Ann Surg Treat Res.  2017 Sep;93(3):143-151. 10.4174/astr.2017.93.3.143.

Aorto-carotid bypass in patients with Takayasu arteritis

• Han HS
• Yoon KW
• Heo SH
• Park YJ
• Kim YW
• Kim DI

• KMID: 2398961
• DOI: http://doi.org/10.4174/astr.2017.93.3.143

Abstract

PURPOSE
Takayasu arteritis is an indication for bypass surgery when this condition results in severe cerebrovascular ischemia due to occlusion of the carotid arteries. We reviewed the patients with Takayasu arteritis who received aorto-carotid bypass due to cerebrovascular ischemia.
METHODS
A retrospective review was performed on 19 patients with Takayasu arteritis who underwent aorto-carotid bypass from March 2002 to April 2015.
RESULTS
All patients were female and the mean of their age was 40.6 ± 15.3 years. Eleven patients (57.9%) underwent aorto-uni-carotid bypass and 8 patients (42.1%) underwent aorto-bi-carotid bypass. Five patients (26.3%) whose postoperative blood pressure was not controlled suffered an intracranial hemorrhage within 8 days after bypass surgery. Of the patients with an intracranial hemorrhage, 2 patients (10.5%) expired on 26 days and 7 years after surgery, and 3 patients (15.8%) resolved spontaneously. One patient (5.3%) expired due to an intracranial infarction 9 years after bypass surgery. The intracranial ischemic symptoms resolved after bypass surgery in all of the surviving patients. None of the patients experienced anastomosis site complication postoperatively.
CONCLUSION
Aorto-carotid bypass is effective for treating Takayasu arteritis with cerebrovascular ischemia, and the results suggest that postoperative blood pressure should be strictly managed to prevent intracranial hemorrhage.

Keyword

Takayasu arteritis; Blood pressure

MeSH Terms

Blood Pressure
Carotid Arteries
Female
Humans
Infarction
Intracranial Hemorrhages
Ischemia
Retrospective Studies
Takayasu Arteritis*

Figure

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  Fig. 1 Pathology of Takayasu arteritis. (A) Adventitia of artery showed markedly fibrotic and inflammatory cell infiltration at medioadventrial junction (H&E, ×10). (B) A few granulomas with giant cells are identified in medioadventitial junction (H&E, ×100).

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  Fig. 2 Aorto-uni-carotid bypass. Connecting aorta to left carotid artery using expanded polytetrafluoroethylene ringed graft.

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  Fig. 3 Aorto-bi-carotid bypass. Connecting aorta to bilateral carotid artery using expanded polytetrafluoroethylene bifurcated graft.

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  Fig. 4 CT angiography: preoperative (A, right; B, left) and postoperative (C) images of aorto-bi-carotid bypass. Female/24 years old, Bilateral common carotid artery occlusion case.

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  Fig. 5 Distribution of interval from diagnosis to operation. Dividing patients to 4 subgroups according to interval within 1 year, 2 years, 3 years, and over 3 years. Bold midline indicates median value, square indicates interquartile range.

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  Fig. 6 Cerebrovascular complications after surgery. Five intracranial haemorrhage cases including 2 expired cases, and 4 intracranial infarction cases including 1 expired case. Two cases suffered both intracranial haemorrhage and intracranial infarction.

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  Fig. 7 Postoperative course according to postoperative blood pressure (BP). ICH, intracranial hemorrhage.

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