Vascular reconstruction using interposition of saphenous vein graft for symptomatic stenosis at the extradural-intradural junction of the vertebral artery. Case report.
BACKGROUND
Symptomatic, medically refractory vertebrobasilar stenosis carries a poor prognosis and is an indication for vascular reconstruction.


METHODS
A 67-year-old man suffered medically refractory recurrent vertigo due to artery-to-artery embolism caused by long, eccentric, and severe stenosis at the extradural-intradural junction of the right vertebral artery. Transluminal angioplasty was deferred because of the occurrence of critical brain ischemia during temporary balloon occlusion. After an occipital artery to posterior inferior cerebellar artery bypass, the vascular lesion in the right vertebral artery was resected and was reconstructed with interposition of a saphenous vein graft. The postoperative course was uneventful, and the patient did not experience further symptoms. Postoperative angiography revealed a widely patent right vertebral artery.


CONCLUSIONS
This surgical procedure is useful for the vascular reconstruction of symptomatic stenosis at the extradural-intradural junction of the vertebral artery when transluminal angioplasty is contraindicated and when bypass surgery is not sufficient.
Kakino
Shunsuke
S
Department of Neurosurgery, Iwate Medical University, Morioka, 020-8505, Japan.
Ogasawara
Kuniaki
K
Konno
Hiromu
H
Suzuki
Michiyasu
M
Ogawa
Akira
A
D000368:Aged; D000792:Angiography; D006801:Humans; D008297:Male; D011379:Prognosis; D012501:Saphenous Vein / Q000637:transplantation*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000601:surgery*; D014717:Vertigo / Q000209:etiology