Surgical Treatment of Aortic Coarctation Associated with Multi-vessel Brachiocephalic Involvement in Takayasu's Arteritis

Yuji Sugawara, MD, Kazumasa Orihashi, MD, Kenji Okada, MD, Kazuhiro Kochi, MD, Katsuhiko Imaiand Taijiro Sueda, MD

In Takayasu's arteritis (TA), both atypical coarctation (CO) and brachiocephalic involvement are common features that occasionally require operative correction. A combination of these abnormalities could duplicate underlying illness in patients, posing an increased risk of operative morbidity. We present, herein, two TA patients in which hypertensive heart disease secondary to CO was surgically corrected. Both patients had multi-vessel brachiocephalic disease. One patient who showed occlusion of all brachiocephalic arteries underwent aorto-aortic bypass, while another with two-vessel lesion underwent axillo-bifemoral bypass grafting. Subclavian reconstruction was supplemental to each procedure, resulting in relief of neurologic stigmata. Strategies to avoid intraoperative cerebral ischemia played an important role in the surgical repair of such TA-related extensive vascular lesions. (Ann Thorac Cardiovasc Surg 2003; 9: 202-205)

Key words: Takayasu's arteritis, aortic coarctation, brachiocephalic involvement

From Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

Received November 25, 2002; accepted for publication January 8, 2003
Address reprint requests to Yuji Sugawara, MD: Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

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