Combined operations on the ipsilateral ICA and VA/SA have been considered risky and seldom justified. The traditional approach in patients with vertebrobasilar symptoms has been to operate on the ICA stenosis first and to proceed with the secondary repair of the VA/SA only if the symptoms fail to disappear or they recur. To the contrary, we believe that combined operations of the ICA and VA/SA are usually safe and appropriate in patients with VBI because they avoid a secondary operation in nearly 50% of cases where the carotid operation fails to relieve VBI symptoms. We also advocate combined ICA and VA/SA operations in patients with a carotid lesion that is either critical or causing hemispheric symptoms, who have, in addition, a critical lesion of a large dominant VA on the same side.
KeywordsVein Graft Carotid Endarterectomy Carotid Bifurcation Distal Anastomosis Combine Operation
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