title: Symptomatic occlusion at the origin of the vertebral artery treated using external carotid artery-cervical vertebral artery bypass with interposed saphenous vein graft.
abstract: BACKGROUND
  Symptomatic atherosclerotic steno-occlusive diseases of the vertebrobasilar artery portend a poor prognosis and high risk of stroke recurrence despite medical therapy. We describe 5 medically refractory patients with occlusion at the origin of the VA and the distal portion of the cervical VA perfused via muscular collateral vessels who underwent ECA-cervical VA (V(2) segment) bypass with interposed SVG.
  
  
  METHODS
  The ECA was isolated through a linear incision along the anterior portion of the sternocleidomastoid muscles. The ECA was either laterally or medially retracted, the longus colli muscle was dissected, and the anterior wall of the foramen transversarium was partially removed, which exposed the cervical VA. Each end of the SVG was anastomosed to both the VA and the ECA in a side-to-end fashion.
  
  
  RESULTS
  Surgery proceeded smoothly in all patients without any new neurologic postoperative deficits. Postoperative cerebral angiography demonstrated that the anastomosis was patent. None of the patients developed further brain ischemic events during follow-up periods ranging from 13 to 114 months (mean, 62 months) after surgery.
  
  
  CONCLUSIONS
  The ECA-cervical VA bypass with interposed SVG is useful when the VA is occluded at the origin and when the distal portion of the cervical VA is perfused via muscular collateral vessels of patients with medically refractory ischemic events in the vertebrobasilar territory.
authors.affiliation: Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan. skakino@iwate-med.ac.jp
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kakino
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kashimura
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D002342:Carotid Artery, External / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012501:Saphenous Vein / Q000637:transplantation*; D014711:Vertebral Artery / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*