External Carotid Artery to Vertebral Artery Bypass With Radial Artery Graft for a Giant Subclavian Aneurysm: A Surgical Anatomy and Technical Note
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Giant aneurysms, in the anterior and posterior circulation, are rarely amenable to simple clipping or endovascular techniques and often require a hybrid approach to achieve flow preservation. In this study, we present a case of a giant subclavian artery aneurysm incorporating the origin of the dominant vertebral artery (VA), which was treated with an external carotid artery (ECA) to V3 segment high-flow bypass using a radial artery (RA) graft and stent occlusion of the aneurysm. METHODS: We describe an illustrative case of a giant subclavian aneurysm, being treated with a VA (V3) to ECA bypass. The patient gave his consent to the publication of his images and case history. RESULTS: Surgical Technique: We describe the surgical anatomy and technique of a high-flow ECA to V3 bypass for flow preservation for a giant subclavian artery aneurysm. The RA was harvested, preserving the 2 adjacent veins. The approach was similar to an anteromedial skull base approach, exposing C1 with the V3 segment and the carotid bifurcation simultaneously. This allowed for sufficient exposure of the V3 segment for a microanastomosis. After the successful anastomoses, the VA was permanently clipped at the V2 segment, and the patient underwent stent occlusion of the subclavian artery aneurysm. CONCLUSION: High-flow bypass from the ECA to V3 using a RA graft is a safe technique for flow preservation to avoid vertebrobasilar infarcts and can be used for subclavian artery aneurysms incorporating the VA origin or other pathologies of a dominant VA with insufficient collaterals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".