Treatment of severe cerebral ischemia in takayasu's disease with arterial reconstruction

Abstract

Objective To explore the effect of surgical bypass and the role of transcranial doppler (TCD) during the bypass operation. Methods A retrospective analysis was performed for the surgical data of cerebral ischemic Takayasu disease from January 2003 to December 2012 in single center. Forty one patients were divided into two groups: Group A with TCD during operation (n=22) and Group B without TCD (n=19). For group A, the main operation methods were 10 ascending aorta-biliteral axillary (brachial)/subclavian artery artificial vascular graft bypass-unilateral internal carotid autologous great saphenous vein grafting, 7 ascending aorta (aortic arch)-biliteral axillary (brachial)/subclavian artery artificial vascular bypass grafting, 3 ascending aorta-unilateral subclavian and unilateral carotid artery artificial graft bypass, and 2 ascending aorta-unilateral internal carotid artery autogenous saphenous vein grafting. For group B, the corresponding number was 8, 9, 1, and 1 case, respectively. On the basis of above-mentioned ascending aorta-biliteral axillary artery graft, there were 5 artificial graft-unilateral internal carotid saphenous vein-grafting in both groups. Results All operations were successful with a success rate of 100% and without death.All grafts remained patency when discharged, and all patients had improved cerebral ischemic symptoms. The effective rate of treatment was 100% in both groups, without statistical significance between two groups (P>0.05). Complications were reversible tongue for 5 cases in group A and 4 in group B (P>0.05), dizziness for 2 cases in group A and 9 in group B (P 0.05), eye swelling for 7 cases in each group (P>0.05), and cerebral hemorrhage for 0 cases in group A and 2 in group B (P>0.05). All patients were followed-up 3.5 to 13.5 years, mean (8.5±2.0)years. Symptom recurrence was 2 cases in group A and 1 in group B, and the recurrence rate of two groups had no difference (P>0.05). Conclusions Cervical arterial blood flow reconstruction is a safe and effective treatment for cerebral ischemia caused by Takayasu arteritis. TCD intraoperative monitoring can reduce postoperative complications caused by hyperperfusion significantly. Key words: Arteritis/SU; Carotid arteries/SU; Blood vessel prosthesis/AE; Brain ischemia/ET; Ultrasonography, doppler, transcranial