Candon E, Canovas F, Kabbaj J, Pieuchot P, Bonnel F, Frerebeau P
Service de Neurochirurgie B, CHU, Gui de Chauliac, Montpellier, France.
Surg Radiol Anat. 1998;20(1):1-6. doi: 10.1007/BF01628107.
In the surgical treatment of aneurysms of the upper cervical portion of the internal carotid a., exclusion of the affected vascular segment combined with an extra-anatomic cervico-petrous bypass using a vein graft (great saphenous v.) may be considered. One of the problems specific to these extra-anatomic bypasses is associated with the sub-cutaneous positioning of the vein graft, exposing it to risks of angulation, torsion or extrinsic compression that may lead to early venous thrombosis. We suggest an alternative technique using the principle of telescoping and consisting of positioning the vein graft within the cervical portion of the artery ("in situ" bypass). The cervical portion of the ICA may be used as a tunnel for the vein graft since there are no collateral arterial branches at this level. The technical features of such a bypass are defined by means of an anatomo-surgical study in the cadaver: exposure of the petrous portion of the internal carotid a. in its horizontal segment by subtemporal access, exposure of the ICA in the neck, transverse arteriotomies of the ICA, angioplasty with a Fogarty balloon, intracarotid telescoping of a saphenous vein graft from the cervical to the petrous region, distal end-to-end anastomosis between the vein graft and the petrous portion of the ICA, and proximal end-to-end anastomosis between the vein graft and the cervical portion of the ICA.
在颈内动脉上段动脉瘤的外科治疗中，可考虑将病变血管段排除，同时使用静脉移植物（大隐静脉）进行解剖外颈-岩骨旁路手术。这些解剖外旁路手术特有的问题之一与静脉移植物的皮下定位有关，使其面临成角、扭转或外部压迫的风险，这可能导致早期静脉血栓形成。我们建议采用一种基于套叠原理的替代技术，即将静脉移植物置于动脉的颈部段内（“原位”旁路）。颈内动脉的颈部段可作为静脉移植物的隧道，因为该水平没有侧支动脉分支。这种旁路手术的技术特点通过在尸体上进行的解剖学手术研究来确定：通过颞下入路暴露颈内动脉岩骨段的水平段，暴露颈部的颈内动脉，对颈内动脉进行横向动脉切开术，用Fogarty球囊进行血管成形术，将大隐静脉移植物从颈部向岩骨区域进行颈内动脉内套叠，静脉移植物与颈内动脉岩骨段之间进行远端端端吻合，以及静脉移植物与颈内动脉颈部段之间进行近端端端吻合。
