Comparative patency between intracranial arterial pedicle and vein bypass surgery

Sheau Fung Sia, Andrew Stewart Davidson, Nazih Nabil Assaad, Marcus Stoodley, Michael Kerin Morgan

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    BACKGROUND: Long-term patency of extracranial-to-intracranial (EC-IC) vein bypass is poorly understood. OBJECTIVE: We report our experience of patency of arterial pedicle grafts and interposition vein grafts for the purpose of EC-IC bypass. METHODS: We analyzed 294 consecutive patients who underwent 178 intracranial arterial pedicle bypass procedures and 152 intracranial vein bypass procedures. Bypass patency was assessed by digital subtraction angiography, computed tomographic angiography, and/or Doppler ultrasound. The modified Rankin Scale (mRS) was assigned for clinical grading at the last follow-up consultation. RESULTS: The main indication for arterial pedicle bypass surgery was internal carotid artery occlusion (79 cases); for vein bypass surgery, it was giant aneurysms (61 cases). Procedure-related complications due to surgery occurred in 3 cases (1.7%; 95% CI: 0.4-5.1%) of arterial pedicle bypass surgery and 12 cases (7.9%; 95% CI: 4.5-13.4%) of vein bypass surgery. The patency rate at 6 weeks was 98% (95% CI: 95.0-99.7%) for arterial pedicle bypass and 93% (95% CI: 87.4-96%) for vein bypass, with almost all graft failures occurring within the first week following surgery. Beyond the first week, bypass patency was similar for both groups, with both arterial pedicle grafts and vein bypass grafts that were patent at 1 week having a long-term patency of 99%. There was no statistically significant difference in early, late, and overall patency between the 2 bypass groups. CONCLUSION: The surgical complication rate was greater for vein bypass. Both arterial pedicle and vein bypass have good long-term patency.

    LanguageEnglish
    Pages308-314
    Number of pages7
    JournalNeurosurgery
    Volume69
    Issue number2
    DOIs
    Publication statusPublished - Aug 2011

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    Veins
    Transplants
    Doppler Ultrasonography
    Digital Subtraction Angiography
    Internal Carotid Artery
    Aneurysm
    Angiography
    Referral and Consultation

    Cite this

    Sia, Sheau Fung ; Davidson, Andrew Stewart ; Assaad, Nazih Nabil ; Stoodley, Marcus ; Morgan, Michael Kerin. / Comparative patency between intracranial arterial pedicle and vein bypass surgery. In: Neurosurgery. 2011 ; Vol. 69, No. 2. pp. 308-314.
    @article{584a228179284b3cb36aadf43c1cd2bc,
    title = "Comparative patency between intracranial arterial pedicle and vein bypass surgery",
    abstract = "BACKGROUND: Long-term patency of extracranial-to-intracranial (EC-IC) vein bypass is poorly understood. OBJECTIVE: We report our experience of patency of arterial pedicle grafts and interposition vein grafts for the purpose of EC-IC bypass. METHODS: We analyzed 294 consecutive patients who underwent 178 intracranial arterial pedicle bypass procedures and 152 intracranial vein bypass procedures. Bypass patency was assessed by digital subtraction angiography, computed tomographic angiography, and/or Doppler ultrasound. The modified Rankin Scale (mRS) was assigned for clinical grading at the last follow-up consultation. RESULTS: The main indication for arterial pedicle bypass surgery was internal carotid artery occlusion (79 cases); for vein bypass surgery, it was giant aneurysms (61 cases). Procedure-related complications due to surgery occurred in 3 cases (1.7{\%}; 95{\%} CI: 0.4-5.1{\%}) of arterial pedicle bypass surgery and 12 cases (7.9{\%}; 95{\%} CI: 4.5-13.4{\%}) of vein bypass surgery. The patency rate at 6 weeks was 98{\%} (95{\%} CI: 95.0-99.7{\%}) for arterial pedicle bypass and 93{\%} (95{\%} CI: 87.4-96{\%}) for vein bypass, with almost all graft failures occurring within the first week following surgery. Beyond the first week, bypass patency was similar for both groups, with both arterial pedicle grafts and vein bypass grafts that were patent at 1 week having a long-term patency of 99{\%}. There was no statistically significant difference in early, late, and overall patency between the 2 bypass groups. CONCLUSION: The surgical complication rate was greater for vein bypass. Both arterial pedicle and vein bypass have good long-term patency.",
    author = "Sia, {Sheau Fung} and Davidson, {Andrew Stewart} and Assaad, {Nazih Nabil} and Marcus Stoodley and Morgan, {Michael Kerin}",
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    language = "English",
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    Comparative patency between intracranial arterial pedicle and vein bypass surgery. / Sia, Sheau Fung; Davidson, Andrew Stewart; Assaad, Nazih Nabil; Stoodley, Marcus; Morgan, Michael Kerin.

