Combined subclavian-external carotid and superficial temporal-middle cerebral artery bypass graft.

A variation of a superficial temporal-middle cerebral artery bypass is presented that can serve as a surgical alternative to long vein subclavian-middle cerebral artery grafting in patients with common carotid artery occlusion and symptoms of ipsilateral ischemia. A vein graft from the subclavian to the external carotid artery at the carotid bifurcation is performed simultaneously with a standard superficial temporal-middle cerebral artery bypass. Advantages of this procedure over a long subclavian-middle cerebral artery vein graft are the technical simplicity associated with a standard superficial temporal-middle cerebral artery bypass, higher patency rates, and lower risk of graft leakage or torsion. Three patients have undergone this procedure, and all had patent bypasses one year after operation.