当前位置： SCI文献检索 > NEUROSURGERY期刊下所有文献 > 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.

Abstract：

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.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Amar AP,Levy ML,Giannotta SL

subject

Has Abstract

pub_date

1998-12-01 00:00:00

pages

1450-7; discussion 1457-8

issue

eissn

0148-396X

issn

1524-4040

journal_volume

pub_type

杂志文章

在线工具

Iatrogenic vertebrobasilar insufficiency after surgery of the subclavian or brachial artery: review of three cases.