Good Long-term Clinical Outcomes Research Articles

Rapid setting calcium phosphate cement for craniomaxillofacial surgery. 6 years experience

Long-term results using hydroxyapatite cement (Bone Source) for the reconstruction of the facial skeleton and the forehead are reported. The cement consists of 73% tetracalcium phosphate and 27% dicalcium phosphate. Using 0.25 M phosphoric acid instead of water, the primary setting time can be shortened from 20 to 5 min in an isothermic reaction. Twenty-two patients suffering from consequences of trauma, tumor-like lesions, or neoplasm as well as dysmorphia were treated. Following implantation, the healing process proceeded in most cases without complications. Due to hematoma and seroma as well as infection, two implants were lost. Follow-up examinations could be performed in 19 of the 22 patients on a average 40 months after operation. Most patients had good clinical long-term results. X-ray-analysis showed some discrete resorption of the implants in six patients. The further course must be decided based on clinical relevance. The hydroxyapatite cement used in this study evidenced good intraoperative handling, an excellent histologically proved biocompatibility, and good long-term stability in normal body fluid. Up to now we have limited its use to non-load-bearing applications in craniofacial surgery.

Oclusión con micro-coils de la primera rama septal en el tratamiento de un paciente con miocardiopatía hipertrófica obstructiva

Nonsurgical septal reduction by induced septal infarction is one of the management options in the treatment of patients with hypertrophic obstructive cardiomyopathy. Good immediate and long-term clinical and hemodynamic results have been reported with this technique for occlusion of the first septal branch of the anterior descending coronary artery followed by ethanol infusion. This is the first report of a case in which nonsurgical septal reduction with microcoils has been attempted.

Long-term assessment of arthroscopic meniscus repair: a 13-year follow-up study

A prospective study was set up to evaluate meniscal suturing using an inside-out technique. Of an initial group of 20 patients who underwent closed meniscus repair between 1985 and 1988 using an inside-out technique, 13 were studied. All patients were subjected to a clinical examination and a magnetic resonance imaging (MRI) investigation. The findings were compared with those of their previous follow-up examination (1994). The Hospital for Special Surgery (HSS) knee rating system (R.G. Stone et al. Athroscopy 1990; 73–78) was used. The study included seven men and six women, ranging in age from 29 years to 50 years (mean age: 35 years 6 months). The mean follow-up was 13 years 2 months (11 years 11 months–15 years 4 months). Six left and seven right knees were involved. Seven patients also had an anterior cruciate ligament (ACL) injury of which one was repaired 6 years after meniscal repair. All patients obtained an HSS score of more than 75%. In all patients, the site of the previous suture was still visible on MRI mainly by small metal artefacts in the meniscus. Patients with an unrepaired ACL lesion had an early onset of arthrosis and cartilage degeneration. Meniscal suturing gives good clinical long-term results. Magnetic resonance imaging, however, showed signs of mucoid degeneration or scar tissue in 46% of the patients.

Surgical treatment for secundum atrial septal defects in patients >40 years old: A randomized clinical trial

ObjectivesWe prospectively examined whether surgical treatment of secundum atrial septal defects (ASDs) in patients ≥40 years old improves their long-term clinical outcome. BackgroundSurgical treatment of secundum ASDs in adults >40 years old is a subject of controversy because of the perception of good long-term clinical outcomes in patients with unrepaired ASDs and the lack of data from randomized trials. MethodsWe recruited 521 patients >40 years old with secundum ASDs referred for treatment; 48 were excluded. Patients were randomly assigned to surgical closure (n = 232) or medical treatment (n = 241). The primary and secondary end points were a composite of major cardiovascular events (death, pulmonary embolism, major arrhythmic event, embolic cerebrovascular event, recurrent pulmonary infection, functional class deterioration or heart failure) and overall mortality, respectively. We assessed possible prognostic markers. The analysis was performed on an intention-to-treat basis. ResultsThe median follow-up period was 7.3 years (range 2 to 13). The risk of having the primary end point was significantly higher in the medical group, which had a univariate hazards ratio of 1.99 (95% confidence interval [CI] 1.23 to 3.22) and a multivariate hazards ratio of 1.85 (95% CI 1.08 to 3.17). Although the survival analysis did not reveal differences in overall mortality between the surgical and medical treatments (hazards ratio 1.71, 95% CI 0.76 to 3.86), the multivariate analysis, adjusted by age at entry, mean pulmonary artery pressure and cardiac index, demonstrated significant differences between the study groups (hazards ratio 4.09, 95% CI 1.41 to 11.89). ConclusionsSurgical closure was superior to medical treatment in improving both the composite of major cardiovascular events and overall mortality in patients >40 years old with secundum ASDs. This superiority was related to the mean pulmonary artery pressure, age at diagnosis and cardiac index. Because of the higher risk of morbidity and mortality, we believe that anatomic closure should always be attempted as the initial treatment for ASDs in adults >40 years old with pulmonary artery systolic pressure <70 mm Hg and a pulmonary/systemic output ratio ≥1.7. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seems to be minimal.

Intramedullary spinal cord tumours: a clinical outcome and radiological follow-up study

Principles: Intramedullary spinal cord tumours are rare. The long-term results depend on their varying natural histories and the surgical approach. Less extensive tumour resection avoids greater postoperative neurological impairment without a negative impact on postoperative outcome.&#x0D; Methods: Twenty-seven patients who underwent a total of 34 surgical interventions (including 7 reoperations) were clinically and radiologically reinvestigated. Histology revealed 19 glial, 4 nonglial and 4 miscellaneous tumours.&#x0D; Results: Postoperative long-term clinical follow-up (mean 62 months postoperatively) in 25 patients revealed functional improvement in 2 cases, stable conditions in 17 and deterioration in 6. Although there was residual tumour on MRI in 19 of the 22 patients reexamined, stable radiological studies were seen in 15 cases. Despite the high percentage of partial resections or biopsies, good long-term clinical results were found in 19 patients (70%).&#x0D; Conclusion: The long-term outcome depends on tumour biology and the type of surgery. For low-grade astrocytomas we propose partial resection without incurring the risk of major postoperative neurological deficits, with semi-annual and, after 5 years, annual follow-up. Despite the fact that ependymomas are amenable to complete surgical resection, this was achieved in only one of six cases in this series. Postoperative MRI follow-up of intramedullary tumours must be protracted, as most of these tumours are slow-growing. An increase in the extent and intensity of contrast enhancement of the tumours was defined as tumour recurrence or progressive tumour growth.

Hemodynamic evaluation of 19-mm Carpentier-Edwards pericardial bioprosthesis in aortic position

Background. The aortic Carpentier-Edwards pericardial bioprosthesis offers good long-term clinical outcomes with a low rate of structural deterioration. However, little in vivo hemodynamic data is available for this bioprosthesis. Methods. To determine the hemodynamic performance of the 19-mm Carpentier-Edwards pericardial valve, both cardiac catheterization and dobutamine stress echocardiography were electively performed in 10 patients. The mean age at the study was 71.6 ± 4.4 years and the mean body surface area was 1.39 ± 0.11 m 2. The peak-to-peak gradient, instantaneous peak gradient, mean gradient, and valve orifice area were measured by standard cardiac catheterization. The Doppler-derived gradients and valve orifice area were also measured both at rest and during dobutamine infusion. Results. The average peak-to-peak gradient, instantaneous peak gradient, mean gradient, and valve orifice area measured by catheterization were 13.0 ± 5.4 mmHg, 28.5 ± 7.7 mmHg, 12.0 ± 4.9 mmHg, and 1.55 ± 0.45 cm 2, respectively. The peak and mean Doppler gradients, and valve orifice area by resting echocardiography were 27.7 ± 9.5 mmHg, 12.3 ± 4.8 mmHg, and 1.39 ± 0.26 cm 2, respectively. At a dosage of 10 μg/kg/min of dobutamine, the mean Doppler gradient rose mildly to 22.2 ± 4.8 mmHg, while the cardiac output increased from 4.49 ± 0.44 to 6.64 ± 0.87 L/min. The valve orifice area during the 10 μg/kg/min dobutamine infusion (1.55 ± 0.25 cm 2) was significantly larger than its value at rest ( p < 0.05). Conclusions. With acceptable hemodynamic performance, use of the aortic 19-mm Carpentier-Edwards pericardial valve is a reliable option for elderly patients with a small annulus.

Incidental durotomy in spine surgery.

