Is Revascularization of V1 Segment of Vertebral Artery Combined with Ipsilateral Carotid Endarterectomy Safe?

Ann Vasc Surg

Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Published: January 2023

AI Article Synopsis

  • - The European Society for Vascular Surgery (ESVS) advises against performing vertebral revascularization with ipsilateral carotid endarterectomy (CEA) in a single operation due to increased death and stroke risks.
  • - A study involving 48 patients compares the outcomes of simultaneous vertebral V1 revascularization with ipsilateral CEA and isolated V1 revascularization, focusing on factors like mortality, complications, and recovery indicators.
  • - The results show no significant differences in postoperative complications between the two groups, suggesting that revascularization of the V1 segment combined with CEA may be safe and should be considered separately from V3 segment procedures.

Article Abstract

Background: The recommendation of the European Society for Vascular Surgery (ESVS) is that vertebral revascularization combined with ipsilateral CEA (carotid endarterectomy) should not be performed in the same operation. ESVS believes that vertebral revascularization combined with ipsilateral CEA increases perioperative death/stroke rates. In our opinion, revascularization of the first segment of vertebral artery (V1) combined with ipsilateral CEA is safe compared to vertebral V1 revascularization in the perioperative period. The purpose of this study is to prove that revascularization of V1 segment of vertebral artery combined with ipsilateral CEA is secure in the perioperative period.

Methods: We describe our experience with homochronous revascularization of V1 segment of vertebral artery with ipsilateral CEA (group B) and simple revascularization of V1 segment of vertebral artery (group A) in 48 consecutive patients during a 5-year period. O.Y. (Ouyang) incisions were used in both groups. We compare the results of the 2 procedures with aspects of mortality, stroke, morbidity, incident rates of complications, and so on.

Results: There was no significant difference between patients in group A and group B in terms of red blood cell reduction, postoperative ventilator using time, postoperative drainage volume, postoperative drainage days, postoperative hospitalize duration, and incident rates of postoperative complications. The postoperative complications include death, stroke, Horner syndrome, vocal paralysis, hypoglossal nerve paralysis, wound hematomas, and lymphatic leakage.

Conclusions: Revascularization of vertebral artery combined with ipsilateral CEA should be divided into revascularization of V1 segment of vertebral artery combined with ipsilateral CEA and revascularization of V3 segment of vertebral artery with ipsilateral CEA. Revascularization of V1 segment of vertebral artery combined with ipsilateral CEA is safe; it can be performed for suitable patients who are fit for indications. O.Y. incisions can fully expose the target blood vessels and simplify the procedures without transecting the sternocleidomastoid muscles in operations.

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Source
http://dx.doi.org/10.1016/j.avsg.2022.07.020DOI Listing

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