Reconstruction for the vertebral artery stenosis at its origin--bypass surgery using a saphenous vein graft with external shunting.

Eight patients with vertebral artery (VA) stenosis at its origin were surgically treated by a new reconstructive technique. Two patients suffered vertebrobasilar transient ischemic attacks, and five had brainstem and/or cerebellar infarction. All patients had multiple stenotic lesions, including bilateral VA stenoses in one and unilateral VA stenosis plus contralateral VA occlusion in seven. They underwent a subclavian artery to VA bypass using a saphenous short vein graft with external shunting. Postoperatively, no patients had aggravated neurological symptoms, and angiography showed all bypasses to be patent. One had an episode of transient loss of consciousness 8 months postoperatively, but the others showed no episodes of ischemia during an average follow-up period of 2 years and 10 months. The results indicate that this procedure is safer and more useful than other surgical procedures.