title: Coronary artery bypass grafting in Takayasu's disease--importance of the proximal anastomosis: a case report.
abstract: BACKGROUND
  Treatment of coronary artery involvement in Takayasu's arteritis is challenging. Coronary artery bypass grafting may be required. The use of saphenous vein grafts is recommended because of possible inflammatory involvement of the internal thoracic arteries. However, inserting the proximal anastomosis on inflamed aortic tissue may give rise to stenosis. Only a few cases of inserting a proximal anastomosis in patients with Takayasu's arteritis have been reported in the literature. To date, no consensus has been reached on the best way to perform this procedure in patients with Takayasu's arteritis.
  
  
  METHODS
  We report a case of a 25-year-old white woman with Takayasu's arteritis who had recurrent angina after two previous treatments had failed, due to left main stem stenosis. She was successfully treated by coronary artery bypass grafting using a Dacron patch to insert the proximal anastomosis.
  
  
  CONCLUSIONS
  We are the first to report an uncomplicated case in which a Dacron (Vascutek®, Renfrewshire) prosthetic patch was used to insert the proximal anastomosis on an inflamed aorta in a patient with Takayasu's arteritis. The patch prevents contact between inflamed tissue and the graft, which we believe reduces the risk of graft failure. This case might inspire other thoracic surgeons in the challenging task of performing revascularization techniques in patients with an inflamed and fragile aorta.
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands. anne_kuijer@hotmail.com.
authors.forename: Anne
authors.initials: A
authors.lastname: Kuijer
authors.affiliation: Department of Pathology, Sint Antonius Hospital Nieuwegein, Koekoekslaan 1, mailbox 2500, 3430 EM, Nieuwegein, The Netherlands. m.van.oosterhout@antoniusziekenhuis.nl.
authors.forename: Matthijs F M
authors.initials: MF
authors.lastname: van Oosterhout
authors.affiliation: Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, Koekoekslaan 1, mailbox 2500, 3430 EM, Nieuwegein, The Netherlands. geoffrey_kloppenburg@hotmail.com.
authors.forename: Geoffrey T L
authors.initials: GT
authors.lastname: Kloppenburg
authors.affiliation: Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, Koekoekslaan 1, mailbox 2500, 3430 EM, Nieuwegein, The Netherlands. w.morshuis@antoniusziekenhuis.nl.
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Morshuis
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D060050:Angina, Stable / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D011093:Polyethylene Terephthalates; D012008:Recurrence; D013625:Takayasu Arteritis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates