高安病による両側総頸動脈狭窄症に対する内胸動脈-内頸動脈吻合術

抄録

Some Takayasu's arteritis (TA) patients suffer from occlusion and/or stenosis of major extracranial cerebral arteries. Various carotid reconstructions have been employed for these patients to relieve brain ischemic insult. Although the occlusive lesions could be treated with bypass grafts, indications and guidelines for operative management have not been well established. We present a new reconstructive procedure using internal thoracic artery (ITA, living graft) as the donor for bypass surgery to supplement the cerebral blood flow.
The case is a 38-year-old woman who presented with three episodes of syncope attack. The patient was admitted to our hospital and diagnosed as TA. Before the operation, the patient was scheduled to undergo aortocarotid bypass using saphenous veins. However, a dilated ascending aorta with an extremely thin wall made it impossible. Finally, we decided to use the ITA as the donor for bypass surgery.
This patient is now free of cerebral ischemic insult 15 months after operation. Although the procedure is still at a preliminary stage, we describe one successful case.