title: Primary extracranial vertebral artery aneurysms.
abstract: BACKGROUND
  Extracranial vertebral artery aneurysms are uncommon and are usually associated with trauma or dissection. Primary cervical vertebral aneurysms are even rarer and are not well described. The presentation and natural history are unknown and operative management can be difficult. Accessing aneurysms at the skull base can be difficult and, because the frail arteries are often afflicted with connective tissue abnormalities, direct repair can be particularly challenging. We describe the presentation and surgical management of patients with primary extracranial vertebral artery aneurysms.
  
  
  METHODS
  In this study we performed a retrospective, multi-institutional review of patients with primary aneurysms within the extracranial vertebral artery.
  
  
  RESULTS
  Between January 2000 and January 2011, 7 patients, aged 12-56 years, were noted to have 9 primary extracranial vertebral artery aneurysms. All had underlying connective tissue or another hereditary disorder, including Ehler-Danlos syndrome (n=3), Marfan's disease (n=2), neurofibromatosis (n=1), and an unspecified connective tissue abnormality (n=1). Eight of 9 aneurysms were managed operatively, including an attempted bypass that ultimately required vertebral ligation; the contralateral aneurysm on this patient has not been treated. Open interventions included vertebral bypass with vein, external carotid autograft, and vertebral transposition to the internal carotid artery. Special techniques were used for handling the anastomoses in patients with Ehler-Danlos syndrome. Although endovascular exclusion was not performed in isolation, 2 hybrid procedures were performed. There were no instances of perioperative stroke or death.
  
  
  CONCLUSIONS
  Primary extracranial vertebral artery aneurysms are rare and occur in patients with hereditary disorders. Operative intervention is warranted in symptomatic patients. Exclusion and reconstruction may be performed with open and hybrid techniques with low morbidity and mortality.
authors.affiliation: Department of Vascular Surgery, St. Vincent Healthcare, Billings, MT 59101, USA. mark.morasch@svh-mt.org
authors.forename: Mark D
authors.initials: MD
authors.lastname: Morasch
authors.forename: Sachin V
authors.initials: SV
authors.lastname: Phade
authors.forename: Peter
authors.initials: P
authors.lastname: Naughton
authors.forename: Manuel
authors.initials: M
authors.lastname: Garcia-Toca
authors.forename: Guillermo
authors.initials: G
authors.lastname: Escobar
authors.forename: Ramon
authors.initials: R
authors.lastname: Berguer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery; D055815:Young Adult