New Challenge:Simultaneous Multi-Supra-Aortic Arteries Bypass in Takayasu Arteritis
Objective Type Ⅰ Takayasu arteritis is a progressive imflammatory disease involving the long segment of aortic arch and its branches.If untreated,which may result in cerebral ischemia and present with ranging from hemiplegia to death.Whilst there is a relatively strong evidence to recommend staged bypass for Type Ⅰ Takayasu arteritis as the simultaneous multi-supra-aortic arteries(SMSAA)bypass was still controversial.In this study,we firstly share our experience on the SMSAA bypass.Methods From June 2012 to November 2015,12 consecutive patients including 58 aorta branch lesions(severe stenosis>70%or occlusion)presenting with severe cerebral or upper limb ischemia symptoms and underwent SMSAA bypass including 27 grafts,10 with great saphenous vein(GSV),17 with artificial blood vessel(ABV).The disease inflammatory activity was evaluated and anti-inflammatory medication(steroids,methotrexate,or azathioprine,or both)were implemented.During perioperative period,it was intensified by intravenous steroids.Blood pressure was carefully monitored and aimed to 10%-20%lower than pre-operation.We reviewed the clinical features,lesion characteristic,operation information and follow up results.EQ-5D questionnaire was used to evaluate the improvement of the life quality.Results Patients were followed for a mean of 31±14.58 months(median,24 months; range,16-58 months).Restenosis(stenosis>50%)of the reconstructed arteries was observed in 2 of 27 grafts and both were recanalized successful by balloon dilatation.All patients experience clinical remission and without symptoms recurrent.No operative deaths occurred.Meanwhile,both ESR and CRP elevated after operation(ESR mean,pre-12.25±7.3,post-26.9±16.76,P<0.01; CRP mean,pre-1.39±1.77,post-12.2±13.8,P<0.01).There are 10 patients increase the dose of hypotension drugs and all patients” mean artery pressure(MAP)was controlled effectively.All patients enjoy satisfactory qualify of life.Conclusion In patients with Type Ⅰ Takayasu arteries,SMSAA bypass is feasible,effective and safely method.Combining with anti-inflammatory medication and tight blood pressure monitoring,which may be effective to reduce the risk of restenosis or major complications.The improvement of supra-aorta arteries blood flow could relieve symptoms of cerebral ischemia and is associated with an improved quality of life.
Zuo-guan Chen Yue-xin Chen Sheng Yan Zhi-yuan Wu Li Ma Yong-peng Diao Yong-jun Li
Department of Vascular Surgery,Beijing Hospital,Beijing,100005 Department of Vascular Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Ch
国内会议
北京
英文
1-17
2017-05-19（万方平台首次上网日期，不代表论文的发表时间）