Surgical treatment of atypical aortic coarctation complicating Takayasu’s arteritis—experience with 33 cases over 44 years

Taketani, Tsuyoshi; Miyata, Tetsuro; Morota, Tetsuro; Takamoto, Shinichi

doi:10.1016/j.jvs.2005.01.022

Cited by 65 publications

(63 citation statements)

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“…The operative mortality of the axillofemoral bypass was reported to be acceptable (4.9%), 9) compared with the other report on aortoaortic bypass (12.1%). 1) On the other hand, it was proposed that the patency of axillofemoral bypass graft was not high enough. Primary graft patency in 3 years was 63% for axillofemoral bypass and 85% for aortofemoral bypass.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, atypical aortic coarctation (AAC) has been reported to occur anywhere along the aorta except for the ascending aorta. 1) AAC is a condition associated with Takayasu's arteritis (TA), congenital hypoplasia, and atherosclerosis. The associated symptoms include hypotension in the lower half of the body (intermittent claudication, ischemic nephropathy, intestinal ischemia), secondary hypertension in the upper half of the body and heart failure due to afterload mismatch.…”

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confidence: 99%

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Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation)

et al. 2017

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SummaryAtypical aortic coarctation (AAC) has been reported to occur anywhere along the aorta, except for the ascending aorta. The associated symptoms include hypotension in the lower half of the body, secondary hypertension in the upper half of the body, and heart failure. Here we present an 80-year-old Asian woman complaining of progressive exertional dyspnea. She was diagnosed with acute decompensated heart failure and kidney injury due to severely calcified stenosis of the thoracoabdominal aorta, the so called AAC. She received hemodiafiltration, and pulmonary congestion improved in part. Generally, surgical treatments are quite invasive in elderly patients. Endovascular stent graft placement is less invasive, however, fracture and rupture should be considered at severely calcified lesions like this case. Therefore, we selected extra-anatomical axillofemoral bypass. Her recovery after the surgery was remarkable. In a few days, she became free from hemodiafiltration, intravenous diuretics, and oxygen administration. We thought the contributive factors are the increase in kidney blood flow and the correction of afterload mismatch. The decrease in pulse pressure may reflect the reduction in systemic arterial compliance by axillofemoral bypass. The operative mortality of axillofemoral bypass was reported to be acceptable, although the patency of the axillofemoral bypass graft was not high enough. In conclusion, axillofemoral bypass is effective and feasible for elderly patients with acute decompensated heart failure and kidney injury due to AAC.(Int Heart J 2017; 58: 820-823)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation)

et al. 2017

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“…Azóta is csak egyes esetek vagy kis szériák ismertetése lelhető fel. Hosszú távú utánkövetésről beszámoló közlemé-nyek nagyon ritkák [9][10][11]. Az atípusos aortacoarctatio előfordulási aránya a típusos coarctatiókhoz viszonyítva 0,5-2% [11].…”

Section: Megbeszélésunclassified

“…A fúzió elmaradása igen ritkán kettős hypoplasticus aorta megmaradását okozhatja [12]. Hasonló morfológiai elváltozásokat okozhat a Takayasu-arteritis, főként ázsiai populációban fordul elő [11,13]. Mások fibromuscularis dysplasiát, posztinfekciós érfali fibrosist, Marfanszindrómát, esetleg Recklinghausen-betegség vascularis manifesztációját, Williams-szindróma részjelenségét vagy autoimmun betegséget tételeznek fel [13][14][15].…”

Section: Megbeszélésunclassified

Atípusos aortacoarctatiók sebészi kezelésének hosszú távú eredményei

Dzsinich¹,

Entz

Berek³

et al. 2016

Orvosi Hetilap

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Bevezetés: Az aortacoarctatio a leggyakoribb congenitalis cardiovascularis elváltozások egyike, azok 5-8%-ában fordul elő. Típusos előfordulási helye az isthmicus szakasz. Atípusos helyen kialakuló coarctatio az esetek mintegy 1%-ában fordul elő és többnyire súlyos hypertoniával szövődik. Célkitűzés: A szerzők célul tűzték ki a kórkép sebészi kezelési lehetőségeinek és azok hosszú távú eredményeinek ismertetését 27 beteg műtéti kezelésével szerzett tapasztalataik alapján. Módszer: A 35 évet felölelő utánkövetés során a diagnosztika és a kezelési módszerek változtak. Napjainkban a morfológiai diagnózis legáltalánosabb módszerei a komputertomográfiás angiográfia és a mágneses rezonanciás angiográfia. Az aortarekonstrukció lehetőségei az endovascularis technikák bevezetésével gazdagodtak, de atípusos aortacoartatio esetében a szerzők ma is túlnyomóan változatos sebészi megoldásokat alkalmaznak. Eredmények: A műtétek után nem veszítettek el beteget. A hypertonia minden esetben jelentősen csökkent. Gyermekkorban operált esetekben a növekedés okozta testméretváltozások 3 esetben újabb rekonstrukciós műtétet indokoltak. Következ-tetések: Az atípusos aortacoarctatio individuális sebészi módszerekkel eredményesen kezelhető. Gyermekkorban operált esetekben a testméret-növekedés a rekonstruált aortaszakasz revízióját teheti szükségessé. Orv. Hetil., 2016, 157(26), 1043-1051. Kulcsszavak: atípusos aortacoarctatio, sebészi kezelés, késői eredmények Surgical treatment of atypical aortic coarctation. Long-term resultsIntroduction: Aortic coarctation is a frequent congenital cardiovascular disorder representing 5-8% of all cases. It is typically localized in the isthmic region. However, in about 1% of cases coarctation may develop in atypical sites of the aorta and it is frequently complicated with severe hypertension. Aim: The aim of the authors was to present diagnostic and surgical methods used in 27 patients with atypical aortic coarctation during the last 35 years with special interest on long-term results. Method: There was a great advance in diagnostic and surgical treatment methods during the time period analyzed in this study. Nowadays morphologic diagnosis is most commonly obtained using computed tomography angiography and magnetic resonance angiography. Some cases were treated with endovascular techniques, but the authors used also a wide variety of surgical approaches in these patients with atypical aortic coarctation. Results: No patient died after surgery and hypertension was reduced in all patients, too. Reintervention was necessary in patients operated in childhood due to change of body measures. Conclusions: Atypical aortic coarctation can be treated surgically with good early and late outcomes. Somatic growth of children may indicate surgical revision.

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“…Patients who do not respond to medical management should go for anatomic correction of lesions. Angioplasty, 14 stenting, 15 valve replacements and bypass surgeries can be done for anatomic correction of lesions. 16 …”

Section: Investigationsmentioning

confidence: 99%