Cervical-to-petrous internal carotid artery saphenous vein in situ bypass for the treatment of a high cervical dissecting aneurysm: technical case report

We describe a novel cervical-to-petrous internal carotid artery (ICA) saphenous vein in situ bypass for the treatment of a high cervical dissecting aneurysm. The cervical ICA has no major collateral branches and can be used as a tunnel for the vein graft. A 25-year-old man was involved in a car accident. A cerebral angiogram revealed a right ICA dissection with aneurysm formation at the C1-C2 level. The patient recovered fully and was anticoagulated. Six months after the initial angiogram, a second angiogram disclosed ICA stenosis (80%) and persistence of the traumatic dissecting aneurysm. Definitive surgical bypass was considered the most appropriate course of action. The horizontal portion of the petrous ICA was exposed by an extradural subtemporal approach. The cervical arteries were exposed by a separate surgical incision. After dividing the petrous ICA and the cervical ICA, the cervical ICA was dilated using a Fogarty balloon embolectomy catheter. A saphenous vein graft was inserted inside the lumen of the cervical ICA and was anastomosed to the ICA end-to-end both proximally and distally (cervical-to-petrous ICA in situ bypass). The graft was patent on the follow-up angiogram. We describe a new technique that could be considered an alternative to the classical extra-anatomic cervical-to-petrous ICA bypass procedures.