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Vertebral artery reconstruction: results in 106 patients
1Clinique Chirurgicale, Chambéry, France.
Insights
Vertebral artery revascularization shows high patency (96%) and survival (91%) at five years, with most patients experiencing symptom recovery. This procedure effectively treats vertebrobasilar insufficiency.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Vertebrobasilar insufficiency poses significant neurological risks.
- Surgical revascularization of the vertebral artery is a treatment option for these conditions.
- Understanding the long-term outcomes of vertebral artery revascularization is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term outcomes of vertebral artery revascularization.
- To assess the patency rates and survival after the procedure.
- To analyze the neurologic recovery and complications associated with vertebral artery surgery.
Main Methods:
- A retrospective review of 109 vertebral artery revascularizations in 106 patients performed between 1982 and 1989.
- Analysis of patient demographics, presenting symptoms, surgical procedures, and complications.
- Assessment of early and late follow-up data, including arteriograms, survival rates, and neurologic outcomes.
Main Results:
- The study included 106 patients undergoing 109 revascularizations, primarily for vertebrobasilar insufficiency (81%).
- Postoperative mortality was 1.9%, with nonfatal neurologic complications in 4.7%, more frequent after combined procedures.
- Five-year actuarial survival was 91%, and overall patency at five years was 96%.
- Late follow-up showed 63% complete neurologic recovery, 30% improvement, and 7% failure or worsening.
Conclusions:
- Vertebral artery revascularization is a safe and effective procedure with excellent long-term patency and survival rates.
- The surgery leads to significant neurologic recovery in the majority of patients treated for vertebrobasilar insufficiency.
- Combined vertebral and carotid procedures may be associated with a higher risk of complications.
Abstract:
Between January 1982 and December 1989, we performed 109 revascularizations of the vertebral artery in 106 patients. Eighty-six patients (81%) had isolated vertebrobasilar insufficiency, 18 (17%) had associated carotid and vertebrobasilar pathology while two (2%) had isolated carotid symptoms. The procedures performed included 98 revascularizations of the proximal vertebral artery and 11 reconstructions of the distal vertebral artery. One distal revascularization was required after early failure of proximal revascularization. In 36 cases (34%), a concomitant ipsilateral carotid artery revascularization procedure was performed, and in one case, an ipsilateral subclavian artery aneurysm was excised. Two patients (1.9%) died postoperatively and five patients (4.7%) had nonfatal neurologic complications. Four of these seven complications occurred after combined vertebral and carotid surgery. One hundred early follow-up arteriograms were obtained (92% of reconstructions). There were four occlusions, two of which were associated with neurologic deficits. Three patients were lost to follow-up. Mean follow-up was 48 months (4-100 months). Seven patients died in the late follow-up period (after one month). Actuarial five year survival was 91%. Overall patency at five years was 96%. The study of late neurologic events showed that 63% of patients had complete recovery, 30% improvement, and 7%, failure or aggravation of symptoms.