Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery
OBJECTIVE: Cerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up.
METHODS: All intracranial bypass procedures performed between 2001 and 2018 were reviewed. Demographic, clinical, angiographic, and operative data were recorded and then analyzed according to SVG type.
RESULTS: A total of 308 consecutive intracranial bypasses were performed during the study period, 53 (17.2%) of which were bypasses with an interposition SVG (38 autologous, 15 cadaveric). At a median follow-up of 2.2 months (IQR 0.2-29.1), 39 (73.6%) bypasses were patent (26 [68.4%] autologous, 13 [86.7%] cadaveric, p = 0.30). Comparing autologous and cadaveric SVG recipients, there were no statistically significant differences in age (p = 0.50), sex (p > 0.99), history of smoking (p = 0.75), hypertension (p > 0.99), diabetes mellitus (p = 0.13), indication for bypass (p = 0.27), or SVG diameter (p = 0.65). While there were higher intraoperative (autologous, 100.0 ml/min, IQR 84.3-147.5; cadaveric, 80.0 ml/min, IQR 47.3-107.8; p = 0.11) and postoperative (autologous, 142.2 ml/min, IQR 76.8-160.8; cadaveric, 92.0 ml/min, IQR 69.2-132.2; p = 0.42) volumetric flow rates in the autologous SVGs compared to those in the cadaveric SVGs, the difference between the two groups did not reach statistical significance. In addition, the blood flow index, or ratio of postoperative to intraoperative blood flow, for each bypass was similar between the groups (autologous, 1.3, IQR 0.9-1.6; cadaveric, 1.5, IQR 1.0-2.3; p = 0.37). Kaplan-Meier estimates showed no difference in bypass patency rates over time between autologous and cadaveric SVGs (p = 0.58).
CONCLUSIONS: Cadaveric SVGs are a reasonable interposition graft option in cerebral revascularization surgery when autologous grafts are not available.
| Errataetall: |
CommentIn: J Neurosurg. 2020 Aug 14;134(5):1678-1679. - PMID 32796148 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:134 |
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| Enthalten in: |
Journal of neurosurgery - 134(2020), 5 vom: 22. Mai, Seite 1562-1568 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Stapleton, Christopher J [VerfasserIn] |
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| Links: |
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| Themen: |
Cerebral blood flow |
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| Anmerkungen: |
Date Completed 09.08.2021 Date Revised 16.06.2023 published: Electronic CommentIn: J Neurosurg. 2020 Aug 14;134(5):1678-1679. - PMID 32796148 Citation Status MEDLINE |
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| doi: |
10.3171/2020.3.JNS192546 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM31025213X |
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| 100 | 1 | |a Stapleton, Christopher J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Revised 16.06.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a CommentIn: J Neurosurg. 2020 Aug 14;134(5):1678-1679. - PMID 32796148 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: Cerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up | ||
| 520 | |a METHODS: All intracranial bypass procedures performed between 2001 and 2018 were reviewed. Demographic, clinical, angiographic, and operative data were recorded and then analyzed according to SVG type | ||
| 520 | |a RESULTS: A total of 308 consecutive intracranial bypasses were performed during the study period, 53 (17.2%) of which were bypasses with an interposition SVG (38 autologous, 15 cadaveric). At a median follow-up of 2.2 months (IQR 0.2-29.1), 39 (73.6%) bypasses were patent (26 [68.4%] autologous, 13 [86.7%] cadaveric, p = 0.30). Comparing autologous and cadaveric SVG recipients, there were no statistically significant differences in age (p = 0.50), sex (p > 0.99), history of smoking (p = 0.75), hypertension (p > 0.99), diabetes mellitus (p = 0.13), indication for bypass (p = 0.27), or SVG diameter (p = 0.65). While there were higher intraoperative (autologous, 100.0 ml/min, IQR 84.3-147.5; cadaveric, 80.0 ml/min, IQR 47.3-107.8; p = 0.11) and postoperative (autologous, 142.2 ml/min, IQR 76.8-160.8; cadaveric, 92.0 ml/min, IQR 69.2-132.2; p = 0.42) volumetric flow rates in the autologous SVGs compared to those in the cadaveric SVGs, the difference between the two groups did not reach statistical significance. In addition, the blood flow index, or ratio of postoperative to intraoperative blood flow, for each bypass was similar between the groups (autologous, 1.3, IQR 0.9-1.6; cadaveric, 1.5, IQR 1.0-2.3; p = 0.37). Kaplan-Meier estimates showed no difference in bypass patency rates over time between autologous and cadaveric SVGs (p = 0.58) | ||
| 520 | |a CONCLUSIONS: Cadaveric SVGs are a reasonable interposition graft option in cerebral revascularization surgery when autologous grafts are not available | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a cerebral blood flow | |
| 650 | 4 | |a cerebral ischemia | |
| 650 | 4 | |a extracranial-intracranial bypass | |
| 650 | 4 | |a intracranial aneurysm | |
| 650 | 4 | |a saphenous vein graft | |
| 650 | 4 | |a vascular disorders | |
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| 700 | 1 | |a Charbel, Fady T |e verfasserin |4 aut | |
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