Retrospective review of a large series of patients who underwent spinal surgery at a single institution during a 10-year period. To further clarify the frequency of incidental durotomy during spine surgery, its treatment, associated complications, and results of long-term clinical follow-up. Incidental durotomy is a relatively common occurrence during spinal surgery. There remains significant concern about it despite reports of good associated clinical outcomes. There have been few large clinical series on the subject. A retrospective review was conducted of clinical and surgical records and radiographic data for consecutive patients who underwent spinal surgery performed by the two senior surgeons from January 1989 through December 1998. A total of 2144 patients were reviewed, and 74 were found to have dural tears occurring during or before surgery. Incidental durotomy occurred at the time of surgery in 66 patients (3.1% overall incidence). Incidence varied according to the specific procedure performed but was highest in the group that underwent revision surgery. The incidence of clinically significant durotomies occurring during surgery but not identified at the time was 0.28%. All dural tears that occurred during surgery and were recognized (60 of 66) were repaired primarily. Pseudomeningoceles developed in five of the remaining six patients. All six patients had subsequent surgical repair of dural defects because of failure of conservative therapy. A mean follow-up of 22.4 months was available and showed good long-term clinical results for all patients. Incidental durotomy, if recognized and treated appropriately, does not lead to long-term sequelae.

Long-term results of angioplasties of pelvic and leg blood vessels

In the context of quality control, the results of balloon angioplasty of iliac and leg vessels in patients with vascular occlusive disease were investigated pertaining to the technical and clinical success. 197 conventional balloon angioplasties were evaluated regarding their success over a period of 1-4 years, retrospectively. The localisations of the primary obstructions and the existence of further obstructions, especially in the lower limb, the risk factors, and the technical and clinical results were compared. The clinical stage and the results of duplex ultrasound during follow-up examinations were recorded over a period of 1-4 years. The technical success of PTA was 95% for stenotic lesions and 80% for occlusions. In the long-term (up to 4 years) PTA of the iliac arteries achieved the best results with a success rate of 88%. The long-term results for the combination of the risk factors nicotine/hyperlipidemia (69%) was better than for the combination of diabetes/hypertonia (54%). The combined PTA of the main obstruction and of lower limb vascular had better results than the PTA without the dilatation of following stenoses 73% to 79% after one year. In our department we achieved a rise in success rate from 84% in 1995 to 96% in 1997. The number of complications during PTA was reduced from 8% in 1995 to 0% in 1997 and 1998. PTA has a high technical success rate and good clinical long-term results at low complication rates. Combined PTA of the main obstruction and an additional lower limb arterial stenosis or occlusion should be discussed because of the better clinical results after one year. By the quality control we achieved a rising technical success rate and a drop in complication rate.

Low rates of clinical restenosis with the new flexible stainless steel tube intracoronary stent: the R Stent. A six-month safety and feasibility study.

BACKGROUND: Coronary stents have been used with increasing frequency and in increasingly complex coronary lesions for the treatment of symptomatic coronary artery disease. A new stainless steel coronary stent, the R Stent, has been designed to provide maximum flexibility for tracking and high radial strength post-deployment. AIMS: To assess the safety and feasibility of the R Stent in patients with coronary artery disease. Specific objectives were to assess the R Stent's deployment success, angiographic and procedural success (< 20% residual stenosis and TIMI 3 flow), safety (absence of complications), 30-day and six-month clinical follow-up. METHODS: Between April 1998 and January 1999, stent deployment was attempted in 36 lesions in 30 patients with stable (43%) or unstable (57%) angina pectoris and 29/36 of the lesions were anatomically complex. Treated lesions were in the LAD (n = 15), RCA (n = 13) or LCX (n = 8). RESULTS: Stent deployment was achieved in 97% with one crossing failure in a patient with a long, calcified, proximal LAD lesion. After the procedure, patients were scheduled for one- and six-month clinical follow-up. One patient experienced a non-Q-wave myocardial infarction in hospital. At one month, there were no additional complications. Only one patient experienced recurrence of angina (CCS class 2) within the 30 days. At six-month follow-up, one sudden death had occurred. Three (10%) patients had anginal complaints, one of them received target lesion repeat PTCA. All other patients (87%) were event- and angina-free. CONCLUSION: This first clinical experience with the R Stent shows acceptable feasibility and safety with good long-term clinical results.

