Long considered dangerous, surgical treatment of lesions of the vertebral artery in its extra-cranial course, may be viewed in parallel with angiographic techniques. Approach to the vertebral artery in its different segments, pre-operative arteriographic assessment, are discussed, and operative indications only mentioned. An aneurysm of the vertebral artery in C2-C3 was treated by exclusion and restoration of continuity by a sub-clavian vertebral vein graft in C1-C2.

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