Operative and Endovascular Management of Extracranial Vertebral Artery Aneurysm in Ehlers-Danlos Syndrome: A Clinical Dilemma

Abstract

The most prevalent lesion of the vertebral artery is an atheromatous plaque located at its origin from the subclavian artery. A case of successful management of a symptomatic vertebral artery aneurysm due to Ehlers-Danlos syndrome is reported. The patient had asymptomatic posterior intracerebral artery dissection on the contralateral side. A common carotid artery to V-3 segment bypass using reversed saphenous vein graft was carried out. Avulsion of the V-2 segment occurred peroperatively and endovascular coil embolization of the vertebral artery aneurysm was performed. Endovascular equipment and training must be in the armamentarium of vascular surgeons as more complex cases are being treated, which demands new approaches for ultimate clinical success. This unique case outlines what might unexpectedly occur. Endovascular intervention as an adjuvant procedure provides a satisfactory outcome in what could have been a catastrophe.

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References

1. Imparato AM : Vertebral arterial reconstruction: A nineteen-year experience. J Vasc Surg 2:626-634, 1985.

2. Branchereau A , Magan PE : Results of vertebral artery reconstruction. J Cardiovasc Surg 31:320-326, 1990.

3. Habozit B : Vertebral artery reconstruction: Results in 106 patients. Ann Vasc Surg 5:61-65, 1991.

4. Berguer R : Distal vertebral artery bypass: Technique, the occipital connection and potential uses. J Vasc Surg 2:621-626, 1985.

5. Kieffer E , Bahnini A , Rancurel G : Surgery of vertebral artery insufficiency. In: Arterial Surgery: New Diagnostic and Operative Techniques, ed. by Bergan JJ , Yao JST . New York: Grune and Stratton, 1988, pp 187-214.

6. Berguer R , Morasch M , Kline R : A review of 100 consecutive reconstruction of the distal vertebral artery for embolic and haemodynamic disease. J Vasc Surg 27:852-859, 1998.

7. Stubbs H : Aneurysm of the vertebral artery. Ligature of the carotid. Liverpool Medico-Chir J 1:110-113, 1857.

8. Rifkinson-Mann S , Laub J , Haimov M : Atraumatic extracranial vertebral artery aneurysm: Case report and review of the literature. J Vasc Surg 4:288-293, 1986.

9. Kline RA , Berguer R : Vertebral artery reconstruction. Ann Vasc Surg 7:497-501, 1993.

10.

10. Crawford ES , Debakey ME , Fields WS : Roentgenographic diagnosis and surgical treatment of basilar artery insufficiency. JAMA 168:509-514, 1958.

11.

11. Sasayama T , Korosue K : Spontaneous resolution of the unruptured dissecting aneurysms of bilateral vertebral arteries with conservative treatment: Analysis of the transient enlargement of aneurysmal dilatation. No Shink Geka 28:47-51, 2000.

12.

12. Serbinenko FA : Balloon catheterisation and occlusion of major cerebral vessels. J Neurosurg 41:125-145, 1974.

13.

13. Debrun G , Fox A , Drake C , et al: Giant unclippable aneurysms: Treatment with detachable balloons. AJNR 2:167-173, 1981.

14.

14. Lanzino G , Wakhloo AK , Fessler RD , et al: Efficacy and current limitations of intra-vascular stents for intra-cranial internal carotid, vertebral and basilar artery aneurysms. J Neurosurg 91:538-546, 1999.

15.

15. Thompson JE , Eilber F , Baker JD : Vertebral artery aneurysm: Case report and review of the literature. Surgery 85:583-585, 1979.

16.

16. Matas R : Traumatisms and traumatic aneurysms of the vertebral artery and their surgical treatment, with the report of a cured case. Ann Surg 18:477-516, 1893.

17.

17. Rosenblum B , Rifkinson-Mann S , Sacher M , et al: Hemodynamic analysis of associated extracranial atraumatic vertebral artery aneurysm and arterio-venous fistula. J Neurosurg 67:940-943, 1987.

18.

18. Barr JD , Lemley TJ : Endovascular arterial occlusion accomplished using microcoils deployed with and without proximal flow arrest: Results in 19 patients. Am J Neuroradiol 20:1452-1456, 1999.

19.

19. Buerger T , Lippert H , Meyer F , et al: Aneurysm of the vertebral artery near the atlas arch. J Cardiovasc Surg (Torino) 40:387-389, 1999.

20.

20. Nuytink L , De Paepe A , Renard JP , et al: Singlestrand conformation polymorphism (SSCP) analysis of COL3A1 gene detects a mutation that results in the substitution of glycine 1009 to valine and causes severe Ehlers-Danlos syndrome type IV. Hum Mutat 3:268-274, 1994.