Management of Complex Aneurysms
Transcript of Management of Complex Aneurysms
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Management of Complex Aneurysms:
Role of Arterial Reconstruction
Neil A. Martin, MD
Geisinger Health
Danville, Pa
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Techniques for Aneurysm Occlusion
• Simple neck clipping
• Clip reconstruction of parent artery
• Clipping under hypothermic cardiac arrest
• Parent artery occlusion (balloon, coil, clip)
• Endosaccular coils
• Stent plus coils
• Wrapping
• Parent artery occlusion with bypass
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Bypass for Aneurysms: Advantages
• Parent artery occlusion generally provides
simple, complete, permanent treatment
• Bypass prevents distal ischemia, and collateral
flow stress (de novo aneurysm formation)
• No need to reconstruct calcified,
atherosclerotic, or thombosed neck region
• Avoids risk of cardiac arrest
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Bypass
Types
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Type II
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Patient HB: 48 yo woman with headaches
and diplopia
Problem: No cross-filling, rapid failure of BTO
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Saphenous vein graft from ICA to MCA
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Pre-op Post-op
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Type II Bypass: Saphenous Vein Interposition
Fusiform MCA Aneurysm
Saphenous vein from ECA
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Type III
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Failed BTO at
9 minutes
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STA vs Saphenous Vein
STA
• One anastomosis
• Acute occlusion: 2-5%
• Late occlusion: 5-10%
• One incision
Vein
• Two anstomoses
• Acute occlusion: 5-
10%
• Late occlusion: 25-
30%
• Three incisions
• Hyperperfusion
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STA vs Saphenous Vein
STA
• Cavernous aneurysm
with small
communicating
arteries
• Aneurysm involving
one branch vessel
(MCA, PICA)
Vein
• Cavernous aneurysm
with no
communicating
arteries
• Aneurysm involving
major trunk (MCA
M1)
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30 y.o. photographer with headaches, episodic aphasia,
and right side weakness
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40 yo woman, progressive headaches, decreased visual
acuity
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ICA aneurysm extends to include Pcom origin - persistent
aneurysm filling post op
Pre opPost op
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Bypass Patency
• Superficial temporal artery : 96%
• Saphenous vein grafts : 95%
• Cerebral artery anastomoses : 100%
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135761Spetzler ‘96
9779
(83%)
95Martin ‘07
433946Drake ‘94
242531Ausman ‘90
542029Sundt ‘86
DeadFair-PoorExc-Goodn
Revascularization for Aneurysms: Results
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