Tibial Artery Autografts: Alternative Conduits for High Flow Cerebral Revascularizations

BackgroundExtracranial-to-intracranial (EC-IC) bypass is a valuable tool in treating intracranial diseases requiring flow replacement or parent vessel sacrifice. Radial artery grafts (RAGs) and saphenous vein grafts (SVGs) have been used as conduits to provide adequate high flow revascularizations. It is a therapeutic challenge when these grafts are unavailable.MethodsAll EC-IC high flow cerebral revascularizations performed using conduits other than RAGs or SVGs were identified from a prospective cerebrovascular registry. These patients were retrospectively reviewed for surgical technique, graft patency, graft flow, and clinical outcomes.ResultsThree patients (all women) underwent EC-IC bypass surgery using tibial artery grafts (two anterior tibial artery and one posterior tibial artery) because of the nonavailability of RAG or SVG. The two anterior tibial artery graft bypasses were patent with good flow at 8 and 3 months. The posterior tibial artery graft occluded intraoperatively. None of the patients developed vascular complications in the lower extremity due to tibial artery harvest.ConclusionsTibial arteries are safe, contingent alternatives to conventional conduits for performing high flow cerebral revascularizations and conduit reconstructions.