gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Intraoperative quantitative assessment of vessel flow facilitates decision making during high-flow bypass surgery

Die intraoperative quantitative Erfassung des Gefäßflusses erleichtert den Entscheidungsprozess im Rahmen der High-Flow-Bypass-Chirurgie

Meeting Abstract

Suche in Medline nach

  • corresponding author Peter Vajkoczy - Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
  • T. Kinfe - Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
  • P. Horn - Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
  • P. Schmiedek - Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.01.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0241.shtml

Veröffentlicht: 23. April 2004

© 2004 Vajkoczy et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Decision making during high-flow bypass procedures is hampered by the lack of adequate intraoperative information on blood flow through the graft. Thus, patients may be placed at risk of ischemia or parent vessel sacrifice may be delayed risking bypass thrombosis. The aim of the present study was to evaluate the benefits of quantitative vessel flow measurments on decision making during high-flow bypass surgery.

Methods

Over one year, 18 patients underwent high-flow bypass procedures. In 9 patients (n=7 giant or large aneurysms within the anterior or posterior circulation, n=1 skull base tumor, n=1 ischemia), intraoperative bypass vessel flow measurements were performed using ultrasound transit-time technology. Therefore, perivascular probes (3 and 6 mm) were placed around the bypass and graft flow (ml/min) was continuously recorded. In the aneurysm and tumor cases, measurements were performed before (baseline flow) and after test parent vessel occlusion (test occlusion flow) in order to assess whether graft flow was sufficient to replace flow through the parent vessel that was to be sacrificed.

Results

Flow measurements were characterized by stable and reliable readings. The information about vessel flow markedly improved the intraoperative assessment not only of bypass patency but also of bypass function, which consequently facilitated decision making on the timing of parent vessel sacrifice. In the ischemia case, bypass flow was 220 ml/min. In the aneurysm and tumor cases, baseline flow and test occlusion flow were 65±59 and 116±45 ml/min, respectively. Preliminary thresholds for aneurysm cases were identified: a baseline flow less than 40 ml/min carries a high risk of bypass thrombosis; test occlusion flows greater than 50 and 100 ml/min allow for a safe intraoperative occlusion of the M1 segment and ICA, respectively.

Conclusions

The quantitative assessment of vessel flow provides unique intraoperative information on not only the patency but also the function of bypass grafts and facilitates decision making during high-flow bypass surgery.