Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Chin Med J (Engl). 2010 May 5;123(9):1122-6.
Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty (PTA). Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA.
From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15 - 42 years (mean 26.5 years). All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years.
There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients (20%) required further surgery for stenosis (5 patients) or anastomotic aneurysms (3 patients). Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5 - 24 months.
When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.
Takayasu 动脉炎(TA)是一种慢性特发性炎症性疾病,影响大中动脉。头臂动脉是 TA 最常受累的部位,多血管病变很常见。手术治疗包括血管重建手术和经皮腔内血管成形术(PTA)。在此,我们报告了我们在因 TA 引起的颈总动脉病变导致的脑缺血的手术治疗方面的初步经验。
从 2000 年 1 月至 2007 年 12 月,我们对 38 例因 TA 导致颈总动脉闭塞性病变引起的脑缺血患者进行了手术治疗。其中男性 3 例,女性 35 例,年龄 15-42 岁(平均 26.5 岁)。所有患者均接受了手术修复。28 例患者接受了旁路手术,10 例患者接受了经皮腔内血管成形术。1 例合并冠状动脉狭窄患者同时接受了冠状动脉旁路移植术。患者随访 11 个月至 8 年。
在脑血管重建患者中,无围手术期死亡。38 例患者中,25 例脑缺血症状改善或治愈。脑再灌注综合征的发生率较低。2 例患者分别于术后 5 年和 7 年死于心力衰竭。另外 8 例(20%)患者因狭窄(5 例)或吻合口动脉瘤(3 例)需要进一步手术。PTA 成功治疗了主动脉和肾动脉病变。6 例 PTA 患者因再狭窄,在术后 5-24 个月行再次血管成形术以实现血运重建。
当脑灌注有可能受到 TA 影响时,建议在患者相对稳定时进行明确的矫正手术。虽然复发率很高,但经皮腔内血管成形术是首选的治疗方法。在 TA 中,头臂血管受累时旁路手术是最佳选择。通过仔细选择手术方法和改进术后治疗,可以避免脑再灌注综合征。