Morfologia da dentina tratada com substâncias dessensibilizantes: avaliação através da microscopia eletrônica de varredura

As constantes recidivas dos tratamentos preconizados para a hipersensibilidade dentinária são causa de estudos a respeito desta patologia. Neste trabalho, in vitro, nos propomos a avaliar, por meio de microscopia eletrônica de varredura, a possível formação de película impermeabilizadora quando da aplicação de substâncias dessensibilizantes, acompanhada de condicionamento ácido da dentina. Discos de dentina, foram utilizados onde foi preparado um esfregaço padronizado, realizado condicionamento ácido e aplicação das substâncias testadas, à base de glutaraldeído, oxalato e fluoretos. Para compor o grupo controle um corpo-de-prova foi mantido sem tratamento e outro apenas condicionado com ácido. Dos resultados morfológicos obtidos pode-se concluir que o condicionamento ácido prévio ao tratamento com substâncias à base de glutaraldeído e de oxalato não é capaz de formar uma película uniforme, impermeabilizante sobre a dentina. O uso de fluoretos forma uma camada sobre a dentina facilmente removível, não produzindo porém efeitos a longo prazo nestes tipos de tratamento.

Coronary artery bypass grafting with the radial artery produced good long-term clinical and angiographic results

Coronary artery bypass grafting with the radial artery produced good long-term clinical and angiographic results

Prevention of Unbalanced Lung Perfusion and Atrial Arrhythmias After the Lateral Tunnel Operation

The lateral tunnel operation has become increasingly popular with pediatric cardiac surgeons, as it is technically reproducible, is relatively easy to perform, and can be used in a variety of patients with single-ventricle physiology. The main drawbacks of the original operation are uneven blood flow distribution to the lungs and increasing incidence of supraventricular arrhythmias over time. In 1988, we modified this technique by avoiding narrowing of the tunnel at the superior vena cava-atrial junction, avoiding incorporation of the crista terminalis in the baffle suture line, and minimizing damage to the sinoatrial node. Between 1988 and 1995, 19 patients underwent this operation at Marie-Lannelongue Hospital in Paris. There was one early death and no late deaths. At a mean follow-up of 5.2 years, all survivors are in New York Heart Association class I. Early atrial flutter, related to atrial scarring secondary to multiple previous surgical procedures, developed in 1 patient, and late atrial flutter developed in 1 patient who had a previous Blalock-Hanlon atrial septectomy. All patients are currently in sinus rhythm. Atrial flutter did not occur in 17 patients who had had no previous atrial wall surgical procedure. We believe that the good long-term clinical results are directly attributable to our modifications, which ensure optimal hemodynamics and absence of rhythm disturbances. All patients who had not previously undergone operation on the atrial wall were free from supraventricular tachyarrhythmias at a mean follow-up of 5.2 years. This is a consequence of protecting the sinus node, crista terminalis, and Bachmann's bundle.

Changes in shape of the McKee-Farrar hip endoprosthesis

The still unsolved problem of aseptic loosening in total hip arthroplasties with identification of polyethylene wear particles as one of its major causes, has led to reintroduction of metal-to-metal articulations, as indicated by a few good clinical long-term results with all-metal McKee-Farrar arthroplasties. In this paper, data on 145 patients from a population of more than 1400, all with implanted McKee-Farrars, who underwent revision surgery for aseptic loosening, are collected and analysed for dependence of duration to brands of the implants and position of the cups. The surface of each of 55 revised implants was measured using a 3-D device. The results showed no interdependence between time of loosening, brand inclination of the cup and deviation in shape of ball and cup. Additionally, the deviations in shape were slight.

Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results.

Endoscopic dilation has proven to be a valid therapeutic alternative to surgery for treating postoperative anastomotic colonic strictures. The authors here evaluate retrospectively the short and long-term clinical results obtained in such patients by pneumatic dilation. From March 1986 to December 1993, 18 patients who had undergone surgery for colorectal cancer were treated for a postoperative symptomatic stricture. Four patients had undergone a left hemicolectomy and 14 an anterior resection. The strictures had a diameter of less than 2 mm, and a length ranging from 5 to 29 mm. The dilations were performed using a 30-40 mm pneumatic dilator for achalasia. The clinical results were classified in relation to the abdominal symptomatology reported by the patients, and were evaluated in the short term (one week) and long term (mean follow-up: 39 months). Seventeen of the 18 patients underwent a total of 45 dilating sessions; one patient was excluded because a recurrence was diagnosed at the suture line. Five patients had a single dilating session; eight patients had two sessions, and four patients had a mean of 4.5 sessions. Two complications were observed: a punctiform bowel perforation and one transient mucosal bleeding. Immediate symptomatic relief was achieved in all cases, and good long-term clinical results were achieved in 16 patients (94.1%). Endoscopic dilation with an achalasia balloon has proved to be safe and simple to perform, and allowed us to obtain good short-term and long-term clinical results. This type of dilation may be considered the first-line therapeutic approach for symptomatic benign colonic anastomotic strictures.

