Open repair of vertebral artery: a 7-year single-center report.

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.