Our Summary

This paper discusses the condition vertebrobasilar insufficiency, which results from blockages in blood vessels due to clots, hardening of the arteries, or tearing of the artery’s inner lining. Treating this condition has always been challenging. The common treatment options are medication, widening the blood vessels with a balloon (angioplasty) and inserting a stent, or surgical rerouting of blood flow (revascularization).

However, large-scale studies have not shown that rerouting blood flow in the brain leads to better outcomes, unlike similar procedures in the heart or other blood vessels. Despite this, the authors suggest that rerouting blood flow in the brain might still be a good option for patients who continue to experience severe symptoms despite receiving the maximum recommended medical treatment.

The authors present three case studies of patients who were diagnosed with vertebrobasilar insufficiency and then underwent revascularization surgery using a graft from the radial artery in their arm. The paper also includes a review of previous research on treatments for this condition.

The authors conclude that surgical rerouting of blood flow could be a useful treatment option for a small group of vertebrobasilar insufficiency patients who are still symptomatic despite extended medical therapy, particularly those with large- or medium-sized blood vessel blockages and poor alternative blood flow routes.

FAQs

  1. What are the main treatment options for vertebrobasilar insufficiency?
  2. What is the role of surgical revascularization in treating vertebrobasilar insufficiency?
  3. How are patients diagnosed with vertebrobasilar ischemia before undergoing revascularization with a radial artery graft?

Doctor’s Tip

A helpful tip a doctor might tell a patient about peripheral artery bypass is to follow post-operative instructions carefully, including taking prescribed medications, attending follow-up appointments, and participating in rehabilitation exercises to promote healing and prevent complications. It is important to communicate any new or worsening symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for peripheral artery bypass surgery are those who have failed maximal medical therapy and have persistent debilitating symptoms of vertebrobasilar insufficiency. This includes patients with large- and medium-sized vessel occlusions in the posterior circulation and poor collateral circulation. These patients may experience symptoms such as dizziness, vertigo, and other manifestations of cerebral ischemia. It is important to carefully evaluate each patient’s individual case and consider surgical revascularization as a potential treatment option in these specific cases.

Timeline

  • Patient presents with symptoms of vertebrobasilar ischemia
  • Diagnosis confirmed with computerized tomographic arteriography and digital subtraction angiography
  • Patient undergoes revascularization with a radial artery graft
  • Post-surgery, patient may experience improved blood flow and relief from symptoms of vertebrobasilar insufficiency

What to Ask Your Doctor

  1. What are the potential risks and benefits of peripheral artery bypass surgery in my case?
  2. How long is the recovery period expected to be after the surgery?
  3. Will I need to make any lifestyle changes or take medications after the surgery?
  4. What type of follow-up care will be necessary after the surgery?
  5. Are there any alternative treatment options available for my condition?
  6. How experienced are you in performing peripheral artery bypass surgery?
  7. Can you provide me with information on the success rates of this surgery for patients with similar conditions?
  8. What can I expect in terms of long-term outcomes following the surgery?
  9. Are there any specific complications that I should be aware of before proceeding with the surgery?
  10. How soon should I expect to see improvement in my symptoms after the surgery?

Reference

Authors: Britz GW, Agarwal V, Mihlon F, Ramanathan D, Agrawal A, Nimjee SM, Kaylie D. Journal: World Neurosurg. 2016 Jan;85:106-13. doi: 10.1016/j.wneu.2015.08.004. Epub 2015 Aug 15. PMID: 26284960