The four step technique of Excisional arteriotomy of the MCA using a suture: A 2- dimensional video demonstration in a case of Moya-Moya disease who underwent STA- MCA end to side anastomoses

Abstract

Arteriotomy is a very important step in an end to side micro-vascular anastomoses. It is a point of no return as once performed, the surgeon cannot go back. It is a difficult step, the success of which will play a key role in the outcome of your anastomoses. It is of two types: Incisional and Excisional. In the incisional type, a linear longitudinal opening is made. It is easy to do but provides a very narrow working space and the edges are often difficult to visualize. Excisional arteriotomy provides a wider working space and its edges are easier to visualize. It is, however, difficult to perform and requires training on adaveric vessels, tubes etc. In this video, we have described our four-step technique of doing Excisional arteriotomy of the M4 segment of the Middle Cerebral Artery using a suture. The suture helps to manipulate the opening. The excised wall attached to the suture can be submitted to histopathological examination.