Pulseless disease

Seventeen-year follow-up after ascending-to-infrarenal aorta bypass for recurrent coarctation in an adult

Anatomic repair of complex aortic coarctation is associated with significant mortality and morbidity, including paraplegia. Extra-anatomic bypass strategies have been developed to reduce these complications and allow the correction of any concomitant conditions during the same operation. We present the case of a woman with uncontrolled hypertension and preductal coarctation of the aorta diagnosed at age 22 who underwent an unsuccessful attempt at primary repair, followed by extra-anatomic bypass from the ascending-to-infrarenal aorta. The patient has remained normotensive, with no additional complications related to the disease or the procedure, during a follow-up of 17 years.

[Therapeutic approach to progressive Takayasu's arteritis]

BACKGROUND

Takayasu's arteritis (TA) is a nonspecific autoimmune inflammation manifested with systemic large vessel vasculitis which affects predominantly the aorta and its main branches.

CASE REPORT

We presented a 40-year-old woman with a two-year history of the symptoms of compromised circulation in the head, the neck, the upper extremities and the right leg, followed by claudications in the left leg, numbness in the left hand and stenocardia. Aortic arch angyography revealed occlusion of the right subclavian artery stenosis of the right vertebral artery (20-30%) and the right iliac artery. Anti-inflammatory agents had no satisfactory effect and due to the discase progression first aorto-bifemoral bypass grafting, and 10 months later left carotid-axillary bypass grafting were performed which led to the restoration of circulation in the lower extremities and the left arm.

CONCLUSION

This case suggested that a surgical therapy should be applied in the cases with progressive Takayasu's arteritis, particularly in the absence of a response to the conventional immunosupressive therapy to prevent eventual fatal complications.