Surgical Treatment for Takayasu Arteritis Complicated with Thoracic Aneurysm

Daisuke Hiraoka＊	Susumu Manabe＊	Kazunobu Hirooka＊
Daiki Hirayama＊	Takashi Yasukawa＊	Sotaro Katsui＊
Hidetoshi Uchiyama＊	Masahiro Onuki＊

（Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital＊, Tsuchiura, Japan）

Anti-inflammatory therapy is generally considered to be prior to surgery for Takayasu disease to achieve better outcomes. We report two Takayasu arteritis patients with thoracic aneurysm. Case 1 was a 19-year-old woman who presented acute trachyphonia for one month. CT revealed aortic arch aneurysm of which maximal diameter was 64 mm with partial cystic protrusion. We performed urgent total arch replacement before anti-inflammation therapy was induced. Postoperative course was uneventful and the patient discharged on steroid therapy. Case 2 was a 35-year-old woman who complained chest pain for two weeks. CT revealed a Valsalva aneurysm with maximal diameter 54mm and the aortic wall of the arch including its branches was surrounded by thick low density area. As the FDG-PET confirmed inflammatory arteritis, initial steroid therapy was planned. However, one day before admission, the patient presented acute aortic dissection and did not respond to any resuscitation. We conclude that the right time of surgery or the initial induction of anti-inflammatory therapy for anuerysmal dilation by Takayasu arteritis is to be determined based not only on the inflammation level but also on aneurysmal size and the patient’s severity of complaints.

 

Jpn. J. Cardiovasc. Surg. 47:289-292（2018）

Keywords：Takayasu arteritis;aneurysm;surgery;anti-inflammatory therapy