Results of vertebral artery reconstruction.

We summarize here the immediate and long term results of 191 vertebral artery reconstructions. Patient selection criteria included vertebrobasilar insufficiency, appropriate angiographic work up, lack of contraindications, and the availability of a suitable technique. Of the 179 patients who underwent these operations, 170 presented with vertebrobasilar insufficiency that in turn was associated with hemispheric manifestations in 29 cases. Five patients had hemispheric manifestations only, and four were asymptomatic. The operation involved the proximal segment of the vertebral artery in 148 instances and its distal segment in 43 instances. Of the eight deaths recorded in this series (4.2%), one occurred in a group of 118 patients who underwent isolated vertebral artery reconstruction and seven in a group of 72 patients who underwent combined vertebral and carotid surgery. This difference was statistically significant (p less than 0.01). The overall survival rate at seven years was 88.8%, and was higher in the group undergoing isolated vertebral repair. Patency at seven years was 90.4% with better results for proximal vertebral artery repair than for distal repair (94.3% versus 77.3%). With a mean follow-up of 34.6 +/- 19 months, 118 patients are asymptomatic, and 15 are improved, for a success rate of 80.1%. Patients with hemispheric manifestations and associated carotid lesions constitute a high risk population for this type of surgery.