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Cervical vertebral and subclavian artery reconstructions
1Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
Neurologia Medico-Chirurgica
|May 11, 1999
Summary
Open surgical reconstructions for subclavian artery (SA) or vertebral artery (VA) occlusive disease are effective when endovascular approaches fail. These procedures, including transpositions and bypasses, demonstrated a low complication rate in a recent series.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cerebrovascular Disease
Background:
- Endovascular treatment is the preferred initial approach for subclavian artery (SA) and vertebral artery (VA) occlusive disease.
- Open surgical reconstructions are reserved for cases where endovascular treatment fails, is not feasible, or for specific proximal occlusions.
Purpose of the Study:
- To review the outcomes and techniques of open surgical reconstructions for SA and VA occlusive disease.
- To discuss the indications and methods for SA and VA reconstructions in the context of current literature.
Main Methods:
- Retrospective review of 19 open surgical procedures performed between 1992 and 1996.
- Procedures included proximal reconstructions (SA/VA to common carotid artery transpositions/bypasses) and distal reconstructions.
- Intraoperative monitoring utilized two-channel transcranial Doppler for simultaneous cross-clamping.
Main Results:
- One technical failure occurred in a distal VA reconstruction.
- No surgical complications were reported in the series.
- The study highlights the feasibility and safety of open reconstructions when indicated.
Conclusions:
- Open surgical reconstruction remains a viable and safe option for managing complex SA and VA occlusive disease.
- Careful patient selection and appropriate surgical techniques are crucial for successful outcomes.
- The findings support the continued role of open surgery in specific scenarios of cerebrovascular reconstruction.