Aortobilateral axillary bypass to treat severe cerebral ischemia due to Takayasu's arteritis.
Cerebral ischemia resulting from four cervical arterial occlusions due to Takayasu's arteritis is a rare condition. Ascending aortounilateral/-bilateral internal carotid arterial bypass is a means for relieving it. However, postoperative reperfusion syndrome remains an unsolved severe, even fatal complication. The following case report reveals new findings. The patient presented massive cerebral infarction in the left cerebral hemisphere, four cervical arterial lesions, and bilateral subclavian steal syndrome. An ascending aorta to bilateral axillary bypass resumed the vertebral blood flow, and as a result the patient had a marvelous improvement. Unlike ascending aorta-carotid bypass, which directly increases brain perfusion, our procedure does so indirectly via axillary arteries. Therefore, there is strong reason to recommend ascending aorta to biaxillary bypass for patients with cerebral ischemia due to four cervical arterial lesions accompanying a bilateral subclavian steal phenomenon that has reversed vertebral flow.
Zhang
Bin
B
Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
Wang
Zhong-gao
ZG
Huang
Ying
Y
Gu
Yong-quan
YQ
Yu
Heng-xi
HX
Chen
Bing
B
Zhang
Jian
J
D000328:Adult; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D012720:Severity of Illness Index; D013349:Subclavian Steal Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013625:Takayasu Arteritis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome