Surgical treatment of brachiocephalic vessel involvement in Takayasu's arteritis.
BACKGROUND
Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty (PTA). Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA.


METHODS
From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15 - 42 years (mean 26.5 years). All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years.


RESULTS
There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients (20%) required further surgery for stenosis (5 patients) or anastomotic aneurysms (3 patients). Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5 - 24 months.


CONCLUSIONS
When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Xin
X
Wu
Hong-yong
HY
Duan
Yong-quan
YQ
Gu
Jian-xin
JX
Li
Bing
B
Chen
Zhong-gao
ZG
Wang
Jian
J
Zhang
D000293:Adolescent; D000328:Adult; D001167:Arteritis / Q000188:drug therapy; D016122:Brachiocephalic Trunk / Q000473:pathology / Q000601:surgery; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D013625:Takayasu Arteritis / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D008775:Methylprednisolone