J Korean Med Sci.  2006 Feb;21(1):20-24. 10.3346/jkms.2006.21.1.20.

Surgical Management of Takayasu's Arteritis

• Joh JH
• Kim DK
• Park KH
• Kim DI

• KMID: 2157776
• DOI: http://doi.org/10.3346/jkms.2006.21.1.20

Abstract

The results of surgical bypass and endarterectomy in Takayasu's arteritis (TA) were reported to be poor compared to usual atherosclerosis patients. However, if ischemic symptoms due to occlusive disease were severe, surgical procedures were inevitable. We report surgical experience of 5 patients with TA. Five women (ranged from 26 to 58 yr) were operated between June 1998 and May 2004. Three patients showed occlusion of main branches of aortic arch and had symptoms of cerebral ischemia. One patient showed near total occlusion in the midabdominal aorta and had symptoms of orthopnea and uncontrolled hypertension. One patient showed total occlusion of abdominal aorta at the level of aortic bifurcation and had a symptom of severe claudication on both legs. Bypasses from the ascending aorta to the carotid artery were performed in 3 cases. Bypass from the thoracic aorta to the left common iliac artery was performed in one case and endarterectomy of abdominal aorta in one case. The ischemic symptoms related with arterial occlusion were resolved after surgery. And the symptoms of cardiac failure disappeared. The symptomatic TA frequently required arterial reconstruction. The symptomatic improvement and excellent mid-term patency could be expected after arterial reconstruction and endarterectomy.

Keyword

Vascular Diseases; Takayasu's Arteritis; Bypass; Endarterectomy, Carotid

MeSH Terms

Adult
Endarterectomy, Carotid/methods
Female
Humans
Middle Aged
Migraine Disorders/etiology
Postoperative Complications
Takayasu's Arteritis/radiography/*surgery
Treatment Outcome

Figure

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  Fig. 1 Preoperative angiography shows patent right (A) and left (B) internal carotid arteries respectively. (C) Postoperative CT-angiography shows ascendo-bicarotid bypass.

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  Fig. 2 Preoperative angiography shows patent right internal carotid artery (A) and severely stenotic left internal carotid artery (B). (C) Postoperative CT angiography shows ascendo-right internal carotid artery bypass.

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  Fig. 3 (A) Preoperative angiography shows no visualization of superior mesenteric artery and left renal artery, a stenotic right renal artery, and a enlarged inferior mesenteric artery. (B) Postoperative CT angiography shows patent thoraco-left iliac bypass graft and stent in the right renal artery.

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  Fig. 4 MR angiography demonstrates stenosis of the aortic bifurcation and both common iliac arteries (A), patent aortoiliac system postoperatively (B).

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