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| Name | Subclavian-to-Extracranial Vertebral Artery Bypass |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 27-02-2018 17:08:47 |
| Video Discription | Hemodynamic insufficiency from extracranial vertebral artery (VA) stenosis is a primary cause for transient ischemic attacks in patients with vertebrobasilar insufficiency (VBI). Carotid-to-VA bypass risks ischemic injury of the anterior intracranial circulation, whereas the subclavian artery (SA)–to-VA bypass avoids potential insult to brain. We present a case of SA-to–extracranial VA bypass in a patient with VBI and discuss technical aspects and nuances of this surgical approach. A 53-year-old woman presented with a history of vertigo, dizziness, and syncope, exacerbated by neck movements. An angiogram demonstrated near-complete bilateral proximal VA occlusions. The patient had collateral flow distally from muscular branches off the thyrocervical trunk and minimal flow through the anterior circulation, worse through the left VA than the right. Given the symptoms, radiographic findings, and our inability to navigate through the VA origin endovascularly, we planned a left VA revascularization. Using an endoscopically harvested interposition saphenous vein (SV) graft, we augmented the posterior circulation with a left SA–to–extracranial VA (V3) vascular bypass. The thyrocervical trunk was used as donor vessel because its caliber matches that of an SV graft with a similar direction of vascular flow to the intended bypass. The horizontal V3 segment of the left VA in the C1-J groove was isolated. After end-to-end anastomosis of the thyrocervical trunk to SV and end-to-side anastomosis of the SV to VA, flow was confirmed using intraoperative Doppler and indocyanine green angiography. Postoperative angiogram showed patent flow through interposition graft and improved posterior circulation, with consequent symptomatic improvement at 6-month follow-up. |
| Category | Science & Technology |
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