    In: Neurosurgery, Vol. 69, No. 2, 08.2011, p. 308-314.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Sia, Sheau Fung

    AU - Davidson, Andrew Stewart

    AU - Assaad, Nazih Nabil

    AU - Stoodley, Marcus

    AU - Morgan, Michael Kerin

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    N2 - BACKGROUND: Long-term patency of extracranial-to-intracranial (EC-IC) vein bypass is poorly understood. OBJECTIVE: We report our experience of patency of arterial pedicle grafts and interposition vein grafts for the purpose of EC-IC bypass. METHODS: We analyzed 294 consecutive patients who underwent 178 intracranial arterial pedicle bypass procedures and 152 intracranial vein bypass procedures. Bypass patency was assessed by digital subtraction angiography, computed tomographic angiography, and/or Doppler ultrasound. The modified Rankin Scale (mRS) was assigned for clinical grading at the last follow-up consultation. RESULTS: The main indication for arterial pedicle bypass surgery was internal carotid artery occlusion (79 cases); for vein bypass surgery, it was giant aneurysms (61 cases). Procedure-related complications due to surgery occurred in 3 cases (1.7%; 95% CI: 0.4-5.1%) of arterial pedicle bypass surgery and 12 cases (7.9%; 95% CI: 4.5-13.4%) of vein bypass surgery. The patency rate at 6 weeks was 98% (95% CI: 95.0-99.7%) for arterial pedicle bypass and 93% (95% CI: 87.4-96%) for vein bypass, with almost all graft failures occurring within the first week following surgery. Beyond the first week, bypass patency was similar for both groups, with both arterial pedicle grafts and vein bypass grafts that were patent at 1 week having a long-term patency of 99%. There was no statistically significant difference in early, late, and overall patency between the 2 bypass groups. CONCLUSION: The surgical complication rate was greater for vein bypass. Both arterial pedicle and vein bypass have good long-term patency.

    AB - BACKGROUND: Long-term patency of extracranial-to-intracranial (EC-IC) vein bypass is poorly understood. OBJECTIVE: We report our experience of patency of arterial pedicle grafts and interposition vein grafts for the purpose of EC-IC bypass. METHODS: We analyzed 294 consecutive patients who underwent 178 intracranial arterial pedicle bypass procedures and 152 intracranial vein bypass procedures. Bypass patency was assessed by digital subtraction angiography, computed tomographic angiography, and/or Doppler ultrasound. The modified Rankin Scale (mRS) was assigned for clinical grading at the last follow-up consultation. RESULTS: The main indication for arterial pedicle bypass surgery was internal carotid artery occlusion (79 cases); for vein bypass surgery, it was giant aneurysms (61 cases). Procedure-related complications due to surgery occurred in 3 cases (1.7%; 95% CI: 0.4-5.1%) of arterial pedicle bypass surgery and 12 cases (7.9%; 95% CI: 4.5-13.4%) of vein bypass surgery. The patency rate at 6 weeks was 98% (95% CI: 95.0-99.7%) for arterial pedicle bypass and 93% (95% CI: 87.4-96%) for vein bypass, with almost all graft failures occurring within the first week following surgery. Beyond the first week, bypass patency was similar for both groups, with both arterial pedicle grafts and vein bypass grafts that were patent at 1 week having a long-term patency of 99%. There was no statistically significant difference in early, late, and overall patency between the 2 bypass groups. CONCLUSION: The surgical complication rate was greater for vein bypass. Both arterial pedicle and vein bypass have good long-term patency.

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