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[Surgery of the proximal vertebral artery. Indications and results]
J Picquet1, Y Jousset, X Papon
1Service de Chirurgie Cardio-Vasculaire et Thoracique, CHU d'Angers, 4 rue Larrey, 49033 Angers, Cedex 01.
Insights
Vertebral artery surgery effectively treats vertebrobasilar insufficiency with low risks, improving patient outcomes. This intervention, though rarely needed, demonstrates good long-term results and artery patency.
Area of Science:
- Vascular Surgery
- Neurology
- Cerebrovascular Disease
Context:
- Vertebral artery diseases can lead to vertebrobasilar insufficiency.
- Surgical revascularization is an option for specific cases.
- Guidelines for operative indications remain debated.
Purpose:
- To detail clinical presentations of diseases requiring vertebral artery revascularization.
- To identify diagnostic explorations for vertebrobasilar insufficiency.
- To define operative indications for vertebral artery surgery.
Summary:
- A retrospective review of 34 patients undergoing vertebral artery revascularization was conducted.
- Common causes of insufficiency included hemodynamic disorders (50%) and embolism (26.5%).
- Vertebrobasilary reimplantation was the most frequent procedure (76%), with no perioperative strokes or deaths.
Impact:
- Vertebral artery surgery shows good outcomes, improving symptoms of vertebrobasilar insufficiency.
- The procedure has a low operative risk and high long-term patency rates (97.06% at 3 years).
- Overall survival was 85.29% at 3 years, supporting surgical intervention when indicated.
Objectives:
The purpose of this study was to: 1) detail the clinical presentations of diseases requiring revascularization of the vertebral artery and recall the guidelines of the 1975 Ad Hoc committee; 2) identify the explorations needed to detect vertebro-basilary insufficiency; 3) define operative indications since no consensus has been reached.
Patients And Methods:
We reviewed retrospectively the files of 34 patients who underwent revascularization of the vertebral artery between January 1990 and December 2000.
Results:
Surgery of the vertebral artery accounted for 4.6% of our vascular surgery cases involving the brain. Fifty percent of the cases of vertebro-basilary insufficiency were caused by hemodynamic disorders and 26.5% by embolism; 23.5% of the patients had no neurological sign. The most frequent neurological signs were vertigo (44%), balance disorders (41%), long pathway involvement (32%). Vertebro-basilary reimplantation was performed in 76% of the cases. There were no cases of stroke and no deaths during the early postoperative period. There was one case of asymptomatic thrombosis. Mean follow-up was 33.6 months with no patients lost to follow-up. Overall survival was 85.29% at 3 years with patent arteries in 97.06% of the cases at 3 years.
Conclusion:
Our series is in agreement with others reported in the literature, emphasizing the good outcome achieved after vertebral artery surgery. Surgery helps improve signs of vertebro-basilary insufficiency with little operative risk. This surgery is rarely indicated but must be recognized. One must also resist the temptation to "treat images".