Surgical experiences with inflammatory arterial aneurysms due to Takayasu's arteritis

This report shows clinical manifestations and provides aspects of surgical strategy for inflammatory aneurysms due to Takayasu's arteritis. Fourteen cases of inflammatory aneurysms among 81 patients with Takayasu's arteritis who underwent surgery in our institute were reviewed. The patient group consisted of six males and eight females, ages from 20 to 61 (mean 39.6±3.5) years. Aneurysmal lesions were located in the ascending aorta or aortic arch (type I) in six (42.9%) patients and the thoracic and/or abdominal aorta (type II) in six patients (42.9%). Type III distribution was determined for two patients (14.3%). Operative procedures for aneurysms included aortic replacement using prosthetic graft (n=6), aneurysmorraphy (n=1), patch angioplasty (n=1), Hardy operation (n=1), aortic valve replacement (AVR) (n=2), and AVR associated with mesh wrapping or aneurysmorraphy (n=3). Operative mortality was 21.4% (three cases) at initial operation and late deaths were found in five cases. Causes of late deaths included rupture of suture aneurysms, rupture of the aortic aneurysm at other aortic lesions, and sudden death due to acute perivalvular leakage. Aggressive surgical approach prior to rupture is required for cases with progressive aortic dilatation even if inflammation signs appear to be controlled. Careful long-term follow-up using periodical angiogram or computed tomography are essential to the best prognosis in pre- and postoperative periods.