A Case of Takayasu's Arteritis That Developed Impending Ruptured Subclavian Artery Aneurysm Associated with Sepsis during Steroid Therapy

(Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan)

Takashi Kunihara Kazuhiro Eya Tsukasa Miyatake
Norihiko Shiiya Keishu Yasuda
A 20-year-old woman had intermittent fever frequently since dental therapy one year previously. Two months previously Takayasu's arteritis had been diagnosed and she had been given 30mg/day prednisolone. She then developed subarachnoid hemorrhage, left arm pain/cataplexy, purpura, sight disturbance, and sepsis caused by Serratia. Finally she felt chest pain and a left subclavian artery pseudoaneurysm was detected out. Therefore she was transferred to our service for emergency surgery. Preoperative angiography demonstrated post-stenosis aneurysm in the right common carotid artery, left common carotid artery aneurysm, and saccular pseudoaneurysm in the left subclavian artery that suggested impending rupture. The operation was performed through a left upper partial sternotomy extended to the left supraclavicular space. The left subclavian artery was ligated proximal to the aneurysm and distal portion was also ligated through a subclavicular approach. The postoperative course was uneventful. No ischemic sign has been seen in her left arm one year after operation and left/right brachial artery pressure index has improved to 0.80. The patient currently takes steroids and remains healthy without signs of expansion of bilateral carotid artery aneurysms.
@Jpn. J. Cardiovasc. Surg. 33: 433-436 (2004)