Surgeons use abdomen veins to treat brain artery blockage

Surgeons at Rush-Presbyterian-St. Luke’s Medical Center in Chicago have documented the first use of a blood vessel from the abdomen to treat a blocked artery in the brain. The case study was published in the December issue of Surgical Laparoscopy, Endoscopy and Percutaneous Techniques.

The case involved a 49-year old man with a history of hypertension and heart disease and a blocked artery in the brain. The patient’s doctors were Dr. Constantine T. Frantzides, professor of surgery and director of the minimally invasive surgery program at Rush and Dr. R. Lawrence Ferguson, a neurosurgeon at Rush and the Chicago Institute for Neuroresearch and Neurosurgery.

Surgeons usually use a blood vessel from the leg to avoid this blockage and restore blood flow, but the procedure involves two invasive surgeries — one to remove the blood vessel in the leg and the other to graft it into the brain.

Frantzides and Ferguson used a laproscopic method to remove a blood vessel from the omentum, which is an apron-like area in the lower abdomen comprised of fatty and other tissues and blood vessels that protects the abdomen. With laproscopy, surgeons use small holes to access areas of the body that would normally require large incisions.

The Rush surgeons grafted the omentum into the cerebellum, which is in front of the artery that was blocked.

Frantzides said that because of the distance between the lower abdomen and the brain, the surgeons made portals that allowed them to create a tunnel for the omental graft. The surgeons then used the portals to pull the omentum through the tunnel until it reached the brain.

“Because we had to stretch the omentum from the abdomen to the brain, we had to map the entire path so the main vessel could maintain its blood supply as it unfolded and reached the brain,” Frantzides said. The portals were placed along the path of the grafted blood vessels so the surgeon could access the vein and pull it along until it reached the brain, he said.

The patient, who had suffered right-sided weakness, slurred speech and loss of balance, fully recovered and showed no signs of these symptoms postoperatively.