• Hidetoshi Matsukawa, Rokuya Tanikawa, Hiroyasu Kamiyama, Toshiyuki Tsuboi, Kosumo Noda, Nakao Ota, Shiro Miyata, and Sadahisa Tokuda.
• Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan. Electronic address: nowornever1982@gmail.com.
• World Neurosurg. 2016 Mar 1; 87: 35-8.

ObjectiveExtracranial to intracranial (EC-IC) high-flow bypass using radial artery or saphenous vein (SV) graft has remained vital for complex aneurysms. If an Allen test is positive, the radial artery cannot be harvested because of poor palmer collateral circulation. The valves are thought to be one of causes of SV graft failure. Herein we illustrate the "valveless SV graft technique" as bypass conduits.MethodsBetween August 2014 and December 2014 at the Department of Neurosurgery at Teishinkai Hospital, 4 patients whose Allen test was positive underwent EC-IC bypass with the valveless SV graft for complex internal carotid artery (ICA) aneurysm. After SV harvesting, we identified the SV valve, cut it, and performed an end-to-end anastomosis using the fish mouth trimming technique. Graft patency was confirmed by computed tomography angiography.ResultsWe have not encountered any problems related to graft failure, and all valveless SV grafts were patent during the follow-up period (median, 210 days; interquartile range, 93-287 days).ConclusionsThe valveless SV graft technique is a useful technique in patients with complex ICA aneurysms who undergo EC-IC high-flow bypass with therapeutic ICA occlusion and whose Allen tests are positive.Copyright © 2016 Elsevier Inc. All rights reserved.

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