Extra-anatomic cerebrovascular aortic debranching for severely symptomatic Takayasu's arteritis
Matthew J Rossi, Javairiah Fatima
Medstar Washington Hospital Center, Washington, DC
A 43-year-old female presented to her primary care physician with bilateral arm claudication and near syncope with exertion of her upper extremities. On exam, she was noted to have absent radial, brachial, and carotid pulses prompting computed tomographic angiography (Figure 1). The patient was diagnosed with Takayasu's arteritis based on elevated ESR and the diffuse narrowing of the common carotid arteries from their origin to bifurcation and subclavian arteries seen on CTA. The patient was placed on high dose steroid therapy but continued to have worsening symptoms. The patient underwent pre-operative cardiac workup including an echocardiogram, nuclear stress test, and cardiac catheterization all of which were unremarkable. Given the severity of symptoms and poor response to medical management, surgical therapy was discussed. Extra-anatomic cerebrovascular debranching was performed via a sternotomy. An 8mm limb was pre-sewn to each limb of a bifurcated 20X 10mm Platinum graft. The ascending aorta was used for inflow and 10mm limbs were sutured to bilateral carotid artery bifurcation and the pre-sewn 8mm limbs were used for bypass jump grafts to bilateral axillary arteries. Post-operatively, the patient was neurologically intact and endorsed resolution of all her pre-op symptoms. She was discharged to home. Postoperative CTA was performed at 1 month with excellent opacification of grafts and recipient arteries. 
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