LATE PATENCY OF LONG SAPHENOUS-VEIN BYPASS GRAFTS TO THE ANTERIOR ANDPOSTERIOR CEREBRAL-CIRCULATION

To evaluate the late results and the natural history of long saphenous vein bypass grafts (SVGs) between the extracranial and intracranial c irculation, the authors retrospectively analyzed 202 consecutive SVGs performed at the Mayo Clinic from 1979 to 1992. The distal anastomosis was to the vertebrobasilar system in 98 patients and to the carotid a rtery system in 103 patients. Surgical indications were advanced cereb roocclusive disease in 63% (127 cases), giant aneurysm in 37% (74 case s), and neoplasm in one patient. In 125 patent SVGs follow-up informat ion was obtained for longer than 1 year and in 23 patent SVGs it was o ver 10 years (maximum 13 years, median 6.5 years). Most of the graft f ailures (76%) occurred during the Ist year after surgery, with 42% of all graft failures found during the first 24 hours after operation. La te graft attrition occurred in only 10 patients (8%). Cumulative paten cy at 1 year was 86% +/- 3%, at 5 years 82% +/- 4%, and at 13 years 73 % +/- 19%. Neurological worsening at the time of occlusion developed i n 72% of patients with early occlusion, whereas 80% of patients with l ate graft occlusion had no new neurological symptoms. Long-term patenc y of SVGs for cerebral revascularization appears to be excellent, with an average failure rate of 1% to 1.5% per year following the 1st year after surgery. To minimize early graft thrombosis, meticulous attenti on must be paid to technical detail.