Table 5 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
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Source publication
Purpose
Takayasu arteritis is an indication for bypass surgery when this condition results in severe cerebrovascular ischemia due to occlusion of the carotid arteries. We reviewed the patients with Takayasu arteritis who received aorto-carotid bypass due to cerebrovascular ischemia.
Methods
A retrospective review was performed on 19 patients with...
Contexts in source publication
Context 1
... case (5.3%) was applied by a 14 × 7-mm size bifurcated type of Dacron graft (Table 3). As shown in Table 4, the graft type in patients who expired, ICH, intracranial infarction and graft occlusion was analyzed (Table 5). Five patients (26.3%) suffered an ICH within 8 days after bypass surgery. ...
Context 2
... pericardial effusion developed in 1 case (5.3%) and was improved by pericardiocentesis. There was superior femoral artery (SFA) occlusion at 11 months after surgery (Table 5). ...
Context 3
... ICH cases occurred within 8 days postoperatively. In contrast, intracranial infarctions occurred at varied post- operative times (Table 5, Fig. 6). ...
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Citations
... NIRS, BIS or cerebral oximetry measurement should be done if possible, especially in patients undergoing cardiac surgery with cardio-pulmonary bypass. 9 Vascular bypass procedures and valve replacement surgeries are generally deferred till the disease becomes inactive. Once the surgical procedure is over, extubation should be slow, smooth and controlled event. ...
Takayasu's arteritis (TA) is a rare disease characterized by chronic progressive pan-endarteritis involving large blood vessels with resultant feeble pulsations in involved arteries. Therefore, it is also referred as pulseless disease. The challenges for anaesthesia management includes uncontrolled hypertension, invasive arterial monitoring, central nervous system monitoring and end-organ dysfunction. We present successful management of a middle-aged female diagnosed with TA posted for aorto-carotid graft. The anaesthesia management and complications encountered are highlighted.
... В настоящее время при стенотических поражениях, таких как стеноз надаортальных, подвздошных и почечных артерий, все чаще применяется баллонная ангиопластика с установкой стента (стентов) в сосуд (сосуды) [69]. При выраженных стенотических и окклюзионных сосудистых изменениях в связи с высоким риском рестеноза для улучшения прогноза целесообразно проведение обходного артериального шунтирования [70][71][72][73]. ...
Takayasu arteritis (AT) is a chronic granulomatous systemic vasculitis that affects large vessels and requires a multidisciplinary approach as the clinical signs are non-specific and disease activity is difficult to assess. Early rational drug treatment of AT suppresses both vascular and systemic inflammation, with glucocorticoids and immunosuppressants being of paramount importance. Advances in the understanding of the pathophysiology of AT have contributed to the development of new treatments that target key pro-inflammatory factors and involve the use of biologic disease-modifying antirheumatic drugs.
... Our findings suggest a potential effect of unilateral carotid reconstruction on the contralateral ocular outcome. A possible explanation could be the initiation of perioperative medications (67). In addition, established patency on one side may reduce the collateral demand from the other, restoring contralateral ocular perfusion, as indicated in cerebral revascularization (68,69). ...
Background
Takayasu’s arteritis (TA) is a rare, chronic granulomatous large-vessel vasculitis that can lead to ocular ischemia. Ocular outcomes after therapeutic management in TA remain largely unknown. We herein conduct a case-based systematic review to address the current treatment options in this particular cohort.
Methods
PubMed, Medline, and EMBASE databases were searched pertaining to ocular outcomes after systemic treatment in TA. Studies reporting ocular examinations before and after treatment in TA patients with ocular ischemia were included. Clinical characteristics, therapies, ocular outcomes, and complications were recorded.
Results
A 29-year-old woman with newly diagnosed TA showed dramatic regression of Takayasu’s retinopathy (TR) following balloon angioplasty. Optical coherence tomography angiography (OCTA) was used as a novel strategy for subsequent follow-up. A total of 117 eyes of 66 patients with a median age of 27 years were included for systematic review. TR was the most common ocular manifestation. Oral steroids were prescribed in nearly all patients (n = 65), followed by the use of methotrexate and antiplatelet therapy. Of the patients, 65.8% and 34.2% underwent open surgery and endovascular procedure, respectively. The median follow-up period was 12 weeks (interquartile range 8–33.5). Surgical therapy showed better ocular improvement (including visual and imaging responses) in both acute and chronic vision loss, along with fewer complications than medical therapy alone. In the surgical group, the visual prognosis was significantly better in patients with initial visual acuity better than 20/200 (p = 0.03) and those who underwent surgery before stage III TR (p = 0.01). Ocular outcomes were equivalent in the two surgical approaches.
