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[Cerebral revascularisation in Takayasu's arteritis]
A El Mesnaoui1, N Sedki, A Bouarhroum
1Service de chirurgie vasculaire, hôpital Ibn-Sina, Rabat, Maroc.
Insights
Surgical bypass is crucial for managing cerebral ischemia in Takayasu
Area of Science:
- Vascular Surgery
- Neurology
- Rheumatology
Context:
- Takayasu's arteritis frequently involves long arterial segments, rendering angioplasty unfeasible.
- Cerebral ischemia is a significant complication of Takayasu's arteritis.
- Surgical intervention plays a vital role in managing cerebral ischemia in these patients.
Purpose:
- To define indications and surgical techniques for head artery lesions in Takayasu's arteritis.
- To present surgical experience with seven patients suffering from cervical arterial lesions due to Takayasu's arteritis.
Summary:
- Seven patients with Takayasu's arteritis underwent bypass surgery for cervical arterial lesions.
- Procedures included aorta-to-carotid and brachiocephalic-to-carotid bypasses.
- Outcomes varied, with some patients showing significant improvement, while others experienced bypass thrombosis or complications like cerebral hemorrhage.
Impact:
- Highlights the importance of surgical treatment for cerebral ischemia in Takayasu's arteritis.
- Suggests that operative indications should consider cerebral blood flow assessment.
- Emphasizes the risk of cerebral hyperperfusion syndrome and the benefit of staged revascularization.
Subject:
Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience.
Methods:
Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years.
Results:
It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases.
Conclusion:
The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.
