Vertebral artery to common carotid artery bypass in Takayasu's disease with delayed cerebral ischemia.
Takayasu's Arteritis is a progressive occlusive disease of the aortic arch and its branches. It may need several bypass procedures along with or without endovascular techniques.


METHODS
A twenty-six year old woman who had a history of Takayasu's Arteritis, and had a Gore-Tex Dacron Y-graft from the ascending aorta to the right subclavian and right common carotid arteries 18 years before, is presented. She presented with recurrent hemispheric ischemia and transient ischemic attacks and severe long segment stenosis in the left common carotid artery. She was successfully treated with a saphenous vein graft bypass from the left vertebral artery to the common carotid artery. The stenosis of the brachiocephalic graft was successfully treated by angioplasty. Three months follow up showed stenosis of the left VA immediately proximal to the proximal anastomosis which was managed successfully with angioplasty.


CONCLUSIONS
The surgical treatment of Takayasu's Arteritis with bypass procedures needs a complex overview and follow up. A regular follow up is mandatory for evaluation and planning of appropriate management, in view of the progressive nature of the disease process.
Department of Neurosurgery, The George Washington University Medical Center, Washington DC 20037, USA.
I M
IM
Ziyal
L N
LN
Sekhar
K
K
Chandrasekar
W O
WO
Bank
D000328:Adult; D017130:Angioplasty; D002545:Brain Ischemia / Q000209:etiology*; D017536:Carotid Artery, Common / Q000601:surgery*; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000637:transplantation; D013625:Takayasu Arteritis / Q000473:pathology / Q000601:surgery*; D014711:Vertebral Artery / Q000601:surgery*