Combined carotid-vertebral vascular disease: a new surgical approach.

Selected patients with vertebral basilar insufficiency may obtain symptomatic relief after carotid endarterectomy. The usual surgical approach is that of initially performing carotid endarterectomy, if appropriate, followed at a second operation by extrathoracic vertebral reconstruction. This surgical approach is based in part on the need for different surgical incisions to reconstruct the cervical carotid and vertebral arteries. We describe a new surgical approach that utilizes a single cervical incision for combined carotid-vertebral reconstruction.