2018 年 46 巻 4 号 p. 262-267
During high flow bypass (HFB) surgery to make a submandibular route using a radial artery, the passage of a graft between an anastomosis site of the cervical external carotid artery to the temporal base is made blindly. This is also a frequent occlusion site of the graft in the surgery. In this study, we focused on complications that can occur during this procedure. Fourteen consecutive patients undergoing HFB for internal carotid artery aneurysms between 2012 and 2017 were evaluated. In all 14 patients, patency of HFB was confirmed with postoperative computed tomography angiograms. Major complications concerning the surgery to make the submandibular route were the following: 1) the use of a medial route to the stylohyoid muscle (SHM) resulted in no extra margin of the radial artery length in 5 patients; 2) a long styloid process obstructed the submandibular route in 2 patients; 3) the superior temporal artery, which was compressed by a route tube at the external carotid artery, was obstructed during the assist bypass procedure in 2 patients; 4) a radial arterial graft was occluded in the submandibular region during the procedure in one patient. Considering the limitation of the available graft length, a submandibular route lateral to the SHM was the most suitable for HFB using a radial artery graft. To obtain good patency of HFB using this route, preparation for possible complications occurring during surgery is essential in addition to sufficient knowledge on the anatomy of this region.
