External Carotid Artery to Vertebral Artery Bypass With Radial Artery Graft for a Giant Subclavian Aneurysm: A Surgical Anatomy and Technical Note.

BACKGROUND AND

OBJECTIVES

Giant aneurysms, in the anterior and posterior circulation, are rarely amenable to simple clipping or endovascular techniques and often require a hybrid approach to achieve flow preservation. In this study, we present a case of a giant subclavian artery aneurysm incorporating the origin of the dominant vertebral artery (VA), which was treated with an external carotid artery (ECA) to V3 segment high-flow bypass using a radial artery (RA) graft and stent occlusion of the aneurysm.

METHODS

We describe an illustrative case of a giant subclavian aneurysm, being treated with a VA (V3) to ECA bypass. The patient gave his consent to the publication of his images and case history.

RESULTS

Surgical Technique: We describe the surgical anatomy and technique of a high-flow ECA to V3 bypass for flow preservation for a giant subclavian artery aneurysm. The RA was harvested, preserving the 2 adjacent veins. The approach was similar to an anteromedial skull base approach, exposing C1 with the V3 segment and the carotid bifurcation simultaneously. This allowed for sufficient exposure of the V3 segment for a microanastomosis. After the successful anastomoses, the VA was permanently clipped at the V2 segment, and the patient underwent stent occlusion of the subclavian artery aneurysm.

CONCLUSION

High-flow bypass from the ECA to V3 using a RA graft is a safe technique for flow preservation to avoid vertebrobasilar infarcts and can be used for subclavian artery aneurysms incorporating the VA origin or other pathologies of a dominant VA with insufficient collaterals.