Treatment of Takayasu's Arteritis: An Analysis of 29 Operated Patients

Abstract

Over a 25-year period 29 patients underwent 49 vascular procedures due to arterial insufficiency or vascular complications caused by Takayasu's arteritis. In bypass operations 36 grafts were inserted. The 5-year patency rates were 53% when grafts were used for patients with the active disease stage and 88% during the inactive disease stage (p = 0.059). The material of the graft, or postoperative warfarin or platelet-inhibitor drug treatment administered for at least 3 postoperative months had less bearing on graft patency. Ten out of the 11 graft occlusions occurred within the first 2 postoperative years. In operations due to lesions of the brachiocephalic arteries (20 patients), bypass procedures appeared to be superior to thromboendarterectomies; 67% (20/30) of the grafts and 17% (1/6) of the thromboendarterectomies remained patent. Five hypertensive patients underwent surgery because of renal artery stenosis. Hypertension was cured in one patient and in another the antihypertensive regimens could be reduced. There were 2 operative deaths, one due to myocardial infarction after aortic valve replacement and the other due to cerebral hemorrhage, probably because of excessive blood flow resulting from the insertion of an aorto-bicarotid bifurcation bypass graft. Four of the 7 late deaths occurring nine months to 15.7 years postoperatively were considered to be related to Takayasu's arteritis.

Endoluminal stenting for unprotected left main stenosis in Takayasu's arteritis

“…Previous studies have shown an increased risk of failure of surgical revascularization during active disease [11]. Findings of histologically active arteritis in this group correlate poorly with clinical assessment of activity [12].…”

Usefulness of femoro(ilio)-axillar bypass surgery for the treatment of subclavian steal syndrome caused by aortitis syndrome

“…Pajari et al [6] reported that graft patency in the active stage of aortitis syndrome was reduced compared to patency in the inactive stage. Therefore, not only general anticoagulant therapy but also good control of the aortitis syndrome seem to be essential for long-term graft patency after this operation.…”

Single Stage Multiple Stenting in Takayasu's Arteritis

“…Some endovascular surgeons claim that single stage multiple deployment may cause drastic dynamic changes in blood flow, which would subsequently increase the risk of cerebrovascular accidents. Cerebral hemorrhage after bilateral aorta to carotid grafts has been the cause of deaths, 12,14) attributed to sudden, excessive blood flow through the graft or to severe autonomic dysregulation that may have been related to bilateral carotid sinus dysfunction as a result of Takayasu's arteritis. 12,14) However, we should note that excessive anti-coagulation or antiplatelet medication during and after surgery may also be implicated in the occurrence of these cerebral hemorrhages.…”

“…Cerebral hemorrhage after bilateral aorta to carotid grafts has been the cause of deaths, 12,14) attributed to sudden, excessive blood flow through the graft or to severe autonomic dysregulation that may have been related to bilateral carotid sinus dysfunction as a result of Takayasu's arteritis. 12,14) However, we should note that excessive anti-coagulation or antiplatelet medication during and after surgery may also be implicated in the occurrence of these cerebral hemorrhages. In our case, single stage multiple deployments had no apparent adverse events during and after the procedure, possibly as our patient had cerebral infarcts limited to the left basal ganglia and the left temporal lobe.…”