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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2000 September;19(3):242-249

language: English

Carotid artery reconstruction for Takayasu’s arteritis. The necessity of all-autogenous-vein graft policy and development of a new operation

Tada Y., Kamiya K., Shindo S., Miyata T. *, Koyama H. *, Sato O. **, Ariizumi K. ***

From the Sec­ond Depart­ment of Sur­gery, Yama­na­shi Med­i­cal Uni­ver­sity, Yama­na­shi, Japan
* Divi­sion of Vas­cu­lar Sur­gery, Depart­ment of Sur­gery, The Uni­ver­sity of Tokyo, Tokyo, Japan
** Depart­ment of Sur­gery, Sai­ta­ma Med­i­cal Cen­ter, Sai­ta­ma Med­i­cal ­School, Kaw­a­goe, Sai­ta­ma, Japan
*** Depart­ment of Car­di­o­vas­cu­lar Sur­gery, Yama­na­shi Kosei Hos­pi­tal, Yama­na­shi, Japan


Back­ground. We have adopt­ed an all-autog­e­nous-vein-graft pol­i­cy in carot­id recon­struc­tion for Takay­a­su arter­itis, name­ly an ascen­do-right carot­id and right sub­cla­vian (axil­lary) arter­ies ­bypass using a pan­ta­loon vein graft for ­patients all of whose arch branch­es are occlud­ed, and an extra-ana­tom­i­cal ­bypass from the right sub­cla­vian ­artery for ­patients whose brach­i­oc­e­phal­ic ­artery is the only arch ­branch that ­remains pat­ent. This ­report is to elab­orate on these oper­a­tions and to ­assess the long-term out­come.
Meth­ods. Six ­patients were oper­at­ed on accord­ing to this pol­i­cy; (5 women, 1 man, age range: 14 to 59 years (mean: 30). The indi­ca­tions for sur­gery were ­severe cere­bral ischae­mia that sig­nif­i­cant­ly inter­fered with their daily lives. The pan­ta­loon vein graft ­bypass was per­formed in four ­patients, and an extra-ana­tom­i­cal ­bypass in two. The spe­cif­ic man­age­ment pro­to­col to pre­vent the “post­bypass hyper­per­fu­sion syn­drome” and cere­bral oede­ma includ­ed a shunt pro­ce­dure to the inter­nal carot­id ­artery using one limb of the pan­ta­loon vein graft, ­induced hypo­ten­sion just ­before the com­ple­tion of the carot­id recon­struc­tion and the admin­is­tra­tion of a glyce­rine-fruc­tose solu­tion.
­Results. Cere­bral ischaem­ic symp­toms dis­ap­peared in all ­patients. All but one, who died of a rup­tured thor­a­co-ab­dom­i­nal aneu­rysm on the 35th post­op­er­a­tive month, are liv­ing a nor­mal life with a pat­ent graft. No ­suture line com­pli­ca­tions have as yet been encoun­tered (fol­low-up: 10 to 205 ­months, mean: 126 ­months).
Con­clu­sions. Carot­id vein ­bypass for Takay­a­su arter­itis, par­tic­u­lar­ly, the pan­ta­loon vein graft ­bypass is rec­om­mend­ed for those of whom all aor­tic arch branch­es are occlud­ed, result­ing in ­severe brain ischae­mia. Per­i­op­er­a­tive blood pres­sure con­trol is impor­tant for pre­ven­tion of the hyper­per­fu­sion syn­drome.

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