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. 2017 Aug;50(4):270-274.
doi: 10.5090/kjtcs.2017.50.4.270. Epub 2017 Aug 5.

Extra-Anatomic Ascending Aorta to Abdominal Aorta Bypass in Takayasu Arteritis Patients with Mid-Aortic Syndrome

Hak Ju Kim  1 , Jae-Woong Choi  1 , Ho Young Hwang  1 , Hyuk Ahn  1
Affiliations

Extra-Anatomic Ascending Aorta to Abdominal Aorta Bypass in Takayasu Arteritis Patients with Mid-Aortic Syndrome

Hak Ju Kim et al. Korean J Thorac Cardiovasc Surg. 2017 Aug.

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±12.2 years and the mean peak pressure gradient between the upper and lower extremities was 54.8±39.0 mm 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±32.3 mm 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±58.9 months 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: Extra-anatomic bypass; Mid-aortic syndrome; Takayasu arteritis.

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Conflict of interest statement

Conflict of interest No potential conflicts of interest relevant to this article are reported.

Figures

Fig. 1
Fig. 1
(A) Preoperative computed tomography angiography. It shows diffuse calcification and narrowing of the descending thoracic and abdominal aorta. (B) Postoperative computed tomography angiography.
Fig. 2
Fig. 2
(A) Operative photographs of the ascending aorta-to-infrarenal abdominal aorta bypass. The graft was anastomosed proximally to the ascending aorta and passed down through right pleural cavity and diaphragm via median sternotomy. (B) Then the graft was made to take ante-hepatic, retro-gastric course and brought into retroperitoneal cavity. (C) The distal anastomosis was performed to infrarenal abdominal aorta, just above the iliac bifurcation.
Fig. 3
Fig. 3
Kaplan-Meier overall survival estimates.
See this image and copyright information in PMC

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