Vertebral Artery Aneurysm Repair in a Vascular Ehlers-Danlos Syndrome Patient

Vertebral artery aneurysms are a rare type of vasculopathy with significant risk of rupture, ischemia, and potential neurological deficits. Their location in the cervical region presents a surgical challenge with open and endovascular options alike and a lack of consensus on the best treatment option. We present an open approach to vertebral aneurysm repair in a patient with vascular Ehlers-Danlos syndrome (type IV). A 44-year-old male was referred to our health system with history of multifocal aneurysms and dissections of bilateral carotid and vertebral arteries. He presented complaining of severe right-sided neck pain associated with a sharp headache. Genetic testing confirmed pathogenic variant in COL3A1 gene confirming diagnosis of vascular Ehlers-Danlos syndrome. Computed tomography angiography revealed a 1.7-cm aneurysm of the right V1 vertebral artery and 1.4 cm aneurysm in the left V1 vertebral artery segment. Focal dissections and aneurysms in the superior mesenteric and right renal arteries were also noted. We recommended repair of the right vertebral artery aneurysm. We used a supraclavicular approach to access the V1 segment of the vertebral artery. Intravenous heparin bolus was administered during phases of arterial occlusion. The aneurysm was identified and resected caudally. Reconstruction of vasculature was carried out with creation of vertebral-to-carotid bypass. Postoperative course was without complications and follow-up imaging revealed a widely patent carotid-to-vertebral bypass and stable carotid and vertebral vessels. Our patient remains neurologically intact, with no deficits and palpable pulses. This case demonstrates the repair of a vertebral artery aneurysm. Open approach to repair of similar cases can be carried out with good outcomes.