title: Open repair of vertebral artery: a 7-year single-center report.
abstract: BACKGROUND
  To report the long-term results of proximal and distal VA open repairs.
  
  
  METHODS
  From January 2002 to December 2009, 74 cases of VA open repair were performed (73 patients, 41 men; mean age, 66.5 ± 15.2 years). Symptoms of vertebrobasilar insufficiency were present in 61 cases (82.4%). Forty-seven have had a proximal VA repair, and 27, a distal one. Bypass grafting using a saphenous vein graft was performed in 21 cases (28.3%). Direct transposition was used in 48 (64.8%), mostly into the common carotid artery.
  
  
  RESULTS
  Mean duration of follow-up was 39.5 ± 31.3 months. A stroke was present in three patients (4.1%), two hemispheric (2.7%) and one vertebrobasilar (1.3%), which turned lethal. The two hemispheric strokes occurred in the subgroup of 35 procedures combined with a carotid artery reconstruction. A transient Horner syndrome was found in 16 cases (21.6%), and a transient vocal palsy, in six (8.1%). Early postoperative occlusion occurred in two cases (2.7%). A total of seven (9.4%) patients died during follow-up, one from a stroke. Cumulative Kaplan-Meier survival rate was 90.7 ± 4.8% at 3 years and 77.3 ± 12.2% at 6 years. Assessment of late patency was obtained in 54 (84.3%) of 64 survivals by duplex scanning (70.3%) or angiography (10.9%). Significant vertebrobasilar symptom-free rate was 87.7 ± 9.2% at 6 years. Primary patency rate was 94.8 ± 3.8% at 3 years and 90.8 ± 9.4% at 6 years.
  
  
  CONCLUSIONS
  VA open repair provides excellent long-term results. Patients with combined carotid and VA reconstruction are at higher risk of postoperative stroke than patients undergoing isolated repair of the VA.
authors.affiliation: Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France. dioclau8@gmail.com
authors.forename: Claudio Alberto
authors.initials: CA
authors.lastname: Ramirez
authors.forename: Guillaume
authors.initials: G
authors.lastname: Febrer
authors.forename: Julien
authors.initials: J
authors.lastname: Gaudric
authors.forename: Salam
authors.initials: S
authors.lastname: Abou-Taam
authors.forename: Kenza
authors.initials: K
authors.lastname: Beloucif
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche
authors.forename: Fabien
authors.initials: F
authors.lastname: Koskas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000601:surgery*