Surgical reconstruction of the vertebral artery.

Thirty-five vertebral artery (VA) reconstructions are reviewed. Detailed neurologic, medical, and angiographic information was obtained for all patients. Various reconstructive techniques were used: VA bypass or reimplantation of the VA into subclavian or common carotid sites. Although endarterectomy of severe internal carotid artery lesions in patients with vertebrobasilar insufficiency is often curative, our experience has shown that in patients with normal or minimally diseased internal carotid arteries and severe bilateral VA disease, a single VA repair results in cure in 83% and improvement in an additional 10% of all patients. Simultaneous VA reimplantation in the course of internal carotid endarterectomy is appropriate in selected instances. There were no deaths or central neurologic deficits among the patients in our study. Lymphocele (11%) and partial Horner's syndrome (14%) are the most frequent complications, and some technical considerations to avoid these problems are described. VA reconstruction in carefully selected patients is a successful and safe technique.