Surgical repair of visceral artery occlusions in Takayasu's disease

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Presentation transcript:

Surgical repair of visceral artery occlusions in Takayasu's disease David Scott, F.R.A.C.S., Hussein Awang, F.R.A.C.S., Bakar Sulieman, F.R.A.C.P., Florence Wang, F.R.C.P., Roslan Bin Arshad, F.R.C.S., Napier Thomson, F.R.A.C.P. Journal of Vascular Surgery Volume 3, Issue 6, Pages 904-910 (June 1986) DOI: 10.1016/0741-5214(86)90158-8 Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Arteriogram of case 1 (17-year-old female patient) shows diffuse irregularity of abdominal aorta with occlusion of the right renal artery and severe stenosis of the left renal artery. Vessel distal to aortic bifurcation were normal. Journal of Vascular Surgery 1986 3, 904-910DOI: (10.1016/0741-5214(86)90158-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Case 1. A, Photomicrograph of aortic wall demonstrates irregular destruction of elastic fibers in the media (elastic van Gieson stain; original magnification, × 30). B, This photomicrograph demonstrates area of chronic inflammatory cells arranged as a granuloma with multinucleate giant cells without caseation in wall of aorta (hematoxylin-eosin stain; original magnification, × 120). Journal of Vascular Surgery 1986 3, 904-910DOI: (10.1016/0741-5214(86)90158-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Lateral abdominal aortogram of case 3, a 9-year-old child shows complete occlusion of celiac, superior mesenteric, and both renal arteries. Only enlarged inferior mesenteric artery supplies viscera via dilated collateral artery. Journal of Vascular Surgery 1986 3, 904-910DOI: (10.1016/0741-5214(86)90158-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Diagram of vascular reconstruction in case 3 shows bilateral autotransplant and left common iliac-to-splenic artery vein bypass graft. Spleen was not removed and survives on short gastric arteries and other collateral pathways. Journal of Vascular Surgery 1986 3, 904-910DOI: (10.1016/0741-5214(86)90158-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Arteriogram in case 3, 6 months after operation, shows bilateral renal autotransplants an considerable dilatation of saphenous vein graft from iliac to splenic artery. This study also demonstrates a stenosis of the artery to left renal autotransplant. Journal of Vascular Surgery 1986 3, 904-910DOI: (10.1016/0741-5214(86)90158-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Aortogram of patient 5 (25-year old man) demonstrates complete occlusion of celiac, superior mesenteric, and right renal artery and stenosis of the left renal artery. Also shown is grossly dilated collateral branch from the inferior mesenteric artery to the superior mesenteric artery. Journal of Vascular Surgery 1986 3, 904-910DOI: (10.1016/0741-5214(86)90158-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 This diagram illustrates surgical reconstruction in case 5. Renal artery repair was by bilateral autotransplantation. Mesenteric inflow was achieved by left common iliac-to-superior mesenteric artery vein bypass graft. Journal of Vascular Surgery 1986 3, 904-910DOI: (10.1016/0741-5214(86)90158-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions