Pushing/Irrigation Technique Against Continuous Bleeding from an Orifice of a Recipient During Direct Anastomosis in Moyamoya Disease: Technical Note

Abstract

Ideally, small branches originating from a recipient should not be cut to obtain enough length for direct anastomosis in moyamoya disease. When these branches are near each other and a temporary clip is used to occlude a recipient and these branches, simultaneously, troublesome bleeding may occur just after opening of the recipient. In this situation, an additional clip is applied to the small branch, which has already been clipped with the first clip. But even after the procedure, bleeding may continue. In the present study, I introduce a technique to overcome this problem. The new technique is as follows: A micro-needle with an 11-0 monofilament was passed through a scalp artery in the usual fashion. After completion of the procedure, a 1 ml syringe including physiological saline with a dull-tip needle was held in the left hand, and the tip of the dull-tip needle was introduced into the inner lumen of the recipient though its orifice. Then, the dull tip of needle was used to slightly push the bottom of the inner wall of the recipient. Continuous irrigation was started to find an edge of the orifice of the recipient. After the edge was clearly defined, the micro-needle held in the right hand was passed through the recipient. The process was repeated until completion of the anastomotic procedure. The procedure required less time than the usual technique.
The pushing/irrigation technique effectively countered continuous bleeding from an orifice of a recipient during direct anastomosis. The use of this technique during the anastomotic procedure can reliably and safely contribute to the treatment of moyamoya disease.