Transthoracic arterial bypass for the treatment of severe cerebral ischemia induced by brachiocephalic arteritis A report of 15 cases

R74; BACKGROUND: Carotid arterial reconstruction is hard to cure the extensive lesions of carotid arteries and subclavian arteries in patients with brachiocephalic arteritis; however, transthoracic arterial bypass surgery provides an opportunity for the treatment of brachiocephalic arteritis.OBJECTIVE: To report the improving effects of transthoracic arterial bypass surgery on the clinical symptoms of severe cerebral ischemia induced by brachiocephalic arteritis and observe the occurrence of complications after the intervention.DESIGN: Case observation.SETTING: Department of Vascular Surgery, Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology.PARTICIPANTS: Fifteen patients with Takayasu arteritis, including 1 male and 14 females, were selected from Department of Vascular Surgery, Wuhan Union Hospital from June 2003 to June 2007. Their ages ranged from 16 to 37 years. All patients were finally diagnosed by clinical histories, health examinations and color Doppler detection. All patients provided the confirmed consent.METHODS: All patients had received transthoracic artificial vascular bypass surgery. Among them, 6 patients had the bridge from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; 3 from ascending aorta to bilateral axillary arteries; 5 from ascending aorta to lateral axillary artery to lateral internal carotid artery; In particular, one patient combining with abdominal aorta occlusion had received two step surgical interventions. In the first step, bridging surgery was performed from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; in the second step, patients received left axillofemoral bypass.MAIN OUTCOME MEASURES: ① Detecting blood velocity in variously intracranial-arterial systoles by using transcranial Doppler postoperatively; ② following-up the improve of clinical symptoms at 40 months after surgery; ③ observing postoperative complications.RESULTS: All 15 patients were involved in the final analysis. ① Intracranial-arterial blood velocity:Average intracranial-arterial blood velocity was significantly increased postoperatively (P ＜ 0.01). ②Following-up results of clinical symptoms: All patients did not have death and blindness; while, transient cerebral ischemia, dizzy, photophobia, giddiness, hemoptysis and other symptoms disappeared gradually;therefore, patients were able to live by themselves. ③ Postoperative complications: