OBJECTIVE: To study the anatomical basis for reconstruction of vertebral artery with neighboring non-trunk arteries. METHODS: Twenty preserved adult cadavers were used in this study to observe the morphology of superior thyroid artery, inferior thyroid artery, transverse cervical artery, thyrocervical trunk and extracerebral portion of vertebral artery, and reconstruction of vertebral artery with these arteries was simulated in two preserved cadavers. RESULTS: The calibers of superior or inferior thyroid artery, or transverse cervical artery were more than 2 mm in diameter, and the arteries had suitable free length for end-to-side anastomosis with vertebral artery. Thyrocervical artery had similar caliber to vertebral artery so that end-to-end anastomosis could be carried out between them, but only 38.5% of this artery had adequate artery trunk (more than 10 mm). It was proved from the simulated procedures that the reconstruction of vertebral artery with these neighboring non-trunk arteries was possible. CONCLUSION: Reconstruction of vertebral artery with neighboring non-trunk arteries has anatomical basis and can be used clinically for treatment of the lesion affecting the first or second portion of vertebral artery.
Objective To investigate the influence of axis pedicle and intra-axial vertebral artery (IAVA) alignment on C2 pedicle screw placement by measuring the data of head and neck CT angiography. MethodsThe axis pedicle diameter (D), isthmus height (H), isthmus thickness (T), and IAVA alignment types were measured in 116 patients (232 sides) who underwent head and neck CT angiography examinations between January 2020 and June 2020. Defined the IAVA offset direction by referencing the vertical line through the center of C3 transverse foramen on the coronal scan, it was divided into lateral (L), neutral (N), and medial (M). Defined the IAVA high-riding degree by referencing the horizontal line through the outlet of the C2 transverse foramen, it was divided into below (B), within (W), and above (A). The rate of pedicle stenosis, high-riding vertebral artery, and different IAVA types were calculated, and their relationships were analysed. Simulative C2 pedicle screws were implanted by Mimics 19.0 software, and the interrelation among the rates of pedicle stenosis, high-riding vertebral artery, IAVA types, and vertebral artery injury were analyzed. ResultsThe rate of C2 pedicle stenosis was 33.6% (78/232), and the rate of high-riding vertebral artery was 35.3% (82/232). According to the offset direction and the degree of riding, IAVA was divided into 9 types, among which the N-W type (29.3%) was the most, followed by the L-W type (19.0%) and the L-B type (12.9%), accounting for 60.9%. The vertebral artery injury rate of simulative implanted C2 pedicle screws was 35.3% (82/232). The vertebral artery injury rate in patients with pedicle stenosis and high-riding vertebral artery was significantly higher than that who were not (P<0.001). The rate of pedicle stenosis, high-riding vertebral artery, and vertebral artery injury were significantly different among IAVA types (P<0.001), and M-A type was the most common. ConclusionVertebral artery injury is more common in pedicle stenosis and/or high-riding vertebral artery and/or IAVA M-A type. Preoperative head and neck CT angiography examination has clinical guiding significance.
【摘要】 目的 观察自发性椎动脉夹层（sVAD）的临床特点及预后。 方法 对2009年1月-2010年1月收治的15例经核磁共振血管成像和数字减影血管造影证实的sVAD患者，进行危险因素、临床表现、影像学特征、治疗及预后的全面分析。 结果 15例sVAD患者，男10例，女5例；平均年龄40岁。12例有同侧头部、后颈部疼痛；13例发生后循环缺血性卒中，表现为延髓背外侧综合征者8例；14例给予抗凝治疗，1例予抗血小板治疗。随访6~12个月，MRS评分5例0分，9例1分，1例2分。 结论 sVAD发病年龄较轻，男性居多。临床多表现为后循环缺血及后枕部或颈部疼痛，预后较好。【Abstract】 Objective To observe the clinical manifestation and prognosis in patients with spontaneous vertebral artery dissection (sVAD). Methods Clinical data of 15 patients with sVAD who were confirmed by MRA and DSA from January 2009 to January 2010 were analyzed on risk factors,clinical symptoms,imaging features,treatment and 6-12 months prognosis. Results The patients were ten males and five females,with the average age of 40 years old. Twelve patients had pain in homolateral head and neck. Thirteen patients had stroke in posterior circulation, among which eight showed Wallenberg Syndrome. Anticoagulant therapy was given in 14 patients and antiplatelet treatment in one. Within 6-12 months follow-up, MRS scores were zero in five patients, one in nine patients, and two in one patient. Conclusion sVAD often occurres in young people, and mainly in men. Stroke in posterior circulation and pain are easily seen in sVAD, and most of them have favorable outcome.
ObjectiveTo evaluate the effect of surgical treatment of vertebral artery stenosis and to summarize the experience.MethodThe clinical data of 6 patients undergoing surgical treatment from September 2018 to September 2019 were retrospectively analyzed.ResultsAll the procedures were successfully performed without intraoperative cerebral infarction, injury of thoracic duct or nerve disconnection by mistake. The operative time was 120 to 270 minutes, the median was 180 minutes. The blood loss was 50 to 150 milliliters, and the median was 65 milliliters. One patient suffered from Horner’s syndrome after the operation. One patient suffered from cerebral infarction on 4 days after the operation. During the follow-up of 3–10 months, three patients felt dizziness relieved and there were no anastomotic stricture or new cerebral infarction happened.ConclusionsSurgical treatment is safeand effective for vertebral artery stenosis. Revascularization of the carotid and vertebral arteries at the same time shouldbe avoided.
