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Staged Combined Endovascular and Open Surgical Approach in a Patient with Takayasu's Arteritis
Alexander Varzari1, Animesh Rathore1, Rasesh M Shah1
1Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA.
Insights
Takayasu
Area of Science:
- Vascular Surgery
- Cardiology
- Rheumatology
Background:
- Takayasu's arteritis (TA) is a rare systemic vasculitis affecting large arteries.
- Cerebrovascular symptoms can occur in TA patients, sometimes requiring intervention.
Observation:
- A 59-year-old female with TA presented with refractory cerebrovascular symptoms including amaurosis fugax, syncope, and slurred speech.
- Vascular imaging revealed extensive arterial occlusions and stenosis, compromising cerebral blood flow.
- The patient's cerebral perfusion relied solely on a stenosed right vertebral artery (RVA).
Findings:
- A two-stage approach was employed for revascularization.
- The RVA was stented to restore posterior circulation.
- A bypass from the right subclavian artery to the right common carotid artery (RCCA) was performed to restore anterior circulation.
Implications:
- This case highlights the successful management of complex TA-related cerebrovascular disease.
- A combined endovascular and surgical strategy can effectively restore cerebral perfusion in select TA patients.
- This approach offers a viable option for TA patients with severe arterial compromise refractory to medical management.
Abstract:
Takayasu's arteritis (TA) is a systemic large vessel vasculitis that affects the aorta and its branches. Most patients with TA respond to medical therapy with a minority of patients requiring surgical intervention. In our report, we describe the case of a 59-year-old Caucasian female with TA who underwent revascularization due to cerebrovascular symptoms refractory to medical therapy. She initially presented with amaurosis fugax and developed episodes of syncope and slurred speech during corticosteroid tapering. Vascular studies showed right common carotid artery (RCCA), left internal carotid artery (LICA), and left subclavian artery (LSA) occlusion with the right vertebral artery (RVA) ostium stenosis, and retrograde flow through the left vertebral artery (LVA). The sole source of cerebral perfusion flowed through her stenosed RVA, so it was decided to first stent the RVA to restore adequate posterior cerebral circulation before creating a right subclavian artery to RCCA bypass to restore anterior circulation. This case represents the successful management of TA utilizing a two-staged combined endovascular and surgical approach.
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