Internal thoracic-carotid bypass surgery for Takayasu's arteritis.

BACKGROUND

Various carotid reconstructions have been used in Takayasu's arteritis (TA) to relieve brain ischemic insult. The indications and guidelines for surgical management, however, have remained poorly defined. The authors present a new reconstructive procedure using the sequential internal thoracic artery (ITA) as the donor for bypass surgery to supplement the cerebral blood flow.

CASE DESCRIPTION: A 38-year-old woman presented with three episodes of syncope. The patient was admitted to our hospital and was diagnosed with TA. Before the operation, the patient was designated to undergo aortocarotid bypass using saphenous veins. However, a dilated ascending aorta with an extremely thin wall made it impossible. Finally, we decided to use the ITA as the donor for bypass surgery. This patient is now free of cerebral ischemic insult 8 months after the operation.

CONCLUSION

Although the procedure is still at a preliminary stage, a successful case is briefly described.