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Axillo-axillary bypass for in-stent restenosis in Takayasu arteritis
Insights
Takayasu arteritis patients experiencing recurrent in-stent restenosis after stent placement may benefit from surgical intervention. Axillo-axillary bypass provided sustained symptom relief in a challenging case.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Rheumatology
Background:
- Takayasu arteritis (TA) is a large vessel vasculitis often affecting the aorta and its branches.
- Subclavian artery stenosis is a common manifestation, frequently treated with percutaneous transluminal balloon angioplasty and stent placement (SP).
- Recurrent in-stent restenosis (ISR) poses a significant challenge in managing TA patients.
Observation:
- A patient with Takayasu arteritis presented with recurrent ISR after initial stent placement for left subclavian artery stenosis.
- The patient underwent three repeat percutaneous transluminal rotational arterectomy (RA) procedures for recurring restenosis.
- Following multiple endovascular interventions, the patient opted for surgical management.
Findings:
- Axillo-axillary bypass surgery was performed to address the persistent subclavian artery stenosis and ISR.
- The patient remained asymptomatic for 10 months post-operatively, indicating successful disease management.
- This case highlights the limitations of repeated endovascular treatments in complex TA-related ISR.
Implications:
- Surgical revascularization, such as axillo-axillary bypass, may be a superior long-term treatment option for refractory ISR in Takayasu arteritis.
- Consideration of surgical intervention should be part of the treatment algorithm for TA patients with complex or recurrent ISR.
- Further studies are warranted to establish the role of surgical management in Takayasu arteritis-associated arterial lesions.
Abstract:
We report a patient with Takayasu arteritis (TA) who initially received stent placement (SP) following percutaneous transluminal balloon angioplasty for stenotic lesion of the left subclavian artery and subsequently had recurrent in-stent restenosis three times. Every time restenosis occurred, percutaneous transluminal rotational arterectomy (RA) was performed. After all, the patient underwent axillo-axillary bypass and has remained asymptomatic for 10 months after the surgery. We suggest that surgical treatment is beneficial for in-stent restenosis in patient with Takayasu arteritis.
