Vascular reconstruction using interposition of saphenous vein graft for symptomatic stenosis at the extradural-intradural junction of the vertebral artery. Case report

Symptomatic, medically refractory vertebrobasilar stenosis carries a poor prognosis and is an indication for vascular reconstruction. A 67-year-old man suffered medically refractory recurrent vertigo due to artery-to-artery embolism caused by long, eccentric, and severe stenosis at the extradural-intradural junction of the right vertebral artery. Transluminal angioplasty was deferred because of the occurrence of critical brain ischemia during temporary balloon occlusion. After an occipital artery to posterior inferior cerebellar artery bypass, the vascular lesion in the right vertebral artery was resected and was reconstructed with interposition of a saphenous vein graft. The postoperative course was uneventful, and the patient did not experience further symptoms. Postoperative angiography revealed a widely patent right vertebral artery. This surgical procedure is useful for the vascular reconstruction of symptomatic stenosis at the extradural-intradural junction of the vertebral artery when transluminal angioplasty is contraindicated and when bypass surgery is not sufficient.