CERVICAL-TO-PETROUS INTERNAL CAROTID-ARTERY SAPHENOUS-VEIN IN-SITU BYPASS FOR THE TREATMENT OF A HIGH CERVICAL DISSECTING ANEURYSM - TECHNICAL CASE-REPORT

OBJECTIVE AND IMPORTANCE: We describe a novel cervical-to-petrous inte rnal carotid artery (ICA) saphenous vein in situ bypass for the treatm ent of a high cervical dissecting aneurysm. The cervical ICA has no ma jor collateral branches and can be used as a tunnel for the vein graft . CLINICAL PRESENTATION: A 25-year-old man was involved in a car accid ent. A cerebral angiogram revealed a right ICA dissection with aneurys m formation at the C1-C2 level. The patient recovered fully and was an ticoagulated. Six months after the initial angiogram, a second angiogr am disclosed ICA stenosis (80%) and persistence of the traumatic disse cting aneurysm. Definitive surgical bypass was considered the most app ropriate course of action. TECHNIQUE: The horizontal portion of the pe trous ICA was exposed by an extradural subtemporal approach. The cervi cal arteries were exposed by a separate cervical incision. After divid ing the petrous ICA and the cervical ICA, the cervical ICA was dilated using a Fogarty balloon embolectomy catheter. A saphenous vein graft was inserted inside the lumen of the cervical ICA and was anastomosed to the ICA end-to-end both proximally and distally (cervical-to-petrou s ICA in situ bypass). The graft was patent on the follow-up angiogram . CONCLUSION: We describe a new technique that could be considered an alternative to the classical extra-anatomic cervical-to-petrous ICA by pass procedures.