Acute and long-term results of coronary stents and atherectomy in women and the elderly

To determine the efficacy of new coronary interventions in women and the elderly. We studied 504 patients who underwent a total of 567 procedures, comprising 275 directional coronary atherectomy and 292 Palmaz-Schatz stents over a 2 1/2 year period; 18% were women and 23% were aged > or = 70 years (elderly). High rates of success were obtained with these procedures in women and the elderly, although the rates were lower in women than in men (89 versus 96%, P = 0.005), and similarly lower in the elderly than in younger patients (91 versus 96%, P = 0.06). In addition to the lower success rates, there was a higher incidence of procedure-related non-Q myocardial infarction and vascular complications in both the women and the elderly, independently. The degree of angiographic restenosis (> or = 50% diameter stenosis), however, was similar in women (36 versus 28% in men, P = 0.22) and in the elderly (28 versus 29% in patients ages < 70 years, P = 0.8). There were no sex-related differences in survival, late myocardial infarction, or repeat revascularization. In the elderly, although the incidence of repeat revascularization was not increased, there was a decrease in late survival (P < 0.001) and an increase in the incidence of late myocardial infarction (P = 0.02), probably reflecting the presence of other co-morbid variables. Both directional coronary atherectomy and coronary stenting can be performed safely and effectively in women and the elderly with good long-term clinical results, despite a somewhat lower rate of success and similarly higher rates of acute complications.

Long-term results of amalgam versus glass ionomer cement as apical sealant after apicectomy

A total of 67 teeth in 64 patients were treated with apicectomy and retrograde fillings. They were randomized to receive fillings of amalgam or glass ionomer cement in a comparative clinical study. Healing was evaluated clinically and radiographically after 1 and 5 years. Evaluation showed no difference in healing capacity between the two materials. Overall success rates in both groups were registered as 90% at 1 year and 85% at 5 years. Contamination with blood or saliva during insertion of the filling material did not affect healing adversely. The study shows that the 5-year follow-up result can be predicted in more than 95% of the cases at the 1-year follow-up. It can be concluded that glass ionomer cement is a valid alternative to amalgam as an apical sealant after apicectomy with equally good long-term clinical results.

Long-Term Clinical and Duplex Follow-up After Proximal Vertebral Artery Reconstruction

From 1977 to 1989, 28 patients, 18 men and 10 women, underwent 29 proximal vertebral artery reconstructions. Indications were vertebrobasilar insufficiency in 17 patients and TIA or stroke in 6. Five were asymptomatic. Procedures performed were endarterectomy in 20, reimplantation in 5, venous bypass in 3, and decompression in 1 case. Concomitant procedures were coronary artery bypass grafting (6) and carotid, subclavian, or innominate artery revascularization (14). There was no operative mortality. There were 3 early reoperations for occlusion, bleeding, and lymph fistula, respectively. Except for 1 foreign patient recent clinical follow-up was complete. Mean follow-up was 85.6 months (range 17-146). During follow-up 10 patients died. Causes were mainly cardiac (3), carcinoma (3), and stroke (2). Seventeen patients were alive, 13 had no cerebrovascular symptoms, 2 sustained a hemispherical stroke, 1 was only slightly improved, and 1 had a drop attack 131 months after operation. Five and ten-year actuarial survival rates were 85% and 51% respectively. Follow-up with duplex scan was available in 26 patients and was complete in 24. Mean duplex follow-up was 78.6 months (range 3-146). Significant abnormalities were noted in 6 but with symptoms in only 1 patient. Mean time to restenosis was 77.3 months. Late angiographic control in 10 patients correlated well with duplex findings. Proximal vertebral artery reconstruction yields good clinical long-term results, and duplex scan is a useful tool in the follow-up of these patients.

Third-time coronary bypass operation. Analysis of selection mechanisms, results and long-term follow-up.

