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Published on: May 11, 2011
Vertebral artery bypass
Insights
A new surgical technique using autogenous vein bypass grafts effectively treated vertebral artery stenosis. This bypass restored blood flow, relieving symptoms of vertebrobasilar insufficiency in patients with inadequate natural compensation.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Vertebral artery stenosis commonly occurs at its origin.
- Normally, collateral circulation compensates for unilateral vertebral artery stenosis.
- Inadequate collateral flow can lead to vertebrobasilar insufficiency and ischemic symptoms.
Observation:
- Four patients presented with symptoms of vertebrobasilar insufficiency due to vertebral artery stenosis.
- These patients had insufficient collateral circulation via intracranial anastomosis or the contralateral vertebral artery.
- A novel surgical approach involving a subclavian vertebral artery autogenous vein bypass graft was employed.
Findings:
- The subclavian vertebral artery bypass graft procedure was successfully performed in all four patients.
- Postoperative angiography confirmed the patency of all bypass grafts one week after surgery.
- Transient complications included lymphocele and Horner syndrome.
Implications:
- Autogenous vein bypass grafting is a viable option for treating complex vertebral artery stenosis.
- This technique can restore adequate cerebral blood flow in patients with compromised collateral circulation.
- Successful bypass grafting alleviates symptoms of vertebrobasilar insufficiency, improving patient outcomes.
Abstract:
The origin of the vertebral artery is a frequent site for the development of stenosing lesions. The flow deficit caused by the stenosis of one vertebral artery is normally compensated for by intracranial anastomosis between the carotid and basilar arteries or by the opposite vertebral artery. A number of patients, however, have inadequate intracranial anastomosis and hypoplasia or stenosis of the opposite vertebral artery, and symptoms of brain ischemia develop. We describe here four cases in which a new technique, a subclavian vertebral artery autogenous vein bypass graft, was used to deal with the diseased segment of the vertebral artery. Transient postoperative problems included lymphocele and Horner syndrome. All four bypasses were patent at the time of angiography one week postoperatively. All four patients were relieved of symptoms of vertebrobasilar insufficiency.
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