Objective To investigate the surgical approach and efficacy of reconstruction of the isolated left vertebral artery (ILVA) in single upper hemisternotomy for total aortic arch replacement. Methods From March 2017 to October 2023, patients who underwent total aortic arch replacement under single upper hemisternotomy in General Hospital of Northern Theater Command were selected. According to the presence of ILVA, they were divided into a conventional group and an ILVA group. All the ILVA group underwent intraoperative ILVA reconstruction. The perioperative clinical data between two groups were compared. Results A total of 504 patients were collected, including 471 males and 31 females, with an average age of 50.4±11.4 years. There was no increase in the duration of cardiopulmonary bypass or postoperative hospitalization in the ILVA group (n=31) compared to the conventional group (n=473), and the rates of perioperative complications and in-hospital mortality were not significantly different between the two groups. There were 2 (6.45%) patients of acute cerebral infarction and 2 (6.45%) patients of perioperative death in the ILVA group, with no spinal cord injuries. Conclusion ILVA reconstruction during total aortic arch replacement in single upper hemisternotomy is feasible, safe, and effective, and prioritizing off pump ILVA-left common carotid artery transposition.
In the variation of vertebral artery in artery groove, high-riding vertebral artery is the most common. High-riding vertebral artery can affect the choice of internal fixation device for upper cervical spine surgery, and may lead to serious complications such as vertebral artery injury and even death. In recent years, great progress has been made in the concept, incidence, diagnostic techniques, classification and impact on upper cervical spine surgery of high-riding vertebral artery. This review summarizes the above contents in order to improve clinicians’ understanding of high-riding vertebral artery, and provide a reference for timely diagnosis of high-riding vertebral artery, make an appropriate plan for upper cervical cervical spine surgical fixation, and reduce surgical complications.
Objective To investigate the therapeutic effects of endovascular covered stent on vertebral dissecting aneurysm and carotid-cavernous fistula (CCF). Methods From March 2006 to May 2007, Jostent coronary stent grafts were used to treat 4 patients with vertebral dissecting aneurysm and 3 patients with CCF. The patients of vertebral dissecting aneurysmwere male and 37-57 years old, the lesion was located on the left vertebral artery in 3 patients and on the right vertebral artery in 1 patient, with the primary symptoms of sudden headache and vomiting; CT scan demonstrated subarachnoid hemorrhage; and the medical history varied from 2 days to 10 years. The patients of CCF were male and 35-51 years old, the lesion was located on the left carotid artery in 2 patients and on the right carotid artery in 1 patient, with the primary symptoms of headache, lateral exophthalmos, eyeball distending pain, conjunctive hyperemia and impaired eyesight; all 3 patients got head injury 2 days to 1 month before the appearance of symptoms and 1 of them had a history of severe nosebleed; and the medical history ranged from 1 week to 2 months. Results For the patients with vertebral dissecting aneurysm, complete obl iteration of aneurysms was achieved, the circulations of the vertebral artery, the adjacent posterior inferior cerebellar artery and the adjacent anterior inferior cerebellar artery were smooth, no compl ications relative to operation occurred, and no recurrence of symptoms and intracranial rehaemorrhagia were observed during the follow-up period of 8 months-2 years. For the patients with CCF, the fistula were completely obl iterated, the circulation of carotid artery was smooth, the exophthalmus and conjunctiva hyperemia were improved obviously 3 days after operation, the eyesight of patient was improved at different levels over the follow-up period of 1-3 months. Conclusion Endovascular covered stent is a new and useful tool for the treatment of vertebral dissecting aneurysm and CCF .
目的 总结颈动脉损伤患者救治的临床经验。 方法 2003年1月－2006年6月，抢救5例颈动脉损伤患者。男3例，女2例；年龄21～35岁。其中左右颈总动脉各1例，左锁骨下动脉2例，左椎动脉1例。合并损伤：左颈内静脉贯通伤1例，左胸导管及交感神经损伤1例，食道损伤1例，左锁骨骨折1例。受伤至入院时间20 min～3个月。受伤原因：刀刺伤3例，误食缝衣针伴感染1例，车祸伤1例。采用血管吻合修复颈总动脉及椎动脉3根、侧壁修补修复左锁骨下动脉1根、左颈内静脉1根及自体血管移植术修复左锁骨下动脉1根。术中输血量1 000～11 000 mL,平均3 800 mL。 结果 所有患者均抢救成功，伤口Ⅰ期愈合，经1～3年随访，无神经功能障碍。 结论 颈动脉损伤救治成功的关键在于尽早做出诊断，快速有效的急救及选择正确的治疗方法。
ObjectiveTo summarize the feasibility and effectiveness of endovascular treatment for vertebral artery stenosis ectopic originating from the aortic arch. MethodThe clinical data of 5 patients with vertebral artery stenosis ectopic originating from aortic arch admitted to Xuanwu Hospital of Capital Medical University from January 2020 to May 2023 were retrospectively analyzed. ResultsAll 5 patients underwent magnetic resonance angiography and CT angiography before treatment. The vertebral arteries of all patients originated from the aortic arch and were severe stenosis, with a median diameter of 1.3 mm (range, 1.1–1.5 mm) by CT angiography. All 5 patients were successfully treated with endovascular intervention. The operation time was 37–45 min, with a median of 39 min. There were no complications of vertebral artery rupture, embolism or occlusion, cerebral infarction, plaque abscission, hematoma at puncture site, pseudoaneurysm, postoperative hemorrhage, or perioperative pulmonary infection. The patients were followed-up for 13–30 months, with a median follow-up time of 20 months. The blood vessels of 5 patients remained unobstructed and no clinically significant vascular restenosis occurred. ConclusionsBased on the experiences of 5 cases of vertebral artery stenosis ectopic originating from the aortic arch, it is safe and effective to choose endovascular treatment for severe symptomatic vertebral artery stenosis. Especially, it is necessary to evaluate the stenosis degree of vertebral artery using CT angiography before treatment.