El Mesnaoui A, Sedki N, Bouarhroum A, Sedki A, El Mahi O, Alaoui M, El Idrissi R, Sefiani Y, Lekehal B, Benjelloun A, Ammar F, Bensaïd Y
Service de chirurgie vasculaire, hôpital Ibn-Sina, Rabat, Maroc.
Ann Cardiol Angeiol (Paris). 2007 Jun;56(3):130-6. doi: 10.1016/j.ancard.2007.02.004. Epub 2007 Mar 15.
Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience.
Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years.
It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases.
The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.
由于动脉长段受累，对于大动脉炎患者，主动脉弓上血管成形术往往不可行。因此，手术治疗在该疾病脑缺血管理中的作用至关重要。本研究的目的是明确该疾病头部动脉病变的手术指征和技术，并报告我们的经验。
在11年的一个时间段内，伊本·西那医院血管外科对7例因大动脉炎导致颈段动脉病变的患者进行了搭桥手术。
确诊时患者年龄为33.8岁，其中6名女性，1名男性。首发症状主要为神经和眼部症状。我们的6例患者在确诊时处于炎症活动期，首先需要以皮质类固醇为基础的药物治疗。6例患者进行了从升主动脉到颈动脉的搭桥手术。1例患者在头臂动脉和颈总动脉之间进行了搭桥手术。血管重建术后2天发生了1例与脑出血相关的死亡。3例患者功能症状明显改善，另外2例部分改善。3例患者发生了搭桥手术继发性血栓形成。
大动脉炎的自然病史及其演变情况了解甚少。手术指征不应仅基于解剖学平衡，而应基于一系列因素，其中脑血流评估可能会有所帮助。脑过度灌注综合征是一个主要风险，可以通过分期血管重建来降低。
