Simultaneous revascularization of coronary and vertebral arteries

Simultaneous vertebral artery and coronary artery bypass are reported in a patient with unstable angina who exhibited signs and symptoms of vertebrobasilar insufficiency while awaiting myocardial revascularization. The indications and various technical options for vertebral artery bypass are reviewed, and the techniques applied in this case are described. Observations on coronary and vertebral vein graft flow, with and without intra-aortic balloon counterpulsation, are presented. Late patency of the aortovertebral vein graft has been documented, and the patient has been free from symptoms of vertebrobasilar and coronary insufficiency for 5 years.