Distal vertebral artery reconstruction: long-term outcome.

Purpose: The purpose of this article was to report our long-term results of distal vertebral artery (DVA) reconstruction.

Method: From 1978 to 2001 we performed 352 DVA reconstructions on 323 patients (177 men, 148 women; mean age, 60.0 +/- 12.1 years). Symptoms of vertebrobasilar insufficiency were present in 332 cases (94.3%). Bypass grafting using mostly saphenous vein graft was performed in 240 cases (68.2%). In 102 cases (29.0%) the DVA was transposed into the internal carotid artery (ICA). Other techniques were used in 10 cases.

Results: Stroke caused all 7 deaths (2.0%) in the early postoperative period. There were 5 nonfatal strokes (1.4%). Strokes were hemispheric in 7 cases (6 ipsilateral, 1 contralateral) and vertebrobasilar in 5 cases. There were 6 strokes (2.3%) in the subgroup of 264 isolated DVA reconstruction and 6 strokes (6.8%) in the subgroup of 88 procedures involving combined ICA and DVA reconstruction (P <.04). Temporary paralysis of the spinal accessory nerve occurred in 26 cases (7.4%). Intraoperative or early postoperative angiography findings were available in 341 of 345 cases (98.8%). Early postoperative occlusion occurred after 25 procedures (7.1%). Complete clinical follow-up was available for 313 (99.1%) of the postoperative survivors. Mean duration of follow-up was 99.5 +/- 62.5 months. Assessment of late patency was performed in 343 (99.4%) of 345 cases by angiography (21.2%) or duplex scanning (78.8%). A total of 65 (23.7%) patients died during follow-up. No deaths resulted from vertebrobasilar or hemispheric stroke. Cumulative Kaplan-Meier survival rate was 89.0% +/- 3.9% at 5 years and 75.4% +/- 7.1% at 10 years. Significant vertebrobasilar symptom-free rate was 94.0% +/- 3.5% at 5 years and 92.8% +/- 3.8% at 10 years. Primary patency rate was 89.3% +/- 3.6% at 5 years and 88.1% +/- 4.0% at 10 years.

Conclusions: This study clearly establishes the excellent long-term results of DVA reconstruction for the treatment of extracranial lesions of the vertebral artery. However, every effort should be made to reduce the rate of early postoperative occlusions. The subgroup of patients involving combined ICA and DVA reconstruction remains at high risk of postoperative stroke.