Iatrogenic vertebrobasilar insufficiency after surgery of the subclavian or brachial artery: review of three cases.
Iatrogenic vertebrobasilar insufficiency after surgery of the subclavian or brachial artery: review of three cases.
复制标题
锁骨下动脉或肱动脉手术后医源性椎基底动脉供血不足：三例病例回顾。
DOI：
10.1227/00006123-199812000-00111
复制
发表时间：
1998
期刊：
影响因子：
4.8
通讯作者：
S. Giannotta
中科院分区：
文献类型：
--
作者：
A. Amar;M. Levy;S. Giannotta
目标和重要性
OBJECTIVE AND IMPORTANCE
Vertebrobasilar insufficiency resulting from disease of the subclavian artery is well recognized. Usually, this occurs as the "subclavian steal" syndrome in the context of chronic subclavian stenosis and is consequently well tolerated because of collateralization. Acute disruption of the hemodynamics of the aortic arch vessels, however, can produce disastrous sequelae.
CLINICAL PRESENTATION
We present three cases of iatrogenic vertebrobasilar insufficiency sustained as complications of surgery of the left subclavian artery or its distal continuation. The cases were chosen from a review of approximately 400 emergency neurosurgery consultations requested at the Los Angeles County Hospital between November 1995 and February 1996.
INTERVENTION
The first patient underwent repair of a traumatic brachial artery occlusion and awoke postoperatively with bilateral cortical blindness, right hemiparesis, and multiple cranial nerve deficits that were most likely caused by acute subclavian steal. The second underwent removal of a subclavian embolus and developed bilateral cerebellar infarction leading to persistent coma, possibly from inadvertent embolization of the vertebral artery during surgery. The third underwent resection and bypass grafting of a subclavian aneurysm. Good backflow was reported when the vertebral artery was disarticulated from the subclavian artery, and this vessel was not reimplanted into the graft. The patient suffered massive cerebellar infarction leading rapidly to brain death.
CONCLUSION
There are myriad ways in which the inherent redundancy of the vertebrobasilar system may be jeopardized, and when this protective mechanism fails, the results can be disastrous. Flow through the vertebral arteries may be compromised by thrombosis, embolization, dissection, inappropriate ligation, excessive head rotation, hypotension, vasospasm, or acute subclavian steal. These examples illustrate the importance of understanding the complex physiology of posterior fossa circulation as the basis of pre-, intra-, and postoperative management of patients undergoing surgery of the subclavian artery.