gms | German Medical Science

Objective: Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is a popular technique for vascular surgeons, but successful and reliable bypass surgery for all cases is difficult.

Methods: About 650 cases with ischemia in the territory of the MCA underwent STA-MCA bypass surgery between December 2001 and November 2011. We describe pitfalls in successful STA-MCA anastomosis especially for small fragile vessels and arteriosclerotic vessels.

Results: Key technical points in successful STA-MCA bypass surgery were: 1. positioning the graft to course naturally between the graft and the recipient artery, 2. adding length between orifice of the donor and preparation of the recipient artery, 3. avoiding suturing the contralateral wall, 4. suturing without too many stitches to facilitate expansion and ensuring good patency of the orifice. Additionally, following two points are very important to carry out successful anastomosis for small and fragile vessels: 1.handling needle carefully to avoid tearing the vessel wall, 2.suturing with loose stitches to facilitate expansion of the orifice. It is especially important for arteriosclerotic vessels to prevent dissecting the intimal layer, and if appeared, to appropriate adapt to dissecting tunica intima. Our originally developed silicon stent and 10–0 monofilament with small needle are very effective to perform successful and reliable bypasses. Moreover, factors which were difficult points to make anastomosis: e.g. bleeding, depth, narrowing, discrepancy between donor and recipient, short graft, etc. should be considered.

Conclusions: We could achieve sufficient results with a patency rate over 99%, by carefully keeping in mind the issues mentioned above.