1. Distal vertebral artery bypass: Technique, the “occipital connection,” and potential uses 
Ramon Berguer, M.D., Ph.D. 
Journal of Vascular Surgery 
Volume 2, Issue 4, Pages (July 1985)
DOI: / (85)
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

2. Fig. 1
“Occipital connection” filling DVA and, in retrograde manner, patent remainder of proximal VA. ICA is occluded.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

3. Fig. 2
Reconstitution of DVA at C-1 to C-2 level (arrow) via branches of occipital artery. Note stump of proximal VA. Left ICA (*) is occluded.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

4. Fig. 3
Incision and first layer of dissection in exposure for DVA bypass.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

5. Fig. 4 Dissection of accessory nerve and of carotid bifurcation.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

6. Fig. 5
Transverse process of atlas can be felt under digastric muscle. Anterior ramus of C-2 is seen emerging from anterior edge of levator scapulae.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

7. Fig. 6
Cutting the levator scapula and splenius cervicis at the C-2 to C-1 intertransverse space.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

8. Fig. 7
Preparation for distal anastomosis. Note DVA has been transposed anteriorly from its original location (left upper insert). Later on (right lower insert) punch arteriostomy will be made in common carotid artery.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

9. Fig. 8
Completed common carotid artery to DVA autogenous vein bypass graft. Graft is tunneled under jugular vein.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

10. Fig. 9
postoperative arteriogram of external carotid artery to DVA bypass (between arrows). There was severe stenosis at origin of this single VA that entered spinal C-7 level, which made reimplantation of its proximal end into common carotid artery difficult.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

11. Fig. 10
Angiogram taken 2 years after surgery shows bypass (between arrows) from carotid bulb to DVA in patient with bilateral ICA aplasia whose left VA thrombosed. Note prompt filling of basilar and middle cerebral artery branches, latter through patent posterior communicating artery.
Journal of Vascular Surgery 1985 2, DOI: ( / (85) )
Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions