title: Complex aortic arch repair in a patient with Takayasu's disease presenting with acute aortic dissection type Stanford A and complete collateral perfusion of the brain.
abstract: We describe a rare case of a 46-year old woman suffering from Takayasu's disease. She had undergone aorto-biaxillary bypass and aorto-cerebral bypass surgery in 1985 for occlusive arterial disease and developed a large ascending pseudoaneurysm of the aorto-biaxillary bypass. The aorto-cerebral bypass and right axillary bypass were occluded. Native supra-aortic arteries were found to be proximally occluded and arterial blood supply to the brain was maintained by a dense arterial collateral network. The patient did not show neurological deficits and was able to work using both arms without restrictions. She refused early surgery but suffered from acute aortic dissection type Stanford A shortly after. Supracommissural ascending aortic and aortic arch repair under deep hypothermic circulatory arrest with no additional bypass to the head vessels was performed. This case demonstrates the significance of aortic complications in Takayasu's disease and the effectiveness of collateral brain perfusion in selected patients.
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: Anneke
authors.initials: A
authors.lastname: Neumann
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: Nurbol
authors.initials: N
authors.lastname: Koigeldiyev
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School (MHH), Hannover, Germany martens.andreas@mh-hannover.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Martens
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D003097:Collateral Circulation; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008875:Middle Aged; D013625:Takayasu Arteritis / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Acute aortic dissection type Stanford A; Aortic disease; Takayasu's disease