Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Extra-Anatomic Ascending Aorta to Abdominal Aorta Bypass in Takayasu Arteritis Patients with Mid-Aortic Syndrome

  • Kim, Hak Ju (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Choi, Jae-Woong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hwang, Ho Young (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Ahn, Hyuk (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2016.08.30
  • Accepted : 2016.12.20
  • Published : 2017.08.05
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Abstract

Background: We evaluated the operative outcomes of an extra-anatomic bypass from the ascending aorta to the abdominal aorta in patients with type II or III Takayasu arteritis (TA) with mid-aortic syndrome. Methods: From 1988 to 2014, 8 patients with type II (n=2) or III (n=6) TA underwent an ascending aorta to abdominal aorta bypass. The mean patient age was $43.5{\pm}12.2years$ and the mean peak pressure gradient between the upper and lower extremities was $54.8{\pm}39.0mm\;Hg$. The median follow-up duration was 54.4 months (range, 17.8 to 177.4 months). Results: There were no cases of operative mortality. The mean peak pressure gradient significantly decreased to $-2.4{\pm}32.3mm\;Hg$ (p=0.017 compared to the preoperative value). Late death occurred in 2 patients. The symptoms of upper extremity hypertension and claudication improved in all patients. The bypass grafts were patent at $47.1{\pm}58.9months$ in 7 patients who underwent follow-up imaging studies. Conclusion: An extra-anatomic ascending aorta to abdominal aorta bypass could be an effective treatment option for severe aortic steno-occlusive disease in patients with type II or III TA, with favorable early and long-term outcomes.

Keywords

References

  1. Giordano JM. Surgical treatment of Takayasu's arteritis. Int J Cardiol 2000;75 Suppl 1:S123-8. https://doi.org/10.1016/S0167-5273(00)00179-0
  2. Heinemann MK, Ziemer G, Wahlers T, Kohler A, Borst HG. Extraanatomic thoracic aortic bypass grafts: indications, techniques, and results. Eur J Cardiothorac Surg 1997;11:169-75. https://doi.org/10.1016/S1010-7940(96)01018-4
  3. Blaisdell FW, De Mattei GA, Gauder PJ. Extraperitoneal thoracic aorta to femoral bypass graft as replacement for an infected aortic bifurcation prosthesis. Am J Surg 1961;102:583-5. https://doi.org/10.1016/0002-9610(61)90568-2
  4. Ueno A, Awane Y, Wakabayashi A, Shimizu K. Successfully operated obliterative brachiocephalic arteritis (Takayasu) associated with the elongated coarctation. Jpn Heart J 1967;8:538-44. https://doi.org/10.1536/ihj.8.538
  5. Ogino H, Matsuda H, Minatoya K, et al. Overview of late outcome of medical and surgical treatment for Takayasu arteritis. Circulation 2008;118:2738-47. https://doi.org/10.1161/CIRCULATIONAHA.107.759589
  6. Bali HK, Bhargava M, Jain AK, Sharma BK. De novo stenting of descending thoracic aorta in Takayasu arteritis: intermediate-term follow-up results. J Invasive Cardiol 2000;12:612-7.
  7. Saxena A, Kothari SS, Sharma S, Juneja R, Srivastava S. Percutaneous transluminal angioplasty of the aorta in children with nonspecific aortoarteritis: acute and follow-up results with special emphasis on left ventricular function. Catheter Cardiovasc Interv 2000;49:419-24. https://doi.org/10.1002/(SICI)1522-726X(200004)49:4<419::AID-CCD15>3.0.CO;2-I
  8. Shumacker Jr HB, Nahrwold DL, King H, Waldhausen JA. Coarctation of the aorta. Curr Probl Surg 1968;5:1-61, 63-4. https://doi.org/10.1016/S0011-3840(68)80017-6
  9. Matsuno Y, Mori Y, Umeda Y, Imaizumi M, Takiya H. A successful case of ascending aorta: abdominal aorta bypass for middle aortic syndrome. Vasc Endovascular Surg 2009;43:96-9. https://doi.org/10.1177/1538574408322756
  10. Yun JK, Kim JB. Extra-anatomic aortic bypass for the management of mid-aortic syndrome caused by Takayasu arteritis. Korean J Thorac Cardiovasc Surg 2015;48:70-3. https://doi.org/10.5090/kjtcs.2015.48.1.70
  11. Ahn H, Hwang HY. Ascending aorta-abdominal aorta bypass for Takayasu's arteritis. Asian Cardiovasc Thorac Ann 2003;11:357-8. https://doi.org/10.1177/021849230301100421
  12. Gelfand ET, Callaghan JC, Sterns LP. Extended aortic bypass. J Thorac Cardiovasc Surg 1980;79:381-7.

Cited by

  1. Endovascular Management of Middle Aortic Syndrome Presenting with Uncontrolled Hypertension vol.2018, pp.None, 2017, https://doi.org/10.1155/2018/9586025
  2. A Minimally Invasive Approach for the Treatment of Mid-Aortic Syndrome in Takayasu Arteritis vol.51, pp.6, 2017, https://doi.org/10.5090/kjtcs.2018.51.6.399