J Korean Neurosurg Soc.  2014 Jun;55(6):353-356. 10.3340/jkns.2014.55.6.353.

The Sundt Encircling Clip as a Vascular Rescue: A Case Report and a Review of Repair Methods for Arterial Tearing

• Kim JK
• Kim JH
• Kim DR
• Kang HI

• KMID: 2191116
• DOI: http://doi.org/10.3340/jkns.2014.55.6.353

Abstract

The Sundt encircling clip was developed to repair defects of the vessel wall. With the advent of microvascular techniques, most parts of the damaged vessel wall during aneurysm surgery can be repaired by primary closure or by the bypass technique. However, these methods are not always successful. Here, we illustrate two cases of surgical clipping with the Sundt encircling clip in the ruptured internal carotid artery trunk aneurysm. The Sundt clip provides prompt control of unexpected tearing of the vessel wall or aneurysm and plays an important role in vascular rescue during aneurysm surgery.

Keyword

Aneurysm; Sundt clip; Vessel injury

MeSH Terms

Aneurysm
Carotid Artery, Internal
Surgical Instruments

Figure

• 

  Fig. 1 A : The initial brain computed tomographic scan shows a diffuse hemorrhage in the basal cistern. B : A 3-dimensional computed tomographic scan reveals fusiform dilatation (arrow) of the right supraclinoid internal carotid artery. C : Digital subtraction angiography shows fusiform dilatation (arrow) of the right internal carotid artery. D : Postoperative brain computed tomographic scan shows hypodense lesion in the genu of the right internal capsule. E : Follow-up angiography after clipping reveals stenotic change in the right internal carotid artery and preservation of distal blood flow.

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  Fig. 2 A : The initial brain computed tomographic scan shows a diffuse hemorrhage in the basal cistern and left Sylvian fissure. B : The subsequent 3-dimensional computed tomographic scan reveals a small aneurysm (arrow) on the posterolateral wall of the left supraclinoid ICA. C : Intraoperative photography shows jet bloodstream from the defect (arrow) of internal carotid artery wall. D : Follow-up angiography shows stenotic change in the left internal carotid artery and preservation of distal blood flow. E : Histopathologic photomicrograph reveals thrombotic materials and no smooth muscle fibers corresponding to vascular wall (Masson's trichrome stain, ×100). ICA : internal carotid artery.

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  Fig. 3 A : Schematic illustrations of various repair methods for arterial tearing during aneurysm surgery. Arterial wall defects. B : Direct suturing. C : Clip with wrapping material. D : Sundt encircling clip.

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