LONG-TERM CLINICAL AND DUPLEX FOLLOW-UP AFTER PROXIMAL VERTEBRAL ARTERY RECONSTRUCTION

From 1977 to 1989, 28 patients, 18 men and 10 women, underwent 29 prox imal vertebral artery reconstructions. Indications were vertebrobasila r insufficiency in 17 patients and TIA or stroke in 6. Five were asymp tomatic. Procedures performed were endarterectomy in 20, reimplantatio n in 5, venous bypass in 3, and decompression in 1 case. Concomitant p rocedures were coronary artery bypass grafting (6) and carotid, subcla vian, or innominate artery revascularization (14). There was no operat ive mortality. There were 3 early reoperations for occlusion, bleeding , and lymph fistula, respectively. Except for 1 foreign patient recent clinical follow-up was complete. Mean follow-up was 85.6 months (rang e 17-146). During follow-up 10 patients died. Causes were mainly cardi ac (3), carcinoma (3), and stroke (2). Seventeen patients were alive, 13 had no cerebrovascular symptoms, 2 sustained a hemispherical stroke , 1 was only slightly improved, and 1 had a drop attack 131 months aft er operation. Five and ten-year actuarial survival rates were 85% and 51% respectively. Follow-up with duplex scan was available in 26 patie nts and was complete in 24. Mean duplex follow-up was 78.6 months (ran ge 3-146). Significant abnormalities were noted in 6 but with symptoms in only 1 patient. Mean time to restenosis was 77.3 months. Late angi ographic control in 10 patients correlated well with duplex findings. Proximal vertebral artery reconstruction yields good clinical long-ter m results, and duplex scan is a useful tool in the follow-up of these patients.