title: Left subclavian-carotid bypass in a 38-year old female with brain ischemic symptoms secondary to Takayasu's arteritis: A case report.
abstract: BACKGROUND
  Takayasu's arteritis (TA) is a rare form of vasculitis that affects the aorta, its branches and pulmonary arteries. TA is primarily treated by pharmacologic therapy; however revascularization procedures may be required to treat organ ischemia. Evidence-based consensus regarding the indications for surgical or endovascular therapy for patients with supra-aortic vessels lesions remains unclear.
  
  
  METHODS
  We herein present a female patient with known TA since 2000, who experienced progressive and frequent episodes of amaurosis fugax in the left eye for 4 months. Computed tomography angiography (CTA) revealed focal stenotic segments in the right common carotid artery (CCA) and internal carotid artery (ICA) and near occlusion of the proximal left CCA. We opted to treat the left side first with open revascularization, and a subclavian-carotid bypass was performed using a 6 millimeters (mm) externally supported ePTFE graft. Patient recovered well from the surgery, her neurological exam was normal and she was discharged home in stable condition in postoperative day three. At three months she remains symptoms-free and her bypass is patent.
  
  
  CONCLUSIONS
  This case illustrates the clinical presentation of TA affecting both carotid arteries; open revascularization via carotid subclavian bypass grafting was successfully performed with minimal morbidity, complete resolution of symptoms and improvement of the patient's quality of life. Revascularization procedures when indicated should be performed while the disease is inactive and close surveillance is mandatory.
authors: Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico. Electronic address: carlos.a.hinojosa@gmail.com.
authors: Carlos A
authors: CA
authors: Hinojosa
authors: Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico.
authors: Rene
authors: R
authors: Lizola
authors: Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico.
authors: Javier E
authors: JE
authors: Anaya-Ayala
authors: Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico.
authors: Adriana
authors: A
authors: Torres-Machorro
authors: Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico.
authors: Hugo
authors: H
authors: Laparra-Escareno