When the parent vessel must be sacrificed during clipping of complex aneurysms an EC-IC or IC-IC bypass is constructed to replace the flow initially supplied by the parent vessel. The University of Illinois group has developed an new flow-based strategy to first determine the deficit created by sacrifice of the parent vessel and then access the adequacy of an EC-IC bypass to replace flow when a aneurysm is trapped and the vessel sacrificed 

“Direct intraoperative measurement of flow deficit in aneurysm surgery requiring parent vessel sacrifice can guide the choice of flow replacement and confirm the subsequent adequacy of bypass flow.” Amin-Hanjani S, Alaraj A, Charbel FT, “Flow Replacement Bypass for Aneurysms: decision-Making Using Intraoperative Blood Flow Measurements” Acta Neuroch DOI 10.1007/a00701-010-0635-4 Published online 06 April 2010.

Flow Replacement Protocol

1. Calculate Flow Deficit created by vessel occlusion / trapping
2. Match supply to demand by Checking the Cut Flow of donor artery
3. Immediately evaluate patency and success of bypass

Flow Replacement Video Case Example - with Dr. Charbel (17.7 MB)

Superficial Temporary Artery - Middle Cerebral Artery Bypass - Case Example #109  

An illustrative case example of measuring flow during a superficial temporary artery, middle cerebral artery bypass