Hokkaido Environment Foundation

Thirty-three vertebral artery (VA) reconstructions were reviewed. Twenty-three patients were symptomatic because of vertebrobasilar ischemic disorder. Various reconstructive techniques were used: VA transposition to common carotid artery (VA·CA) (22), VA·CA+carotid endarterectomy (CEA) (3), VA transposition to subclavian artery (VA·SA) (2), external carotid-vertebral artery anastomosis (ECA-VA) (4), and vertebral artery endarterectomy (VAE) (2). Postoperative arteriograms were obtained in all the patients with 9%occlusion and 91%excellent results (patency rates: VA·CA 20/22 (91%), VA·CA+CEA 3/3 (100%), VA·SA 2/2 (100%), ECA-VA 3/4 (75%), VAE 2/2 (100%). Clinical results were the following: improvement 15/23 (65%) and no exacerbation in symptomatic group, but in asymptomatic group exacerbation was noted in 3 cases of VA·CA+CEA. The conclusions are as follows: (1) VA reconstruction, especially VA·CA, in carefully selected patients, is a safe and effective procedure. (2) The use of internal shunt during crossclamping of CA in surgery of VA·CA for the protection of temporary ischemia is occasionally advised. (3) Temporary ischemia due to the vertebral artery clamping is generally well tolerated in proximal VA reconstructive surgery. (4), In performing a combined reconstructive surgery of VA and CA in one single procedure, special technical care is needed to prevent embolic complication.