Conclusion
Clinicians should be familiar with ophthalmic manifestations of this potentially treatable complication in TA. Compared with medical therapy alone, surgical intervention might be a better choice for both acute and chronic vision loss. Surgery is best recommended before the onset of irreversible ischemia to the globe. A combined regimen (oral steroids, immunosuppressants, and antiplatelet drugs) might be effective for those with surgical contradictions or reluctance to an invasive procedure. Physicians should be aware of the importance of ocular examinations, including OCTA, during the diagnosis and follow-up in TA.
... Aorto-carotid bypass is a rare but well described procedure. The indication for intervention is typically malperfusion in the setting of either a dissection or vasculitic process [2]. Here, we present the case of severe orthostatic mediated TIAs secondary to atherosclerotic disease of the innominate and right common carotid artery (CCA) and internal carotid artery (ICA) requiring an aorto-carotid bypass graft. ...
... An aorto-carotid bypass was performed as described in collaboration with the vascular and cardiothoracic surgeons. This procedure is well documented in the literature with and without the support of CPB [2,9,10]. There is minor variations in surgical technique. ...
... There is minor variations in surgical technique. The indication for this procedure is typically malperfusion in the setting of a type A dissection with branch vessel involvement or a vasculitic process (usually Takayasu arteritis) with proximal occlusion of the branch vessels [2,9]. There were no previous reports of aorto-carotid bypass graft performed for orthostatic mediated cerebral hypoperfusion in the setting of atherosclerotic disease. ...
Introduction and importance
Aorto-carotid bypass is a rare procedure. It is reported to be performed for management of cerebral malperfusion in the setting of supra-aortic branch vessel disease. Malperfusion requiring a bypass is largely secondary to dissection or vasculitis. Atherosclerotic disease of the supra-aortic branch vessels is commonly managed via an endovascular approach. We report a rare and atypical presentation of cerebral malperfusion in the setting of atherosclerotic disease of the innominate and carotid arteries managed with an aorto-carotid bypass graft.
Case presentation
A case report of an 80-year-old female presenting with orthostatic mediated hypoperfusion transient ischaemic attacks with episodes of limb shaking and unilateral weakness with postural changes. The malperfusion was in the setting of severe atherosclerotic disease of the innominate and carotid arteries.
Clinical discussion and conclusion
Our patient was not amendable to endovascular intervention or a less invasive open approach. The patient underwent an aorto-carotid bypass graft with complete resolution of symptoms. This case highlights a rare manifestation of orthostatic mediated cerebral malperfusion and a successful novel treatment method.
... Both open and endovascular surgical approaches have been adopted in those with refractory symptoms despite optimal medical therapy. Aorto-carotid bypass is the most commonly used procedure [53,54]. The risk of complications are higher with open surgery, however there is superior long-term patency with restenosis rates approximately 12.5% [53,55]. ...
... Thus, these procedures are reserved for patients with short-focal lesions, or those considered to be very high risk for open surgery [56]. Tight blood pressure control and unilateral, as opposed to bilateral aorto-carotid bypass, reduces the risk of cerebral hyperperfusion haemorrhage [53,54]. ...
Takayasu arteritis is a large vessel vasculitis which commonly affects the aorta and its major branches. Active arterial inflammation is characterised by the presence of T and B lymphocytes, natural killer cells, macrophages and occasional multinucleate giant cells. Uncontrolled vascular inflammation can progress to cause arterial stenosis, occlusion or aneurysmal dilatation. Medical treatment involves combination immunosuppression and more recently biologic therapies targeting TNF-α and IL-6. Due to the typical delays in diagnosis and accumulation of arterial injury, open and endovascular surgical intervention are important and potentially life-saving treatment options for Takayasu arteritis. Common indications for surgery include aortic coarctation and ascending aortic dilatation ± aortic valve regurgitation, renal artery stenosis, ischaemic heart disease, supra-aortic disease, mesenteric ischaemia, severe limb-threatening claudication and aneurysm repair. Surgical outcomes are markedly improved in patients with clinically inactive disease and those who receive adequate periprocedural immunosuppression. Decisions regarding surgical approaches are best made as part of a multi-disciplinary team.
