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Contemporary outcomes after distal vertebral reconstruction
Dawn M Coleman1, Andrea Obi, Enrique Criado
1Section of Vascular Surgery, Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI 48109-5867, USA. dawnbarn@umich.edu
Journal of Vascular Surgery
|March 13, 2013
Summary
Distal vertebral artery reconstruction effectively treats ischemia caused by flow-limiting lesions or emboli. Arterial transposition offers superior patency rates compared to bypass, ensuring excellent stroke protection and symptom relief.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Vertebrobasilar ischemia can result from flow-limiting lesions or embolic events.
- Distal vertebral artery (VA) reconstruction aims to address these causes.
Purpose of the Study:
- To differentiate the pathophysiology of vertebral ischemia.
- To examine outcomes of distal vertebral artery reconstruction.
Main Methods:
- 41 distal VA reconstructions in 34 patients (2005-2011).
- Procedures included bypass and arterial transposition.
- Symptoms were primarily flow-limiting lesions (52%) or emboli (29%).
Main Results:
- 97% patency achieved with successful redo bypass for late failures.
- Arterial transposition showed significantly higher patency (100% at 1-2 years) than bypass (65%).
- Low perioperative morbidity (2% stroke, 7% cranial nerve injury) and no perioperative deaths.
Conclusions:
- Distal VA reconstruction offers excellent stroke protection and symptom relief.
- Arterial transposition is a superior technique for distal VA reconstruction.
- The procedure has acceptable perioperative risk in selected patients.
