Superficial temporal artery-grafted vessel-anterior cerebral artery anastomosis

In 1981, the autologous gastric retinal artery was transplanted between the superficial temporal artery and the anterior cerebral artery to treat cerebral ischemia caused by proximal occlusion of the anterior cerebral artery. In the following year, Japanese scholar R. Ishii performed a similar operation with the cephalic vein as a graft. Comparing the advantages and disadvantages of arterial and venous transplantation, arterial graft patency rate is high, complications are few, and the operation is relatively easy. The gastric retinal artery is located on the large curved side of the stomach. Its length is 15-20 cm, and its caliber is 2 to 2.5 mm. It is similar to the superficial temporal artery and middle cerebral artery. The suture of the arterial wall is easier than the vein. Because of the abundant blood supply to the stomach, there is no sputum of gastric or omental ischemia, which is superior to the commonly used radial artery. It is only necessary to do a laparotomy, but if it is done, its trauma and difficulty are not great. Treatment of diseases: cerebral ischemic diseases Indication Superficial temporal artery-transplantation vascular-anterior cerebral artery anastomosis is suitable for occlusion of the anterior segment of the anterior cerebral artery, causing ischemia in the donor area. Contraindications Aged, frail or severe systemic disease that can not tolerate craniotomy. Preoperative preparation In addition to the routine preoperative preparation, the use of the gastric retinal artery as a graft, should also be prepared according to open surgery. Surgical procedure 1. Take the graft Patients with gastric retinal artery were treated with a median incision or a median midline incision. In addition to the incision of the stomach, a section of the gastric retinal artery was taken along the large curve of the stomach, which was about 12 cm long. The short gastric artery and the branch to the greater omentum were ligated one by one, together with a retinal tissue and fat. The removed vascular lumen was rinsed with heparin saline and immersed in 1% procaine solution for later use. The cephalic vein can also be used as a graft vessel. 2. Exposing the superficial temporal artery The main artery of the superficial temporal artery is exposed in front of the ear, and the distal side is followed to find its branch, and the larger one is selected as the blood supply artery. 3. Craniotomy The craniotomy of the anterior sinus across the sagittal sinus is performed, and the periorbital artery (or the iliac artery) is found in the longitudinal fissure as the recipient artery. 4. Anastomotic vessels One end of the graft vessel was anastomosed to the superficial temporal artery, and the other end was an end-to-side anastomosis with the anterior cerebral artery. If the vein is used as the graft vessel, due to its large diameter, the end-to-side anastomosis can be performed with the trunk of the superficial temporal artery. complication 1. Avascular necrosis of the scalp. 2. Subdural hematoma, water tumor. 3. Pseudoaneurysm formation at the anastomosis. 4. Due to temporary blockage of the anterior cerebral artery, causing loss of nerve function. 5. Gastrointestinal bleeding.