... According to previous literature, the post-operative blood pressure was maintained 10e20% lower than pre-operative levels, not >160 mmHg. 19,20 Furthermore, the blood pressure was tightly monitored and timely regulated according to patients' symptoms before discharging from the ICU. Eleven antihypertensive drugs were administered to different patients. ...
Objective
Type I Takayasu arteritis is common in Chinese patients and usually leads to cerebral ischaemia. There are limited data regarding simultaneous multi-supra-aortic artery (SMSAA) bypass in patients with type I Takayasu arteritis. The present study shares experience of using this method.
Methods
Seventeen patients with Takayasu arteritis who received SMSAA bypass from June 2012 to March 2016 were included in this analysis. Demographic features and basic information were recorded. Follow up results, including major complications, patency rates, and survival rates, were also obtained. The EQ-5D questionnaire was also administered to evaluate the quality of life of patients.
Results
Among these 17 patients, there were 77 supra-aortic arteries affected by TA and 37 arteries were reconstructed, 10 with great saphenous vein and 27 with artificial blood vessels. All the operations were technical successes and the mean operation time was 396.6 ± 93.4 min. The patients were followed for a mean of 25.2 ± 12.3 months. Two graft restenoses were found, and both were successfully recanalised by balloon dilatation. One patient suffered a minor stroke but was free from obvious sequelae. No major complications, recurrent symptoms, or deaths occurred during the follow up period. The EQ-5D questionnaire scores were significantly improved after the operation compared with the pre-operative scores (87.14 ± 8.25 vs. 58.93 ± 14.4, p < .01), and all the patients enjoyed a satisfactory quality of life.
Conclusion
SMSAA bypass in type I Takayasu arteritis can be effectively and safely performed with rigorous peri-operative management. Maintaining the patency of the bypass graft relieves the symptoms of cerebral ischaemia and helps sustain patients’ quality of life.
... Percutaneous transluminal angioplasty with stenting should be reserved for short lesions that are refractory to medication, but the odds of restenosis occurring are high if inflammation continues after vascular intervention. The use of steroids and tocilizumab preoperatively, and the use of tocilizumab postoperatively are a marvelous combination that not only control inflammation but also reduce the incidence of postoperative complications like stroke [3] restenosis, aneurysm, thrombosis, embolism, hypertension, neurologic impairment, and death [4]. Tocilizumab is an antibody, a biological agent that binds interleukin 6 receptor and hinders its pro-inflammatory effect [5]. ...
Takayasu arteritis is an idiopathic chronic vasculitis that involves large blood vessels, including
the aorta and its main branches. This disease presents typically as ischemia or aneurysms that
could be prevented by timely diagnosis and vigilant management. We present here the case of a
19-year-old male who presented with a history of visual disturbance, chest pain, dizziness, and
a feeble pulse.
Surgical brain revascularization is an important treatment for acute or chronic ischemia, intracranial aneurysms and skull base tumors. Individual anatomy of brain vessels should be clearly understood for this procedure. Variants of collateral cerebral blood flow in patients with cerebrovascular diseases depend on individual characteristics of circle of Willis and reserve mechanisms of collateral circulation. These anatomical variations require careful preoperative planning to choose the optimal revascularization option.
Objective: We present a rare case of Takayasu arteritis complicated by eosinophilic granulomatosis with polyangiitis (EGPA), followed by common carotid artery occlusion. Case Presentation: A 49-year-old woman with a history of EGPA rapidly developed left hemiplegia. MRI revealed acute infarction in the right middle cerebral artery territory. The right common carotid artery was not visualized on magnetic resonance angiography. She was transferred to our hospital for a detailed examination. Her erythrocyte sedimentation rate and C-reactive protein level were slightly increased. PET-CT showed high uptake in the aortic arch, right innominate artery, and common carotid artery, which supported the diagnosis of Takayasu arteritis. Rest ¹²³I-IMP-SPECT demonstrated low uptake in the right middle cerebral artery territory; therefore, subclavian-carotid bypass for revascularization of the right carotid artery was performed. She eventually recovered well from the surgery and was discharged home. Conclusion: Revascularization for common carotid artery occlusion of Takayasu arteritis with EGPA was safe and effective in improving the neurological status, and it should be performed while the disease is inactive.
