J. V. Robbs, Ch. M. , F. R. C. S. , R. R. Human, F. C. S. (S. A. ), P

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Presentation transcript:

Operative treatment of nonspecific aortoarteritis (Takayasu's arteritis) J.V. Robbs, Ch.M., F.R.C.S., R.R. Human, F.C.S.(S.A.), P. Rajaruthnam, F.R.C.S. Journal of Vascular Surgery Volume 3, Issue 4, Pages 605-616 (April 1986) DOI: 10.1016/0741-5214(86)90285-5 Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Photomicrographs showing typical histologic features of nonspecific aortoarteritis. A, Low power illustrating intimal fibrosis, disintegration and fragmentation of media, and adventitial fibrosis. There is diffuse nonspecific inflammatory infiltrate. Typical giant cells (arrow) can be seen in media (original magnification, ×30). B, Higher power view of typical giant cell (arrow) in media. These cells are usually found at interface between relatively normal and disintegrating media (original magnification, ×250). Journal of Vascular Surgery 1986 3, 605-616DOI: (10.1016/0741-5214(86)90285-5) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Midstream aortogram of 14-year-old patient (patient 16, Table II) with renovascular hypertension demonstrating total occlusion of main left renal artery extending into peripheral branches. At operation thrombosed aneurysm of renal artery was found. Journal of Vascular Surgery 1986 3, 605-616DOI: (10.1016/0741-5214(86)90285-5) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Arch aortogram of 16-year-old girl (patient 1, Table I) showing total occlusion of left common carotid and subclavian arteries and tight stenosis of distal brachiocephalic trunk (arrow). Journal of Vascular Surgery 1986 3, 605-616DOI: (10.1016/0741-5214(86)90285-5) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Operative photograph showing transected diseased brachiocephalic trunk (D). Note gross thickening and fibrosis of arterial wall resulting in almost complete occlusion of vessel, contrasted with normal transected subclavian artery (N). One limb of bifurcated Dacron graft between ascending aorta and right common carotid artery can be seen passing between both. Other limb was anastomosed to subclavian artery. Angiogram of this patient (patient 1, Table I) is shown in Fig. 3. Journal of Vascular Surgery 1986 3, 605-616DOI: (10.1016/0741-5214(86)90285-5) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Midstream aortogram of 23-year-old woman (patient 23, Table III) showing stenosis of infrarenal aorta and stenosis of right renal artery with distal reconstitution. This is classic appearance of so-called middle aortic syndrome. Journal of Vascular Surgery 1986 3, 605-616DOI: (10.1016/0741-5214(86)90285-5) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Patient 23, Table III. Transfemoral aortogram 42 months after aortic replacement and bilateral renal artery reconstruction with Dacron prostheses. There has been no apparent progression of disease process. Journal of Vascular Surgery 1986 3, 605-616DOI: (10.1016/0741-5214(86)90285-5) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 A, Arch aortogram of 19-year-old man (patient 25, Table III) showing total occlusion of left common carotid (arrow) and subclavian arteries. There is some dilatation of brachiocephalic and right common carotid arteries. B, Descending aortogram of same patient showing gross aneurysmal dilatation of lower thoracic and infrarenal abdominal aorta. Segment of aorta below renal artery is stenosed near origin and left is totally occluded. Visceral vessels all appear ectatic. At operation proximal inferior mesenteric artery was frankly aneurysmal. Journal of Vascular Surgery 1986 3, 605-616DOI: (10.1016/0741-5214(86)90285-5) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions