• Erez Nossek, Peter D Costantino, David J Chalif, Rafael A Ortiz, Amir R Dehdashti, and David J Langer.
• *Department of Neurosurgery, North Shore-Long Island Jewish Health System, Lenox-Hill Hospital, New York, New York; ‡The New York Head & Neck Institute, Hofstra North Shore-Long Island Jewish School of Medicine, New York, New York.
• Neurosurgery. 2015 Sep 23.

BackgroundThe cervical carotid system has been used as a source of donor vessels for radial artery or saphenous vein grafts in cerebral bypass. Recently, internal maxillary artery to middle cerebral artery bypass has been described as an alternative, with reduction of graft length potentially correlating with improved patency.ObjectiveTo describe our experience using the forearm cephalic vein grafts for short segment internal maxillary artery to middle cerebral artery bypasses.MethodsAll vein grafts were harvested from the volar forearm between the proximal cubital fossa where the median cubital vein is confluent with the cephalic vein and the distal wrist.ResultsSix patients were treated with internal maxillary artery to middle cerebral artery bypass. In 4, the cephalic vein was used. Postoperative angiography demonstrated good filling of the grafts with robust distal flow. There were no upper extremity vascular complications. All but 1 patient (mortality) tolerated the procedure well. The other 3 patients returned to their neurological baseline with no new neurological deficit during follow-up.ConclusionThe internal maxillary artery to middle cerebral artery "middle" flow bypass allows for shorter graft length with both the proximal and distal anastomoses within the same microsurgical field. These unique variable flow grafts represent an ideal opportunity for use of the cephalic vein of the forearm, which is more easily harvested than the wider saphenous vein graft and which has good match size to the M1/M2 segments of the middle cerebral artery. The vessel wall is supple, which facilitates handling during anastomosis. There is lower morbidity potential than utilization of the radial artery. Going forward, the cephalic vein will be our preferred choice for external carotid-internal carotid transplanted conduit bypass.AbbreviationsEI-IC, external carotid-internal carotidICA, internal carotid arteryIMax-MCA, internal maxillary artery to middle cerebral arteryMCA, middle cerebral arteryRAG, radial artery graft.

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