their
respective groups.
Conclusion Our study supports the view that the proximal vessel can be safely occluded during
aneurysm surgery. The total occlusion period could be safely prolonged when employed
in an intermittent fashion with periods of reperfusion to attain the objective of
safe dissection. The reduction in duration of each episode of occlusion, though resulted
in fewer complications, did not reach statistical significance.
Keywords
aneurysm surgery - temporary occlusion - elective - intermittent - time limit
