Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Beijing, PR China; Peking Union Medical College, Chinese Academy of Medical Science, Beijing, PR China.
Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, PR China; Peking Union Medical College, Chinese Academy of Medical Science, Beijing, PR China.
Eur J Vasc Endovasc Surg. 2018 Dec;56(6):903-909. doi: 10.1016/j.ejvs.2018.08.044. Epub 2018 Oct 11.
Type I Takayasu arteritis is common in Chinese patients and usually leads to cerebral ischaemia. There are limited data regarding simultaneous multi-supra-aortic artery (SMSAA) bypass in patients with type I Takayasu arteritis. The present study shares experience of using this method.
Seventeen patients with Takayasu arteritis who received SMSAA bypass from June 2012 to March 2016 were included in this analysis. Demographic features and basic information were recorded. Follow up results, including major complications, patency rates, and survival rates, were also obtained. The EQ-5D questionnaire was also administered to evaluate the quality of life of patients.
Among these 17 patients, there were 77 supra-aortic arteries affected by TA and 37 arteries were reconstructed, 10 with great saphenous vein and 27 with artificial blood vessels. All the operations were technical successes and the mean operation time was 396.6 ± 93.4 min. The patients were followed for a mean of 25.2 ± 12.3 months. Two graft restenoses were found, and both were successfully recanalised by balloon dilatation. One patient suffered a minor stroke but was free from obvious sequelae. No major complications, recurrent symptoms, or deaths occurred during the follow up period. The EQ-5D questionnaire scores were significantly improved after the operation compared with the pre-operative scores (87.14 ± 8.25 vs. 58.93 ± 14.4, p < .01), and all the patients enjoyed a satisfactory quality of life.
SMSAA bypass in type I Takayasu arteritis can be effectively and safely performed with rigorous peri-operative management. Maintaining the patency of the bypass graft relieves the symptoms of cerebral ischaemia and helps sustain patients' quality of life.
Ⅰ型 Takayasu 动脉炎在中国患者中较为常见，通常导致脑缺血。关于Ⅰ型 Takayasu 动脉炎患者同时行多支主动脉上动脉（SMSAA）旁路移植术的相关数据有限。本研究介绍了应用该方法的经验。
回顾性分析 2012 年 6 月至 2016 年 3 月期间收治的 17 例行 SMSAA 旁路移植术的 Takayasu 动脉炎患者的临床资料。记录患者的一般资料、随访结果，包括主要并发症、通畅率和生存率。同时采用 EQ-5D 问卷评估患者的生活质量。
17 例患者中，TA 共累及 77 支主动脉上动脉，共重建 37 支动脉，其中 10 例采用大隐静脉，27 例采用人工血管。所有手术均获得成功，手术时间为（396.6±93.4）min。患者平均随访 25.2±12.3 个月。2 例患者发生吻合口狭窄，均经球囊扩张再通。1 例患者发生轻度卒中，但无明显后遗症。随访期间无重大并发症、症状复发或死亡。术后患者 EQ-5D 问卷评分显著高于术前（87.14±8.25 比 58.93±14.4，p<0.01），且所有患者生活质量满意。
严格围手术期管理能安全有效地为Ⅰ型 Takayasu 动脉炎患者实施 SMSAA 旁路移植术。保持旁路移植通畅能缓解脑缺血症状，维持患者的生活质量。
