Takayasu’s Arteritis with Symptomatic Brachiocephalic Artery Stenosis and Left Common Carotid Artery Occlusion Undergoing Partial Arch Replacement after Coronary Artery Bypass Grafting

Taishi Inoue＊	Atsushi Omura＊	Soichiro Henmi＊
Mari Hamaguchi＊	Takanori Tsujimoto＊	Yu Murakami＊
Hidekazu Nakai＊	Katsuhiro Yamanaka＊	Takeshi Inoue＊
Kenji Okada＊

（Department of Cardiovascular Surgery, Kobe University＊, Kobe, Japan）

A 49-year-old man was referred to our hospital for surgical treatment of cerebral ischemia due to critical stenosis of aortic arch vessels;he had undergone coronary artery bypass grafting（CABG）using the bilateral internal thoracic artery for angina pectoris caused by left main trunk lesion due to Takayasu arteritis 9 years earlier. During follow-up after the CABG, asymptomatic total occlusion of the left common carotid artery was detected by surveillance imaging CT, and he started to complain of recurrent syncopal episodes along with progressive stenosis of the brachiocephalic artery. Since a bypass from the ascending aorta to the cervical artery seemed to be difficult due to the severely calcified and moderately dilated ascending aorta, partial arch replacement was then planned. Re-sternotomy was done without injury to patent internal thoracic arteries. Cardiopulmonary artery bypass was established with double inflow of an 8mm-graft anastomosed to the right axillary artery and left femoral artery. Brain protection was performed with the antegrade cerebral perfusion through direct cannulation to left subclavian artery, and right vertebral artery and right common carotid artery via the graft. Since reconstruction of the left common carotid artery was unnecessary because of long total occlusion, partial arch replacement with individual reconstruction of the right common carotid artery and right subclavian artery was successfully performed. The patient was discharged on postoperative day 20 without any complication.

 

Jpn. J. Cardiovasc. Surg. 50:101-105（2021）

Keywords：Takayasu’s arteritis;reoperation;coronary artery bypass grafting;aortic replacement