[Treatment of severe cerebral ischemia in Takayasu's disease with arterial reconstruction].
OBJECTIVE
To evaluate the effect of surgical bypass and to explore the role of transcranial doppler (TCD) during the bypass operation.


METHODS
From March 2003 to February 2008, sixteen patients (4 male and 12 female) with mean age of 32 years old and mean disease course of 7.5 years were treated by surgical procedures. The main clinical presentations were dizziness, headache, vertigo, and visional dysfunction. Variated degree of artery stenoses in the 4 arteries (bilateral carotid and vertebral arteries) were revealed by color doppler ultrasonography and DSA. Eight patients underwent aorto-bi-subclavian arteries prosthetic graft bypass. Three patients underwent aorto-bi-subclavian artery prosthetic graft bypass and graft-unilateral carotid artery bypass with autologous great saphenous vein. Three patients underwent aorta-unilateral subclavian artery-unilateral carotid artery prosthetic graft bypass. Two patients underwent aorta carotid artery bypass with autologous great saphenous vein, of which one patient underwent aortocoronary artery bypass simultaneously. Cerebral blood supply was monitored in 14 patients with transcranial doppler. Unilateral subclavian carotid and femoral carotid artery shunt was used respectively to avoid cerebral ischemia during operation in 2 patients.


RESULTS
Symptoms and signs of cerebral ischemia improved in all patients with effective rate of 100% apart from deflected tongue-protrusion in 3 patients which recovered in 2 weeks after operation. All patients survived and no symptoms recurred at the end of a 2.2 year's follow-up. Unfortunately, two patients developed aneurysm at the anastomosis within 4 years after operation.


CONCLUSIONS
Arterial reconstruction is an effective method for Takayasu's disease with severe cerebral ischemia. TCD monitoring plays an important role during the bypass operation. It can help to determine the revision of blood pressure and prevent postoperative brain reperfusion injury.
Gu
Yong-Quan
YQ
Vascular Institute, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, China. gu-yq@263.net
Zhang
Jian
J
Qi
Li-Xing
LX
Yu
Heng-Xi
HX
Li
Jian-Xin
JX
Li
Xue-Feng
XF
Guo
Lian-Rui
LR
Cui
Shi-Jun
SJ
Chen
Bing
B
Wu
Ying-Feng
YF
Tong
Zhu
Z
Wang
Zhong-Gao
ZG
D000328:Adult; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000209:etiology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012039:Regional Blood Flow; D013625:Takayasu Arteritis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult