Surgical reconstruction of the proximal subclavian and vertebral arteries.

The diagnosis and management of atherosclerotic lesions of the extracranial internal carotid artery has become fairly well established. Symptoms of basilar artery hypoperfusion may be due to stenotic lesions at the origin of either or both vertebral arteries or the proximal subclavian artery. Surgical correction can offer relief of symptoms. For the past decade, we have used a direct anastomosis from the vertebral or subclavian artery distal to the lesion to the adjacent common carotid artery. We have done this procedure 579 times, with one death and no neurologic deficit. A lymph fistula required closure in one patient, and reoperation was necessary in three patients because of bleeding. The results have been excellent, and we continue to offer this method of restoring arterial circulation in patients with cerebellar symptoms and vertebral hypoperfusion.