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Aorto-carotid bypass in patients with Takayasu arteritis
Hong Seok Han1, Kyoung Won Yoon1, Seon-Hee Heo1
1Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Aorto-carotid bypass effectively treats cerebrovascular ischemia in Takayasu arteritis patients. Strict postoperative blood pressure management is crucial to prevent intracranial hemorrhage and improve outcomes.
Area of Science:
- Vascular Surgery
- Neurology
- Rheumatology
Background:
- Takayasu arteritis can cause severe cerebrovascular ischemia due to carotid artery occlusion.
- Bypass surgery is indicated for such cases.
Purpose of the Study:
- To review outcomes of aorto-carotid bypass in patients with Takayasu arteritis and cerebrovascular ischemia.
- To evaluate the effectiveness and complications of this surgical intervention.
Main Methods:
- Retrospective review of 19 Takayasu arteritis patients who underwent aorto-carotid bypass between March 2002 and April 2015.
- Analysis of patient demographics, surgical procedures (aorto-uni-carotid vs. aorto-bi-carotid bypass), and postoperative complications.
Main Results:
- All 19 patients were female, with a mean age of 40.6 years.
- Postoperative intracranial hemorrhage occurred in 26.3% of patients with uncontrolled blood pressure, leading to mortality in 10.5%.
- One patient (5.3%) died from intracranial infarction 9 years post-surgery; surviving patients showed resolution of ischemic symptoms. No anastomosis site complications were reported.
Conclusions:
- Aorto-carotid bypass is an effective treatment for Takayasu arteritis-induced cerebrovascular ischemia.
- Strict postoperative blood pressure control is essential to mitigate the risk of intracranial hemorrhage.
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.