Distal vertebral artery reconstruction: long-term outcome

Area of Science:

• Vascular Surgery
• Cerebrovascular Surgery
• Interventional Neurology

Background:

• Vertebrobasilar insufficiency (VBI) affects a significant portion of patients with extracranial vertebral artery lesions.
• Distal vertebral artery (DVA) reconstruction aims to restore blood flow and alleviate symptoms of VBI.
• Long-term outcomes of DVA reconstruction are crucial for guiding clinical practice and patient selection.

Purpose of the Study:

• To report the long-term results of distal vertebral artery (DVA) reconstruction.
• To evaluate the efficacy and safety of DVA reconstruction for treating extracranial vertebral artery lesions.

Main Methods:

• A retrospective analysis of 352 DVA reconstructions performed between 1978 and 2001 on 323 patients.
• Surgical techniques included bypass grafting (saphenous vein graft) in 240 cases and transposition into the internal carotid artery (ICA) in 102 cases.
• Follow-up included clinical assessment and angiography or duplex scanning to assess patency and outcomes.

Main Results:

• The early postoperative period had a 2.0% mortality and 1.4% nonfatal stroke rate.
• Long-term follow-up (mean 99.5 months) showed a 5-year survival rate of 89.0% and a 10-year survival rate of 75.4%.
• The 5-year vertebrobasilar symptom-free rate was 94.0%, and the 5-year primary patency rate was 89.3%; combined ICA and DVA reconstruction showed a higher stroke risk (6.8%).

Conclusions:

• Distal vertebral artery (DVA) reconstruction demonstrates excellent long-term results for extracranial vertebral artery lesions.
• Reducing early postoperative occlusions is critical for improving patient outcomes.
• Combined ICA and DVA reconstruction procedures are associated with a higher risk of postoperative stroke.