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At least 19 recordsLinked to original sources

Surgical possibilities in the third portion of the vertebral artery (above C2). Anatomical study and report of a case of anastomosis between subclavian artery and vertebral artery at C1-C2 level.

A reappraisal of surgical possibilities in the third portion of the vertebral artery (VA) above C2, has been done from an anatomical study on twenty autopsy specimens. A route passing between the internal jugular vein and the Sterno-cleido-mastoid muscle allows a simple approach to the transverse process of C1. After division of two muscles attached to this process, 1.5 cm of the VA can be exposed. For larger exposure of the artery, the foramen transversarium of C1 must be unroofed and the artery dissected in the guttering of the posterior arch of the atlas. This surgical route was used in a case of aneurysmal dysplasia at the C3 level. An anastomosis between the subclavian artery and VA at the C1-C2 level was performed with an autologous saphenous vein graft. The key points are the highest possible freeing of the XI nerve and the head position. Rotation and extension move the transverse process and the posterior arch of the atlas superficially and anteriorly.

Cerebral Revascularization

Noninvasive angiography for the diagnosis of vertebral artery disease using Doppler ultrasound (vertebral artery Doppler).

A transoral noninvasive procedure in the oropharynx using local anesthesia was applied to detect flow in the vertebral arteries with a bidirectional continuous-wave Doppler ultrasound system. Common carotid artery compression was used to identify the vertebral artery. Flow direction, amplitude of flow signals, diastolic flow, and reaction of flow on common carotid artery compression served as diagnostic parameters. The procedure was applied in 90 patients of whom 42 underwent angiography. The method has proved to be 82% accurate. It was most reliable in the diagnosis of occlusion or aplasia, subclavian steal and normalcy, and was less reliable in the detection of stenosis or hypoplasia of a vertebral artery. Eleven patients with subclavin steal, five patients with a missing vertebral artery three patients with hypoplasia or stenosis, and 15 patients with normal angiorgraphical findings were correctly diagnosed by Doppler; normal Doppler findings were present in three patients with a mission or stenosed vertebral artery. Those patients (five) with Doppler indications of subclavian steal (one patient), missing vertebral artery (two patients), or stenosis (two patients) had normal angiograms. Application of the Doppler procedure, after 11 subclavin endarterectomies, informed the surgeon immediately about the hemodynamic effect of surgical intervention. Rethrombosis was diagnosed in two patients by postoperative Doppler examination.

Cerebral Angiography

Vertebral artery bypass.

The origin of the vertebral artery is a frequent site for the development of stenosing lesions. The flow deficit caused by the stenosis of one vertebral artery is normally compensated for by intracranial anastomosis between the carotid and basilar arteries or by the opposite vertebral artery. A number of patients, however, have inadequate intracranial anastomosis and hypoplasia or stenosis of the opposite vertebral artery, and symptoms of brain ischemia develop. We describe here four cases in which a new technique, a subclavian vertebral artery autogenous vein bypass graft, was used to deal with the diseased segment of the vertebral artery. Transient postoperative problems included lymphocele and Horner syndrome. All four bypasses were patent at the time of angiography one week postoperatively. All four patients were relieved of symptoms of vertebrobasilar insufficiency.

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Traumatic arteriovenous fistulas of the vertebral artery.

Arteriovenous fistulas of the vertebral artery are uncommon. Trauma, arterial erosion by abscess and congenital weakness of the arterial wall are the most frequent cause of these fistulas. Few of them have been reported following percutaneous puncture of the vertebral artery. Two such cases, as well as an exceptionnel false traumatic aneurysm of the V4 segment of the vertebral artery in front of a fracture of the occipital bone, are described here. The latter patient also has a malformation of the craniovertebral joint.

Arteriovenous Fistula

Subclavian steal syndrome. Part 2: Intraoperative vertebral artery blood flow measurement.

Intraoperative vertebral artery blood flow was measured in two patients with symptomatic subclavian steal syndrome, before and after proximal end-to-side vertebral to common carotid artery transposition. This confirmed retrograde flow in the vertebral artery before transposition, and antegrade flow after transposition. The measured flow rates were compared to values in other series involving different operative procedures for correction of symptomatic subclavian steal. The greatest mean antegrade flow rates in the vertebral artery were restored by proximal end-to-side vertebral to common carotid artery transposition.

Collateral Circulation

Diagnostic reliability of the percutaneous ultrasonic Doppler technique for vertebral arterial occlusive diseases.

There is little data on the diagnostic reliability of the ultrasonic Doppler technique for vertebral arterial occlusive lesions. Percutaneous vertebral Doppler examination and the vertebral angiograms were compared to determine the diagnostic reliability of this technique in 64 vertebral arteries of 53 patients with cerebrovascular disease. The percutaneous vertebral Doppler findings were quantitatively analyzed using a sound spectrograph and were classified into three types: no flow signal type, poor flow type and normal flow type. In nine patients with the no flow type the angiograms revealed vertebral occlusion or a missing vertebral artery in six, giving a diagnostic reliability of 67%. In 17 patients with poor flow type the angiograms revealed vertebral occlusion or a missing vertebral artery in five, terminal narrowing of the artery in nine, and hypoplasia in two giving a diagnostic reliability of 94%. For all vertebral arteries examined with this technique, including normal ones, the diagnostic reliability was 92% (59/64). Percutaneous vertebral Doppler examination has clinical usefulness as a screening test for occlusive vertebral arterial diseases.

