The Incision Edge “Lifting Method” in Cerebral Bypass Surgery: A novel optional technique for narrow or thin recipient arteries

BACKGROUND Cerebral bypass surgery, such as the STA-MCA bypass, is one of the essential procedures for cerebral revascularization. However, very narrow or thin blood vessels increase the risk of anastomotic problems, as seen in Moyamoya disease. For such vessels, we have devised the "lifting method" in the recipient arteriotomy. Here, we introduce this novel optional technique and evaluate its effects. METHODS The "lifting method" is a procedure of lifting the incision edge in a linear incision on the recipient vessel to widen the ostium. We attempted the "lifting method" in 23 consecutive cases (41 arteries) and, as a historical control, compared it with the conventional method of 25 consecutive cases (37 arteries) for the previous 3 years. We compared patient age, years of surgical experience, recipient vessel diameter, anastomotic events and final patency. As a sub-analysis, the same evaluations were done for Moyamoya disease cases. Furthermore, the time required for the lifting procedure was measured retrospectively. RESULTS The incidence of anastomotic events in the conventional method was 13.5% overall and 19% in Moyamoya disease. No events occurred with the "lifting method" (P <0.05). There was no significant difference in other factors including final patency between the two groups. The time required for lifting procedure averaged at 1 minute 15 seconds. CONCLUSIONS The "lifting method" widens and secures the ostium in a recipient vessel and greatly facilitates operability. This is a foolproof method enabling safe and reliable anastomosis even in conditions of narrow or thin vessels.