Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
J Cardiothorac Surg. 2021 Mar 20;16(1):37. doi: 10.1186/s13019-021-01413-1.
Takayasu arteritis (TA) is a chronic inflammatory disease that induces stenosis, occlusion, or aneurysmal degeneration of the aorta and its major branches. Though rarely reported, proximal aneurysmal lesions from the aortic root to the arch are more common in Asian populations than in Western populations. In the surgical treatment of TA, anastomotic aneurysm can be problematic. Furthermore, atherosclerotic complications should be considered in surgical treatment for elderly TA patients.
Here, we report a case of brachiocephalic artery (BCA) aneurysm with TA for which surgical treatment was successful. Though it was solely a lesion of the brachiocephalic artery, after considering the patient's clinical background and the features of TA, we chose a partial arch replacement. Further, for avoidance of anastomotic aneurysm, both distal and proximal anastomosis were reinforced with Teflon felt strips. Preoperative computed tomography detected severe atherosclerotic changes in the arch vessels. The patient underwent partial arch replacement using isolated cerebral perfusion (ICP) for brain protection and recovered without any neurological deficits.
In avoidance with anastomotic aneurysm, reinforcement of the anastomosis was introduced. ICP was effective for brain protection in case with severe atherosclerotic changes.
Takayasu 动脉炎（TA）是一种慢性炎症性疾病，可导致主动脉及其主要分支的狭窄、闭塞或动脉瘤样变性。虽然很少有报道，但亚洲人群中从主动脉根部到弓部的近端动脉瘤性病变比西方人群更常见。在 TA 的手术治疗中，吻合口动脉瘤可能是一个问题。此外，在老年 TA 患者的手术治疗中应考虑到动脉粥样硬化并发症。
这里，我们报告一例 Takayasu 动脉炎合并头臂动脉（BCA）动脉瘤的病例，手术治疗成功。尽管这只是头臂动脉的单一病变，但考虑到患者的临床背景和 TA 的特点，我们选择了部分弓部置换。此外，为了避免吻合口动脉瘤，我们使用特氟隆毡条加固了远端和近端吻合口。术前计算机断层扫描发现弓部血管有严重的动脉粥样硬化改变。患者接受了使用孤立性脑灌注（ICP）进行脑保护的部分弓部置换，无任何神经功能缺损恢复。
为了避免吻合口动脉瘤，我们引入了吻合口加固。在存在严重动脉粥样硬化改变的情况下，ICP 对脑保护是有效的。
