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Bypass using V2-V3 segment of the vertebral artery as donor or recipient: technical nuances and results
Tong Yang1, Farzana Tariq1, Huy T Duong1
1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Insights
This study shows vertebral artery (VA) bypasses using the V2-V3 segment are effective for posterior circulation diseases. The technique offers high graft patency and good patient outcomes.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Disease
Background:
- Surgical revascularization is a treatment for posterior circulation vascular diseases.
- The V2-V3 segment of the vertebral artery (VA) is a potential site for bypass grafting.
Observation:
- Twenty patients underwent bypasses utilizing the V2-V3 VA segment as donor or recipient.
- The majority (19/20) received intervening grafts, with one VA reimplantation.
- Mean follow-up was 24.7 months, with one perioperative death and one postoperative stroke.
Findings:
- Graft patency was high (19/20 bypasses patent without flow limitation).
- 14 patients achieved a modified Rankin Scale score of 2 or better, indicating good functional outcomes.
- Two patients died from unrelated causes (tumors).
Implications:
- The V2-V3 VA segment is a viable option for both donor and recipient sites in bypass surgery.
- Refined surgical techniques can lead to high graft patency and favorable functional results.
- This approach offers a valuable treatment strategy for complex posterior circulation pathologies.
Objective:
Surgical revascularization (bypass) technique has been used to treat vascular diseases of the posterior circulation, including ischemia, aneurysms, and tumors encasing a major artery. We focused on procedures using the V2-V3 segment of the vertebral artery (VA) as either the donor or recipient of the bypass. We have described technical nuances developed over time and evaluated the surgical results of those cases.
Methods:
Data on all patients who underwent bypasses using the V2-V3 segment were collected retrospectively from a prospectively maintained database.
Results:
Twenty patients had bypasses using V2-V3 distal VA as either the donor (13) or recipient (7); 19 patients had an intervening graft and in 1 patient, the VA was used for reimplantation of the posterior inferior cerebellar artery. Except for 1 patient, who died during the perioperative period, the mean follow-up time for the rest of the patients was 24.7 months (range 1-72 months). One patient developed postoperative stroke. One radial artery graft occluded, and a redo saphenous vein graft also occluded in the same patient. All the other bypasses were patent without flow limitation at the latest follow-up. Fourteen patients had a modified Rankin Scale score of 2 or better at the latest follow-up, and 2 died of unrelated causes as the result of their tumors.
Conclusions:
The V2-V3 segment of the VA can be used both as a donor and a recipient for bypass surgery. Using the technical steps perfected over time, we are able to achieve surgical results with high rate of graft patency and good functional outcome in patients.
