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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
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.