Adult

[A case with bilateral internal carotid and left vertebral artery occlusion (author's transl)].

Since Moniz reported the obstruction of the extracranial internal carotid artery in 1937, there have been many reports of extracranial arterial occlusion. The authors experienced a case of 40-year-old woman who had minor neurological deficit such as attack of black out, disturbance of the bilateral visual acuity, concentric narrowing of the bilateral field and disturbance of the bilateral auditory acuity, in spite of complete obstruction of both internal carotid arteries and the left vertebral artery, and possible obstruction of the right vertebral artery. The angiograms showed well developed collateral circulation. The cause of the obstruction was considered to be angitis following otitis media and meningitis in her childhood. The symptoms were alleviated by drugtherapy.

Adult

Bilateral obstruction of the vertebral arteries in a three-year-old child.

A three-year-old boy developed gait instability, nausea, vomiting, cranial nerve disturbances, hypotonus and dysarthria. Angiography of the four main cranial arteries showed complete obstruction of both vertebral arteries at the level of C1 to C2. Abundant collateral circulation was observed, which by-passed the obstruction to the vertebral arteries before their enterance into the posterior cranial fossa. The left vertebral artery was hypoplastic and both internal carotid arteries showed coiling in their extracranial portions. A high erythrocyte sedimentation rate at the beginning of the disease suggests an inflammatory alteration of both dysplastic vertebral arteries. The child recovered completely one month after the onset of symptoms. All other reported cases of childhood vertebro-basilar obstruction are reviewed and it is emphasized that the site of arterial obstruction has an important bearing on the clinical outcome.

Arterial Occlusive Diseases

Duplicate origin of left vertebral artery.

A verified case of duplicate origin of the left vertebral artery in association with a large aneurysm arising from the aortic arch immediately distal to the left subclavian artery is presented. An anomalous left vertebral artery arises directly from the aortic arch between the left common carotid and subclavian arteries, and joins with the normal left vertebral artery in the transverse foramen of the fifth cervical vertebra.

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[Studies on the role of high pressure baroreceptors in vasopressin (ADH) secretion. Effect of occlusion of common carotid and vertebral arteries on blood ADH level (author's transl)].

The role of baroreceptors in common carotid and vertebral arteries and arteries in the thoracic cavity in vasopressin secretion was investigated in this study. Effects of bilateral occlusion of common carotid and vertebral arteries on blood ADH level as well as mean arterial pressure were studied in common carotid arterial plexus-denervated dogs, cervically vagotomized dogs and intact dogs. Blood ADH titers were determined by bioassay technic before and 5 minutes after the occlusion of the arteries and were compared with the changes of mean arterial pressure (MAP). The following results were obtained. (1) Blood ADH titers and MAP were elevated by the occlusion of the common carotid arteries in both intact and vagotomized dogs, while they were not significantly affected in denervated dogs. Elevation of blood ADH titers was more pronounced in vagotomized dogs than in intact dogs. (2) Blood ADH titers and MAP were elevated by the occlusion of vertebral arteries in all groups of dogs. However, the elevation of blood ADH titers in denervated dogs was more pronounced than in intact dogs, but less than in vagotomized dogs. (3) The effects of the occlusion of common carotid arteries on blood ADH titers and MPA were more pronounced than those of the occlusion of vertebral arteries. These results may suggest that: a. baroreceptors involved in vasopressin secretion are present in vertebral arteries as well, and that b. the intrathoracic baroreceptors are dominant in controlling vasopressin secretion, while those in common carotid arteries are secondly and those in vertebral arteries thirdly dominant.

Animals

Surgical treatment of partial extraluminal occlusion of the vertebral artery.

Twenty-three patients with insufficiency of the vertebral artery due to partial extraluminal occlusion of a segment of the first part of the vertebral artery were operated upon with postoperative symptomatic improvement. Selection of patients is dependent on angiography of the aortic arch with visualization of the vessels of the neck. There was no mortality and no significant morbidity among these patients.

Adult

[Clinical picture and localization of foci of softening in the brain following vertebral artery thrombosis].

The authors conducted a clinico-anatomical analysis of 45 observations with thrombosis of the vertebral arteries. In the majority of cases thrombosis of the vertebral arteries was isolated. In 5 observations it was combined--with thrombosis of the carotid artery (2 cases), with the middle brain artery (2 cases) and with the posterior cerebellum artery (1 case). In one observation thrombosis of the right innominate, subclavian, general carotid and vertebral arteries was diagnosed clinically and angiographically. Thrombosis of the vertebral arteries occurs in the presence of expressed atherosclerotic changes in the brain vessels with acute stenosis.

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Reversal of vertebral artery blood flow demonstrated by Doppler ultrasound.

Vertebral artery blood flow was studied by a Doppler ultrasound technique in two patients with the subclavian steal syndrome. The Doppler probe was positioned in the region of the Chassaignac tubercle. The direction of vertebral artery flow corresponded with the angiographic flow direction preoperatively. Postoperatively, the technique was used to confirm the patency of a carotid-subclavian graft, and also to study the hemodynamic effects of axillary-axillary grafting. Reversal of vertebral flow direction was easily demonstrated by this technique, which is simpler to perform than previously described methods.

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