Hiu Takeshi, Kitagawa Naoki, Suyama Kazuhiko, Nagata Izumi
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Neurosurgery. 2008 May;62(5):E1178-9; discussion E1179. doi: 10.1227/01.neu.0000325887.07657.25.
This report describes a unique case of Takayasu arteritis with occlusion of the left common carotid artery (CCA) and the right internal carotid artery (ICA), which was successfully treated by right CCA-left ICA crossover bypass grafting using the saphenous vein. The histological findings of the original occluded prosthetic graft are also described.
A 63-year-old woman with a history of Takayasu arteritis was admitted to our hospital with a history of progressive dizziness, frequent syncopal attacks, and repetitive blurred vision in the left eye. She had undergone repeat transthoracic bypass surgeries, including grafting with the use of a Gore-Tex (W.L. Gore & Associates, Inc., Flagstaff, AZ) prosthesis between the left external ilioaxillary bypass and the left CCA. However, cerebral angiography demonstrated total occlusion of the left CCA, the right ICA, and the bilateral subclavian arteries. On admission, I-iodoamphetamine single-photon emission computed tomography showed a decreased cerebrovascular reactivity to acetazolamide in the bilateral cerebral hemispheres. Moreover, cerebral angiography revealed an occlusion of the Gore-Tex graft, whereas the left ICA was opacified through the retrograde filling in the left external carotid artery.
Crossover bypass grafting was performed using the saphenous vein between the right CCA and the left ICA. The Gore-Tex graft was partially removed, and myointimal hypertrophy with an inflammatory response around the wall was found histologically. The postoperative course was uneventful. A normalized cerebrovascular reserve in both cerebral hemispheres was demonstrated on I-iodoamphetamine single-photon emission computed tomography.
Although it is not frequently indicated, crossover bypass grafting using the saphenous vein between bilateral carotid arteries is considered to be a feasible alternative procedure in patients with Takayasu arteritis.
本报告描述了一例罕见的高安动脉炎病例，其左颈总动脉（CCA）和右颈内动脉（ICA）闭塞，通过使用大隐静脉进行右CCA - 左ICA交叉旁路移植术成功治疗。还描述了原始闭塞人工血管的组织学发现。
一名有高安动脉炎病史的63岁女性因进行性头晕、频繁晕厥发作和左眼反复视力模糊入院。她曾接受多次经胸旁路手术，包括在左髂外腋旁路和左CCA之间使用戈尔特斯（W.L. Gore & Associates, Inc., Flagstaff, AZ）人工血管进行移植。然而，脑血管造影显示左CCA、右ICA和双侧锁骨下动脉完全闭塞。入院时，I - 碘安非他明单光子发射计算机断层扫描显示双侧大脑半球对乙酰唑胺的脑血管反应性降低。此外，脑血管造影显示戈尔特斯人工血管闭塞，而左ICA通过左颈外动脉的逆行充盈显影。
使用大隐静脉在右CCA和左ICA之间进行交叉旁路移植术。部分切除戈尔特斯人工血管，组织学检查发现内膜肌层肥厚伴血管壁周围炎症反应。术后过程顺利。I - 碘安非他明单光子发射计算机断层扫描显示双侧大脑半球的脑血管储备恢复正常。
尽管并非经常需要，但在高安动脉炎患者中，使用大隐静脉在双侧颈动脉之间进行交叉旁路移植术被认为是一种可行的替代手术。
