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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2011 October;24(5):257-62
Long-term neurologic outcome and durability of proximal vertebral artery reconstructions
Linni K., Aspalter M., Magometschnigg H., Hölzenbein T.
Department of Vascular and Endovascular Surgery, PMU Salzburg, Austria
Aim. Reports on the long-term outcome of vertebral artery (VA) reconstructions are scarce. The aim of this study was to evaluate the long-term patency of isolated surgical VA reconstructions and to assess the lasting effect on vertebrobasilar ischemia (VBI).
Methods. Isolated VA reconstructions performed at a tertiary university based care center were collected prospectively and analyzed in a retrospective manner.
Results. From 1/1994 to 6/2006 81 isolated VA reconstructions were performed in 75 patients (vertebral-to-carotid artery transpositions n=73, vein interposition grafts n=8). In six patients a bilateral transposition was carried out. Cardiovascular risk factors were hypertension (79%), hyperlipidemia (44%), coronary artery disease (41%), smoking (36%), and diabetes (22%), respectively. High-grade stenosis (>80%) of the internal carotid artery (ICA) or of the subclavian artery (SA) were revascularized prior to VA reconstructions. The 30-day stroke rate was 1.2% without perioperative death. Transient cranial nerve injuries and local hematoma occured in 3.7% each. The mean follow-up was 100 months. Survival probabilities at 5 years and 10 years were 78.3% and 61.7%, respectively. There has been one late occlusion of an interposition graft. A lasting improvement or freedom of VBI symptoms at last follow-up was noted in 88%.
Conclusion. Although endovascular options are available, there is still a need for an open surgical management of central VA lesions. Despite technically demanding, perioperative mortality is low. Long term patency of VA reconstructions is excellent with a lasting freedom of VBI symptoms in the vast majority of patients.