A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease^{, ,}

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• 作者：Ramon Berguer ; Mark D. Morasch ; Ronald A. Kline
• 刊名：Journal of Vascular Surgery
• 出版年：1998
• 出版时间：May 1998
• 年：1998
• 卷：27
• 期：5
• 页码：852-859
• 全文大小：96 K

文摘

Purpose: The aim of our study was to assess the outcome of distal vertebral artery (VA) reconstructions through a retrospective review conducted at a university-affiliated referral center. Methods: One hundred consecutive distal VA reconstructions had been performed during a period of 14 years (98 patients) and included reversed saphenous vein bypass from the ipsilateral common, internal, or external carotid to the third portion of the VA at the Cl-2 level (68 reconstructions) or the C0-l level (4); transposition of the external carotid or its occipital branch to the VA (23); and transposition of the third portion of the VA onto the internal carotid artery (2). Other methods were used in 3 additional patients. Eighteen patients underwent concomitant carotid operations, and 1 patient underwent a concomitant subclavian transposition. Symptoms were present in 98 % of patients and included vertebrobasilar ischemia (89 % ), vertebrobasilar plus hemispheric ischemia (7 % ), and hemispheric ischemia (2 % ). Two asymptomatic patients with bilateral carotid occlusions underwent operations to provide a single artery for cerebral perfusion (2 % ). Sixty-three lesions were atherosclerotic, 18 were dynamic bony compressions, and 14 were dissection, fibromuscular dysplasia, arteritis, or aneurysm. Five had miscellaneous anatomic indications. Results: Stroke caused the four perioperative deaths that occurred. There was one occurrence of nonfatal hemispheric stroke. Routine postoperative arteriography identified 16 graft abnormalities; 11 patients underwent attempted revision. The introduction of the use of intraoperative angiography in 1990, halfway through the series, lowered the incidence of graft abnormalities from 28 % to 4 % and the incidence of perioperative death from 6 % to 2 % . Eighty-seven percent of patients had complete or significant resolution of symptoms. Follow-up ranged from 1 to 168 months (mean, 79 months). Ten patients were lost to follow-up. Twenty late deaths occurred; none were stroke related. Five reconstructions required late revision. The cumulative primary patency at 5 and 10 years was 75 % ± 6 and 70 % ± 7 (mean ± SE), respectively; cumulative secondary patency was 84 % ± 5 and 80 % ± 6 at 5 and 10 years, respectively. Median survival was 107 months. Conclusions: Distal VA reconstruction provides excellent long-term patency and stroke protection. Intraoperative angiography is mandatory. (J Vasc Surg 1998;27:852-9.)