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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Open repair of vertebral artery: a 7-year single-center report
Claudio Alberto Ramirez1, Guillaume Febrer, Julien Gaudric
1Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France. dioclau8@gmail.com
Insights
Open repair of the vertebral artery (VA) offers excellent long-term outcomes for vertebrobasilar insufficiency. Combined carotid and VA repair increases stroke risk, highlighting the need for careful patient selection.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Research
Background:
- Vertebrobasilar insufficiency (VBI) poses significant neurological risks.
- Open surgical repair of the vertebral artery (VA) is a treatment option for VBI.
- Long-term outcomes of proximal and distal VA open repairs require comprehensive reporting.
Purpose of the Study:
- To evaluate the long-term results of open surgical repairs for proximal and distal vertebral artery (VA) conditions.
- To assess the safety and efficacy of VA open repair in patients with VBI.
- To compare outcomes between isolated VA repair and combined carotid-VA reconstruction.
Main Methods:
- A retrospective analysis of 74 VA open repairs performed between 2002 and 2009.
- Procedures included proximal (n=47) and distal (n=27) repairs, with bypass grafting (28.3%) or direct transposition (64.8%).
- Follow-up data were collected to assess clinical outcomes, patency rates, and survival.
Main Results:
- Mean follow-up was 39.5 months. Stroke occurred in 4.1% of patients, with a higher incidence in combined carotid-VA repairs.
- Long-term survival rates were 90.7% at 3 years and 77.3% at 6 years.
- Six-year symptom-free rates for VBI were 87.7%, and primary patency rates were 90.8%.
Conclusions:
- Open repair of the vertebral artery (VA) demonstrates excellent long-term efficacy and durability.
- Combined carotid and VA reconstruction is associated with a higher risk of postoperative stroke compared to isolated VA repair.
- VA open repair is a safe and effective treatment for selected patients with VBI.
Background:
To report the long-term results of proximal and distal VA open repairs.
Methods:
From January 2002 to December 2009, 74 cases of VA open repair were performed (73 patients, 41 men; mean age, 66.5 ± 15.2 years). Symptoms of vertebrobasilar insufficiency were present in 61 cases (82.4%). Forty-seven have had a proximal VA repair, and 27, a distal one. Bypass grafting using a saphenous vein graft was performed in 21 cases (28.3%). Direct transposition was used in 48 (64.8%), mostly into the common carotid artery.
Results:
Mean duration of follow-up was 39.5 ± 31.3 months. A stroke was present in three patients (4.1%), two hemispheric (2.7%) and one vertebrobasilar (1.3%), which turned lethal. The two hemispheric strokes occurred in the subgroup of 35 procedures combined with a carotid artery reconstruction. A transient Horner syndrome was found in 16 cases (21.6%), and a transient vocal palsy, in six (8.1%). Early postoperative occlusion occurred in two cases (2.7%). A total of seven (9.4%) patients died during follow-up, one from a stroke. Cumulative Kaplan-Meier survival rate was 90.7 ± 4.8% at 3 years and 77.3 ± 12.2% at 6 years. Assessment of late patency was obtained in 54 (84.3%) of 64 survivals by duplex scanning (70.3%) or angiography (10.9%). Significant vertebrobasilar symptom-free rate was 87.7 ± 9.2% at 6 years. Primary patency rate was 94.8 ± 3.8% at 3 years and 90.8 ± 9.4% at 6 years.
Conclusions:
VA open repair provides excellent long-term results. Patients with combined carotid and VA reconstruction are at higher risk of postoperative stroke than patients undergoing isolated repair of the VA.
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