Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#20 SURGICAL MANAGEMENT OF TAKAYASU'S ARTERITIS OF THE SUPRA-AORTIC TRUNKS
Donald P. Spadone, MD and Timothy K. Liem, MD University of Missouri-Columbia Columbia, MO
Takayasu's arteritis is uncommon in North America. Few surgeons have experience with medical or surgical management of this illness. This patient is a 36-year-old female who presented with a right carotid bruit associated with non-specific hemispheric symptoms. She had multiple episodes of near syncope and dizziness with changes in position that significantly limited her activities. Her past medical history was significant for inactive Crohn's disease. On physical examination, her brachial artery pulses were absent with equal blood pressures. Color imaging showed high-grade stenosis of the right common carotid artery (CCA) with occlusion of the left CCA. There was no involvement of the abdominal aorta or the visceral arteries. An angiogram showed type I Takayasu's arteritis with a 5-60% stenosis of the right subclavian artery (SA) proximal to the vertebral artery (VA). The right VA was supplying all cerebral hemispheres except the right frontal temporal lobe. There was a 60-70% stenosis of the right CCA. The left CCA was occluded with patency of the left internal and external carotid arteries. The left proximal SA was occluded with a 99% stenosis of the left SA. Surgical repair was performed by a bypass from the ascending aorta to the left carotid bulb, mid-right CCA, and transposition of the left VA onto the graft. The patient did very well after surgery and had relief of her symptoms. Review of the pathophysiology of Takayasu's arteritis, the preoperative ultrasound and angiogram images, intraoperative images, and postoperative ultrasound images will be presented.
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Last updated January 10, 1999