Twenty-six patients underwent a third coronary artery revascularization between 1984 and 1993 at Hôpital de la Tour, Geneva, Switzerland. These patients represent 5.4% of coronary artery bypass graft (CABG) reoperations and 0.8% of the total CABG operations (3129) during the same time period. There were 23 men (85%), the mean age was 57.2 years (range 33-71), 18 patients (69%) had 3-vessel disease and the mean left ventricular ejection fraction (LVEF) was 59% (range 32-83%). The reason for the third operation was graft failure in 62% of the cases. Twenty-five patients (96%) were in Canadian Cardiovascular Society (CCS) class 3 or 4 preoperatively. Direct myocardial revascularization was performed in all patients with a mean of 3.2 grafts per patient (range 1-6). Thromboendarterectomy was performed in six patients (23%) and patch was used in four (15%). The internal mammary artery (IMA) was utilized in 85% of the patients. In-hospital mortality was 11.5% (3 patients). Non-fatal perioperative myocardial infarction and re-exploration for bleeding did not occur in this group of patients. Respiratory failure necessitating prolonged ventilatory support occurred in five patients (19.2%). Long-term follow-up was carried out for all 23 hospital survivors. The mean follow-up time was 52 months. The 5-year actuarial survival rate was 84.5% for the entire group and 95.7% for hospital survivors. The preoperative CCS functional class had significantly improved at the end of the follow-up, P < 0.001. Our data suggests that a third-time coronary revascularization can be justified, with gratifying operative success and good long-term clinical results.

Therapeutic alternatives for vein of Galen vascular malformations.

From September, 1986, to March, 1990, the authors treated 28 children harboring a vein of Galen vascular malformation. Eleven (39.3%) of the patients were neonates, 13 (46.4%) were 1 to 2 years old, and four (14.3%) were more than 2 years old. Fifteen patients (53.6%) presented with severe congestive heart failure, six (21.4%) had seizures, four (14.3%) had hydrocephalus, and three (10.7%) presented with intraventricular hemorrhage. Based on the Yaşargil classification of malformations, 10 lesions (35.7%) were Type I, seven (25%) were Type II, eight (28.6%) were Type III, and three (10.7%) were Type IV. In 11 patients (39.3%), a combined transfemoral, transarterial, and transvenous embolization of the vein of Galen malformation was performed. A pure transtorcular approach was utilized in eight patients (28.6%), and postembolization surgical clipping of arterial feeders was performed in two cases with intractable congestive heart failure. Complete anatomical occlusion of the galenic malformation was achieved in 13 patients (46.4%). An immediate postembolization improvement in the patient's clinical status was obtained in 23 (82.1%) of 28 patients and a good long-term clinical outcome was seen in 17 patients (60.7%). Five deaths (17.9%) occurred in this series of 28 patients; three (10.7%) were related to a transtorcular embolization and two (7.1%) to the unchanged natural history of the disease.

Long-term clinical and duplex follow-up after proximal vertebral artery reconstruction.

From 1977 to 1989, 28 patients, 18 men and 10 women, underwent 29 proximal vertebral artery reconstructions. Indications were vertebrobasilar insufficiency in 17 patients and TIA or stroke in 6. Five were asymptomatic. Procedures performed were endarterectomy in 20, reimplantation in 5, venous bypass in 3, and decompression in 1 case. Concomitant procedures were coronary artery bypass grafting (6) and carotid, subclavian, or innominate artery revascularization (14). There was no operative mortality. There were 3 early reoperations for occlusion, bleeding, and lymph fistula, respectively. Except for 1 foreign patient recent clinical follow-up was complete. Mean follow-up was 85.6 months (range 17-146). During follow-up 10 patients died. Causes were mainly cardiac (3), carcinoma (3), and stroke (2). Seventeen patients were alive, 13 had no cerebrovascular symptoms, 2 sustained a hemispherical stroke, 1 was only slightly improved, and 1 had a drop attack 131 months after operation. Five and ten-year actuarial survival rates were 85% and 51% respectively. Follow-up with duplex scan was available in 26 patients and was complete in 24. Mean duplex follow-up was 78.6 months (range 3-146). Significant abnormalities were noted in 6 but with symptoms in only 1 patient. Mean time to restenosis was 77.3 months. Late angiographic control in 10 patients correlated well with duplex findings. Proximal vertebral artery reconstruction yields good clinical long-term results, and duplex scan is a useful tool in the follow-up of these patients.