Rodríguez JÓA, Velasco OEC, Cossío ZA, Enríquez VE Bizueto RH, Gámez GE, Rivadeneira IM

Language: Spanish
References: 10
Page: 50-55
PDF size: 217.09 Kb.

ABSTRACT

Objective: The aim of this study is to report ethiology, surgical technique, clinical outcome, and experience in the HECMN “La Raza” as to surgical reconstruction in V1 segment of vertebral artery.
Methods: It was designed an observational, descriptive, retrolective and transversal study. From March 2000 to August 2005 we examined the experience in HECMN “La Raza.” We recolected age, gender, clinical presentation, complementary studies, surgery techniques, morbidity and mortality from clinical registration. The results were analized using descriptive statistics.
Results: Four reconstructions of V1 were done. Etiology: atherosclerotic lesions in 3 patients, one of them with a coil; the fourth case had aneurysmal disease. Clinical presentation was: dizziness in 100%, amaurosis fugax 75%, TIA and posterior cephalea (50%) and diplopia (25%). Three cases underwent endarterectomy. A vertebrosubclavian saphenous vein graft was placed in the second case, and coil resection in the first one; in another, an ascendent cervicovertebral transposition was done, and in the fourth case aneurysmal resection was done as well as artery reconstruction with its own arterial wall. All patients were asymptomatic during one-year follow-up. No perioperative deaths were present.
Conclusions: Symptomatic vertebral disease joins together with high stroke probability, with a prognosis worse than those ocurred in the carotid artery area.
Surgical reconstruction of V1 is safe, its mortality rate low and with complete sintomatology release.

REFERENCES

1. Berguer R. Surgical management of the vertebral artery. In: Moore WS: Surgery for cerebrovascular disease, 2nd ed. Philadelphia: W.B. Saunders Co., 1996; 549-89.

2. Wityk RJ, Chang HM, Rosengart A, Han W, DeWitt L, Pessin M, et al. Proximal extracranial vertebral artery disease. In the New England Medical Center Posterior Circulation Registry. Arch Neurology 1998; 55(4): 470-8.

3. Hutchinson EC, Yates PO. The cervical portion of the vertebral artery: a clinicopathological study. Brain 1956; 79: 319-31.

4. Cloud GC, Markus HS. Diagnosis and management of vertebral artery stenosis. QJM 2003; 96(1): 27-34.

5. Berguer R. Vertebrobasilar ischaemia: indications, techniques, and results of surgical repair. In: Rutherford RB. Vascular surgery, 5th ed. Philadelphia: W.B. Saunders, 2000; 1823-37.

6. Berguer R, Morasch M, Kline R, Ronald A. A review of 100 consecutive reconstructions of the distal vertebral artery for embolia and hemodynamic disease. J Vasc Surg 1998; 27(5): 852-9.

7. Berguer R, Flynn L, Kline R, Ronald A, Caplan L. Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg 2000; 31(1): 9-18.

8. Sultan S, Morasch M, Colgan M, Madhavan P, Moore D, Shanik G. Operative and endovascular management of extracranial vertebral artery aneurysm in Ehlers-Danlos síndrome: a clinical dilemma. Case report and literature review. Vasc Endovascular Surg 2002; 36(5): 389-92.

9. Dexter M, Samson D. Vertebral artery reconstruction for vertebrobasilar insufficiency. In: Ernst CB, Stanley JC, eds. Current therapy in vascular surgery, 4th ed. Missouri: Mosby Co., 2001; 86-90.

10. Sottiurai VS, Lyons R, Omlie W, Roberts R, Smith B, Ross C, et al. Combined carotid endarterectomy and vertebral transposition or bypass for cerebral and vertebrobasilar insufficiency. Vasc Surg 2000; 34(2): 137-46.