Use of the anterior interosseous artery for external to internal carotid artery bypass procedures: a cadaveric feasibility study

Abstract

Introduction. Interpositional grafts are often used for extracranial to intracranial artery bypass procedures. However, donors often suffer from size mismatch and donor site morbidity. We sought a novel donor vessel that has not been used for these procedures. Materials and methods. In 10 adult cadavers, we dissected the length of the anterior interosseous artery (AIA). A pterional craniotomy was performed on each with overlying superficial temporal artery skeletonized and the proximal middle cerebral artery (MCA) and supraclinoid segment of the internal carotid artery (ICA) isolated. Measurements were made and the artery was transected proximally and distally. Harvested segments of the AIA were anastomosed to the superficial temporal artery at the root of the zygoma and cranially to the MCA or ICA. Redundant graft was trimmed and the anterior interosseous anastomosed to the recipient vessel. Results. Mean proximal and distal diameters for the AIA were 2 mm and 1 mm, respectively. Mean length before dissecting the pronator quadratus muscle was 13.5 cm, and after dissecting was 17 cm. There was adequate length of the AIA for grafting between the superficial temporal artery at the root of the zygoma and the MCA and ICAs at the skull base. In fact, each specimen had a mean excess length of 3 cm. Conclusion. The AIA is more than long enough to graft the superficial temporal artery at the root of the zygoma to the vessels of the anterior and posterior circulations. This obviates the possibility of ischemic complications following radial artery harvest and graft size mismatch when using other grafts. Indications for the potential use of the AIA may be limited, but they include special situations such as second craniotomy with a previously damaged superficial temporal artery.