INTERPOSITION SAPHENOUS-VEIN BYPASS GRAFT BETWEEN THE COMMON AND INTRACRANIAL INTERNAL CAROTID ARTERIES

22 common carotid to intracranial internal carotid artery bypass graft s with interposition saphenous vein were performed in 20 patients over a four pear period, The distal anastomosis was end-to-end on the inte rnal carotid artery at a site between the ophthalmic and posterior com municating arteries, Early occlusion (rendered patent with Urokinase) occurred in one graft resulting in fatal infarction, Flow included all the anterior and middle cerebral arteries in 17 bypass procedures and middle cerebral artery only in five bypasses. Complications attributa ble to the bypass were seen following six procedures, These complicati ons resulted in mortality in one case (early graft occlusion) and perm anent morbidity (partial monocular visual loss) in two cases, Other co mplications resulting in no, or temporary, morbidity were cortical inf arction due to division of collateral meningeal supply during opening (n=1), epidural haematoma (n=1), and intimal hyperplasia causing delay ed graft stenosis (n=1), With the exception of the operative complicat ions no patient subsequently experienced a hemispheric ischaemic episo de. Minimising complications is possible with avoidance of proximal Li gation of the internal carotid artery whenever possible, ligation of t he ophthalmic artery when steal into a cavernous sinus fistula is a po ssibility, careful evaluation of existing collaterals from the middle meningeal artery (and their preservation) and attention to timing for the postoperative introduction of anticoagulants, Early graft occlusio n (4.5%) is likely to remain the most feared complication of this proc edure, Immediate intervention with intragraft Urokinase may re-establi sh graft patency. (C) Pearson Professional 1996