Experimental cerebral revascularization with autogenous grafts

✓ Autogenous saphenous arterial or venous grafts were anastomosed between the commond carotid and the middle cerebral artery in 14 dogs with the aid of microsuturing techniques and a new type of microtourniquet. Four of the six saphenous artery grafts were patent when studied angiographically 4 to 70 days postoperatively. Three of the eight venous grafts were patent when studied 1, 3, and 18 days following surgery. The patency rate with arterial grafts was better than that with venous grafts because of the ease of handling due to the thicker wall, the reduced tendency toward redundancy and kinking, and the better graft-to-host-artery ratio. Obvious technical factors were found that accounted for all graft failures. Faulty suture placement; failure to remove an elliptical segment of the host artery; twisting, angulation and kinking of vein grafts; intimal flaps or adventitia caught in the suture line; and cerebral laceration and subsequent infarction were all causes of failure. Successful cerebral revascularization occurred only when these technical factors were surmounted and a satisfactory graft-to-host-artery ratio obtained.