Resection of apical lung carcinoma involving the vertebral artery

We report a patient with left apical lung carcinoma involving the left subclavian artery with the origin of the vertebral artery who had hypoplasia of the right vertebral artery and the bilateral posterior communicating arteries. After induction chemoradiotherapy, a vein graft was used to create a bypass between the left common carotid artery and the vertebral artery, followed by a successful left upper lobectomy with combined resection of the subclavian artery together with the left vertebral artery. Because anatomic variations of vertebral arteries and cerebral arterial circle are known, preoperative evaluation of the cerebral blood flow should be performed and a relevant reconstruction considered.