Takayasu's aortitis treated surgically by extensive aortic replacement. A case report.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Rheumatology

Background:

• Takayasu's arteritis is a rare, chronic inflammatory disease affecting large arteries, primarily the aorta and its branches.
• Aneurysmal dilatation of the aorta is a serious complication, requiring complex surgical management.
• Extensive aortic involvement presents significant challenges in surgical planning and execution.

Observation:

• A case of Takayasu's arteritis with aneurysmal involvement of the ascending aorta, aortic arch, and descending thoracic aorta is reported.
• The patient underwent a successful two-stage surgical repair utilizing the "Elephant trunk" technique.
• The first stage involved ascending aorta and aortic arch replacement with selective cerebral perfusion.
• The second stage addressed the descending thoracic aorta replacement under partial cardiopulmonary bypass.

Findings:

• The two-stage "Elephant trunk" technique provided a successful surgical solution for extensive aortic aneurysms in Takayasu's arteritis.
• Selective cerebral perfusion and partial cardiopulmonary bypass were crucial for managing complex aortic arch and descending aorta repairs.
• The patient experienced an uneventful postoperative course and remains well one year after surgery.

Implications:

• This case highlights the feasibility and effectiveness of a staged surgical approach for extensive aortic disease in Takayasu's arteritis.
• The "Elephant trunk" technique is a viable strategy for managing complex aortic pathologies involving multiple segments.
• Optimal surgical planning and tailored cardiopulmonary bypass strategies are essential for favorable outcomes in these challenging cases.