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[Surgical tactics in nonspecific aortoarteritis of the thoracoabdominal region]
Insights
This study evaluated surgical strategies for nonspecific aortoarteritis affecting the thoracoabdominal aorta and brachiocephalic trunks. Surgical reconstruction, often involving simultaneous repair of visceral and renal arteries, demonstrated effective management for these complex vascular conditions.
Area of Science:
- Vascular Surgery
- Cardiovascular Diseases
- Aortoarteritis
Context:
- Nonspecific aortoarteritis (Takayasu arteritis) is a rare inflammatory condition affecting the aorta and its major branches.
- Thoracoabdominal localization presents complex surgical challenges due to the involvement of multiple critical arteries.
Purpose:
- To detail surgical tactics and outcomes for patients with thoracoabdominal nonspecific aortoarteritis.
- To evaluate the efficacy of reconstructive operations on both the thoracoabdominal aorta and brachiocephalic trunks.
Summary:
- A retrospective analysis of 66 patients with nonspecific aortoarteritis treated between 1984-1989.
- 49 patients underwent surgery, including 42 reconstructive interventions on the thoracoabdominal segment, with 35 involving simultaneous repair of visceral and renal arteries.
- 16 patients had reconstructive operations on brachiocephalic trunks due to concurrent aortic arch branch involvement.
Impact:
- Highlights the feasibility and results of complex surgical reconstructions for a challenging vascular disease.
- Provides insights into managing patients with multi-segmental aortoarteritis.
- Contributes to the understanding of surgical decision-making in aortoarteritis treatment.
Abstract:
Sixty-six patients with nonspecific aortoarteritis of thoracoabdominal localization were treated at the department of vascular surgery of the Vishnevsky Institute of Surgery, AMS USSR from 1984 to 1989. Operations were performed on 49 (74.9%) patients. Percutaneous angiodilatation of the renal arteries was conducted in 3 (4.5%) patients. Nonoperative treatment was carried out in 14 (21.2%) patients. In view of concurrent affection of the branches of the arch of the aorta, reconstructive operations were performed in 16 (24.2%) cases on the brachiocephalic trunks: aorto-biocarotid prosthetics (6), aortocarotid prosthetics (1), subclavian-carotid autovenous prosthetics (6), carotid-subclavian autovenous shunt (2), carotid endarterectomy (1). Reconstructive operations on the brachiocephalic trunks were preceded by reconstruction of the arteries in 5 (7.6%) cases and were conducted after correction of the blood flow in the thoracoabdominal segment in 2 (3%) cases. In 9 (13.6%) patients only the brachiocephalic trunks were reconstructed. A total of 42 reconstructive interventions on the thoracoabdominal segment were carried out on 40 (60.6%) patients, in 35 (87.5%) correction of the blood flow in the visceral branches and renal arteries was performed simultaneously. The surgical tactics suggested by the authors and the results produced by it are discussed in detail.