Titanium hemostatic clip tailoring method to overcome vessel caliber discrepancy in interposition saphenous vein graft for carotid artery resection

Abstract

CONCLUSION: This method makes it possible to perform the ISVG simply and within a short time and, therefore, is very useful for shortening the duration to block circulation. OBJECTIVE: Complete excision of a malignant tumor which invades carotid artery walls essentially requires the resection and reconstruction of the carotid artery. In most cases, an interposition graft using a saphenous vein has been performed; however, the discrepancy in vessel caliber between the common carotid artery and the saphenous vein can complicate the surgical technique. We have introduced and evaluated a new titanium hemostatic clip tailoring method to overcome the vessel caliber discrepancy in interposition saphenous vein graft (ISVG) for carotid artery resection in the treatment of head and neck cancers. MATERIAL AND METHODS: After carotid artery resection, the calibers of the proximal common carotid artery and the vein were compared, and the size of the orifice of the common carotid artery was gradually reduced to a little larger than or the same as that of the vein using a titanium hemostatic clip. Subsequently, the common carotid artery was connected to the vein by means of anastomosis. The same method was also applied to the distal anastomosis site. Thereafter, the vessels were connected through the anastomosis, and circulation was restored by releasing a vascular clamp. Then, the redundant portion on the outside of the carotid artery was sutured by means of the blanket-edge suture method, using 6-0 Prolene. RESULTS: We employed this method in two patients with recurrent squamous cell carcinoma and neuroblastoma, respectively. The ISVG of these patients was found to maintain good patency at follow-up angiography after 1 year, and no specific vascular complications were observed.