Repair of the Vertebral Artery

Abstract

Even though access to the vertebral artery (VA) is feasible at any level, only two sites are generally used for its reconstruction (Figure 9.1). Proximal reconstructions of the VA are done in its first segment, which extends from its takeoff to the transverse process of C6. Distal reconstructions are done in the third segment, which extends from the top of C2 to the atlantooccipital membrane. Within this segment, the VA is specifically isolated between the transverse processes of C1 and C2. It is better to reconstruct the artery in this third segment when treating occlusive disease involving the second segment of the VA. The approach to the second segment is fraught with difficulties caused by venous bleeding, narrow spaces between the transverse processes, and the danger of traumatic and ischemic injury to the nerve roots of the brachial plexus. (Access to the second segment of the VA for traumatic injuries is discussed in Chapter 11) On rare occasions the artery must be exposed in the upper half of its third segment, between the transverse process of C1 and the occipital bone.