VERTEBRAL ARTERY SURGERY

During the past two decades, improved understanding of vertebrobasilar insufficiency and posterior circulation infarction has increased awareness of the contribution of the vertebral arteries to the posterior cerebral circulation. With improved diagnostic abilities and vascular surgical techniques, reconstruction of the vertebral arteries provides safe and consistent long-term results. Early vertebral artery operations usually involved trauma and resulted in packing or ligation of the vertebral artery. In 1959, thromboendarterectomy of the proximal vertebral artery was first reported by Cate and Scott. 6 Since then advances in diagnostic and surgical techniques have made reconstruction of the vertebral artery an important adjunct in the management of cerebrovascular disease. Identification of transient ischemic attacks (TIAs) by Fisher 11 in 1951 increased our understanding of the anterior (carotid) versus posterior (vertebral) cerebral circulation. Categorizing symptoms in terms of anterior or posterior cerebral circulation is not always easy. The characterization of vertebrobasilar insufficiency as described by Kubik and Adams 16 has helped define the contribution of vertebral circulation to symptomatic posterior circulation insufficiency.