Morasch Mark D, Phade Sachin V, Naughton Peter, Garcia-Toca Manuel, Escobar Guillermo, Berguer Ramon
Department of Vascular Surgery, St. Vincent Healthcare, Billings, MT 59101, USA.
Ann Vasc Surg. 2013 May;27(4):418-23. doi: 10.1016/j.avsg.2012.08.002. Epub 2013 Mar 26.
Extracranial vertebral artery aneurysms are uncommon and are usually associated with trauma or dissection. Primary cervical vertebral aneurysms are even rarer and are not well described. The presentation and natural history are unknown and operative management can be difficult. Accessing aneurysms at the skull base can be difficult and, because the frail arteries are often afflicted with connective tissue abnormalities, direct repair can be particularly challenging. We describe the presentation and surgical management of patients with primary extracranial vertebral artery aneurysms.
In this study we performed a retrospective, multi-institutional review of patients with primary aneurysms within the extracranial vertebral artery.
Between January 2000 and January 2011, 7 patients, aged 12-56 years, were noted to have 9 primary extracranial vertebral artery aneurysms. All had underlying connective tissue or another hereditary disorder, including Ehler-Danlos syndrome (n=3), Marfan's disease (n=2), neurofibromatosis (n=1), and an unspecified connective tissue abnormality (n=1). Eight of 9 aneurysms were managed operatively, including an attempted bypass that ultimately required vertebral ligation; the contralateral aneurysm on this patient has not been treated. Open interventions included vertebral bypass with vein, external carotid autograft, and vertebral transposition to the internal carotid artery. Special techniques were used for handling the anastomoses in patients with Ehler-Danlos syndrome. Although endovascular exclusion was not performed in isolation, 2 hybrid procedures were performed. There were no instances of perioperative stroke or death.
Primary extracranial vertebral artery aneurysms are rare and occur in patients with hereditary disorders. Operative intervention is warranted in symptomatic patients. Exclusion and reconstruction may be performed with open and hybrid techniques with low morbidity and mortality.
颅外椎动脉动脉瘤并不常见，通常与创伤或夹层有关。原发性颈椎动脉瘤更为罕见，相关描述较少。其临床表现和自然病程尚不清楚，手术治疗可能具有挑战性。显露颅底的动脉瘤可能困难，而且由于脆弱的动脉常伴有结缔组织异常，直接修复尤其具有挑战性。我们描述了原发性颅外椎动脉动脉瘤患者的临床表现及手术治疗。
在本研究中，我们对颅外椎动脉原发性动脉瘤患者进行了一项回顾性、多机构研究。
2000年1月至2011年1月期间，7例年龄在12至56岁之间的患者被发现患有9个原发性颅外椎动脉动脉瘤。所有患者均有潜在的结缔组织或其他遗传性疾病，包括埃勒斯-当洛综合征（3例）、马方综合征（2例）、神经纤维瘤病（1例）以及未明确的结缔组织异常（1例）。9个动脉瘤中有8个接受了手术治疗，其中1例尝试进行搭桥手术，最终需要结扎椎动脉；该患者对侧的动脉瘤未进行治疗。开放性手术包括静脉搭桥、颈外动脉自体移植以及椎动脉转位至颈内动脉。对于埃勒斯-当洛综合征患者，采用了特殊技术处理吻合口。虽然未单独进行血管内栓塞，但实施了2例杂交手术。围手术期未发生卒中或死亡病例。
原发性颅外椎动脉动脉瘤罕见，发生于患有遗传性疾病的患者。有症状的患者有必要进行手术干预。可采用开放手术和杂交技术进行动脉瘤的排除和重建，手术的发病率和死亡率较低。
