Scientific journal
European Journal of Natural History
ISSN 2073-4972

PHARMACOLOGICAL AND SURGICAL SYMPATHECTOMY OF VERTEBRAL ARTERIES

Losev R.Z., Khachatryan A.M., Sizgunov D.S.

With degenerative damages of cervical spine (CS), by force of closely linked with the second segment of vertebral arteries (VA), the symptoms of vertebro-basilar insufficiency (VBI) are often developed. Hypoperfusion in the bath of VA with spondylogenium damage is sometimes caused by their irritative or reflector spasm, even for lack of considerable extravasal compression. The syndrome of cervical artery (CAS) is developing for correction of which many specialists follow the conservative medicine tactics.

We observed 52 patients with the CAS with the signs of VBI. Discirculation in the vertebral basilar system (VBS) mostly (77%) showed itself as transient ischemic attacks, other patients had chronic disease. All patients had radiography confirmation of cervical spine damage, with triplex scanning of VA one-sided and two-sided spasm came into light, with contrast angiography the extravasal compression of VA is not revealed.

All patients were made Procaine and spirit-Procaine blockades of the periarteric plexus of VA in the third segment with clinic - ultrasonic positive effect at 43 (82,7%). The duration of therapeutic effect of blockades was variated from 72 hours to 14 days. If Procaine is intolerated, we used 2% Lidocaine solution.

Taking into account pathogenetically founded high effectiveness of sympathectomy of VA, in order to liquidate their pathologic spasm 10 patients were made surgical denervation of the vertebral artery in the third segment under the endotracheal anesthesia. The conditions for making this operation were absents of the hemodynamic significant changes in the first segment of VA and positive effect with making spirit-Procaine blockades.

Under general anesthesia by poster lateral approach on the neck with the usage of magnifying optics nervous fibers of the periarterial plexus of the vertebral are excised and cut, without interference on the vessel itself.

Thanks to liquidation of efferent sympathetic influence on the vertebral artery, irritative or reflector vasoconstriction are fully disappeared, thereby blood flow in the third segment of the vertebral artery and other parts of VBS is improved. Destruction of sensitive fibers of vertebral nerve reduces the appearance of vegetalgetic symptom complex.

In long term observation from 2 to 8 months all operated patients had stable improvement with considerable reduction of manifestations of VBI and algetic component of the vertebral artery syndrome. The clinic improvement is correlated with data of ultrasonic research - on the side of operation the spasm of vertebral artery is fully disappeared, volumetric speed of blood flow is increased. More often we observed the reduction of vestibulocochlear dysfunction, pains in occiput and orbit. 5 patients had diminishing of arterial hypertonic with diminishing of system arterial tension on 20 mm/hg in average.

The usage of pharmacological and surgical sympathectomy of vertebral arteries with their spondylogenic spasm is the affective and little invasion method in the complex treatment of patients with vertebral basilar failure.

The work is submitted to Scientific Conference "The Problems of International Integration of Educational Standards", England (London) - France (Paris), April, 20-28, 2009. Came to the Editor´s Office on 20.04.2009.