Chen Xiyang, Zhao Jichun, Yuan Ding, Yang Yi, Huang Bin
Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
Ann Vasc Surg. 2020 Jan;62:498.e1-498.e5. doi: 10.1016/j.avsg.2019.06.021. Epub 2019 Aug 23.
Takayasu arteritis (TA) is a nonspecific and chronic inflammatory vasculitis that mainly affects the aorta and its main branches, resulting in stenosis or occlusion of the aorta or its main branches with related symptoms. Up to 60% of TA patients have renal artery involvement, which often lead to refractory hypertension and impaired renal function. Surgical repair and endovascular intervention are commonly employed in clinical practice. Surgical bypass with prosthetic or autologous vein graft is preferred for complicated lesions not suitable for endovascular intervention or patients who are allergic to contrast. Restenosis of bypass graft is one of the complications that vascular surgeons need to fix. Restenosis of graft is consistently eliminated by angioplasty based on the current studies. Limited literature reported surgical repair of restenosis of bypass graft. We report a patient with TA-induced bilateral renal arteries stenosis who underwent aorta-renal artery bypass and suffered from restenosis of bilateral grafts in a short period. Twice surgical bypass with saphenous vein graft for the initial treatment and with prosthetic graft for the second restenosis elimination was performed. The details of procedures, choice of graft, and analysis of restenosis will be discussed.
高安动脉炎（TA）是一种非特异性慢性炎症性血管炎，主要累及主动脉及其主要分支，导致主动脉或其主要分支狭窄或闭塞并伴有相关症状。高达60%的TA患者有肾动脉受累，这常导致难治性高血压和肾功能损害。临床实践中常用手术修复和血管内介入治疗。对于不适合血管内介入治疗或对造影剂过敏的复杂病变，首选使用人工血管或自体静脉移植物进行手术搭桥。搭桥移植物再狭窄是血管外科医生需要解决的并发症之一。根据目前的研究，血管成形术可持续消除移植物再狭窄。关于搭桥移植物再狭窄手术修复的文献报道有限。我们报告一例TA引起双侧肾动脉狭窄的患者，该患者接受了主动脉-肾动脉搭桥手术，短期内双侧移植物均出现再狭窄。首次治疗采用大隐静脉移植物进行两次手术搭桥，第二次消除再狭窄采用人工血管移植物。将讨论手术过程细节、移植物选择及再狭窄分析。
