Hybrid endovascular surgical repair in Takayasu's arteritis: Duplex ultrasound follow-up

Research output: Contribution to journalArticle

Introduction. - Takayasu's arteritis (TA), a rare condition occurring primarily in young women, is a granulomatous vasculitis usually affecting the aorta and its branches. Our case report describes the duplex ultrasound findings in a 16-year-old Hispanic woman after a hybrid endovascular procedure. Patient Description. - TA in this patient was diagnosed in 2005 after a pulsatile neck mass developed on the right side of her neck. To date, she has required four vascular interventions in less than 3 years. The first procedure was an aortic root, ascending aorta and aortic arch replacement with Dacron graft replacement of the left common carotid and innominate arteries. She then developed a pseudoaneurysm in the distal left common carotid artery replacement graft, which was excluded with a stent-graft. The third procedure was a balloon angioplasty of an anastomotic stenosis of the aorto-innominate artery graft. This, however, recurred and there was also a small anastomotic pseudoaneurysm at this site. Revascularization was complicated by the fact that the left subclavian artery was occluded, with reversed flow in the left vertebral artery. Consequently, preservation of antegrade flow in the right vertebral artery was a priority. Transposition of the right common carotid artery to the subclavian artery with placement of a balloon expandable stent graft from the aortoinnominate artery graft into the subclavian artery (proximal to the vertebral artery) was performed. Methods. - All available imaging exams and operative reports were reviewed. Bilateral carotid duplex evaluation in addition to duplex examination of all bypasses and the distal native arteries were performed using high resolution ultrasound equipment and probes of varying frequency. Results. - Normal caliber wall thickness was identified in bilateral common carotid arteries. No evidence of intimai hyperplasia could be detected in stented areas. All open surgical or endovascular repair sites were well visualized, with the exception of only the proximal most innominate artery bypass graft and the aortic arch. Primarily retrograde left vertebral artery flow feeds the left subclavian artery. There was no evidence of restenosis or pseudoaneurysm formation. Discussion. - Long-term follow-up of the patient with TA after open surgical or endovascular procedures is extremely important because of the chronic nature of the disease process. Duplex ultrasound is a safe, effective adjunct to the standard radiologic arsenal usually used to follow these high-risk patients.

Original languageEnglish
Pages (from-to)80-87
Number of pages8
JournalJournal for Vascular Ultrasound
Volume33
Issue number2
StatePublished - Jun 1 2009

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Standard

Hybrid endovascular surgical repair in Takayasu's arteritis : Duplex ultrasound follow-up. / Broadbent, Karen; Garami, Zsolt; Peden, Eric K.; Lumsden, Alan B.

In: Journal for Vascular Ultrasound, Vol. 33, No. 2, 01.06.2009, p. 80-87.

Research output: Contribution to journalArticle

Harvard

Broadbent, K, Garami, Z, Peden, EK & Lumsden, AB 2009, 'Hybrid endovascular surgical repair in Takayasu's arteritis: Duplex ultrasound follow-up' Journal for Vascular Ultrasound, vol. 33, no. 2, pp. 80-87.

APA

Broadbent, K., Garami, Z., Peden, E. K., & Lumsden, A. B. (2009). Hybrid endovascular surgical repair in Takayasu's arteritis: Duplex ultrasound follow-up. Journal for Vascular Ultrasound, 33(2), 80-87.

Vancouver

Broadbent K, Garami Z, Peden EK, Lumsden AB. Hybrid endovascular surgical repair in Takayasu's arteritis: Duplex ultrasound follow-up. Journal for Vascular Ultrasound. 2009 Jun 1;33(2):80-87.

Author

Broadbent, Karen ; Garami, Zsolt ; Peden, Eric K. ; Lumsden, Alan B. / Hybrid endovascular surgical repair in Takayasu's arteritis : Duplex ultrasound follow-up. In: Journal for Vascular Ultrasound. 2009 ; Vol. 33, No. 2. pp. 80-87.

BibTeX

@article{da76e7eb14e8483a874fc790bf4b1dce,
title = "Hybrid endovascular surgical repair in Takayasu's arteritis: Duplex ultrasound follow-up",
abstract = "Introduction. - Takayasu's arteritis (TA), a rare condition occurring primarily in young women, is a granulomatous vasculitis usually affecting the aorta and its branches. Our case report describes the duplex ultrasound findings in a 16-year-old Hispanic woman after a hybrid endovascular procedure. Patient Description. - TA in this patient was diagnosed in 2005 after a pulsatile neck mass developed on the right side of her neck. To date, she has required four vascular interventions in less than 3 years. The first procedure was an aortic root, ascending aorta and aortic arch replacement with Dacron graft replacement of the left common carotid and innominate arteries. She then developed a pseudoaneurysm in the distal left common carotid artery replacement graft, which was excluded with a stent-graft. The third procedure was a balloon angioplasty of an anastomotic stenosis of the aorto-innominate artery graft. This, however, recurred and there was also a small anastomotic pseudoaneurysm at this site. Revascularization was complicated by the fact that the left subclavian artery was occluded, with reversed flow in the left vertebral artery. Consequently, preservation of antegrade flow in the right vertebral artery was a priority. Transposition of the right common carotid artery to the subclavian artery with placement of a balloon expandable stent graft from the aortoinnominate artery graft into the subclavian artery (proximal to the vertebral artery) was performed. Methods. - All available imaging exams and operative reports were reviewed. Bilateral carotid duplex evaluation in addition to duplex examination of all bypasses and the distal native arteries were performed using high resolution ultrasound equipment and probes of varying frequency. Results. - Normal caliber wall thickness was identified in bilateral common carotid arteries. No evidence of intimai hyperplasia could be detected in stented areas. All open surgical or endovascular repair sites were well visualized, with the exception of only the proximal most innominate artery bypass graft and the aortic arch. Primarily retrograde left vertebral artery flow feeds the left subclavian artery. There was no evidence of restenosis or pseudoaneurysm formation. Discussion. - Long-term follow-up of the patient with TA after open surgical or endovascular procedures is extremely important because of the chronic nature of the disease process. Duplex ultrasound is a safe, effective adjunct to the standard radiologic arsenal usually used to follow these high-risk patients.",
author = "Karen Broadbent and Zsolt Garami and Peden, {Eric K.} and Lumsden, {Alan B.}",
year = "2009",
month = "6",
day = "1",
language = "English",
volume = "33",
pages = "80--87",
journal = "Journal for Vascular Ultrasound",
issn = "1544-3167",
publisher = "Society of Vascular Ultrasound",
number = "2",

}

RIS

TY - JOUR

T1 - Hybrid endovascular surgical repair in Takayasu's arteritis

T2 - Journal for Vascular Ultrasound

AU - Broadbent, Karen

AU - Garami, Zsolt

AU - Peden, Eric K.

AU - Lumsden, Alan B.

PY - 2009/6/1

Y1 - 2009/6/1

N2 - Introduction. - Takayasu's arteritis (TA), a rare condition occurring primarily in young women, is a granulomatous vasculitis usually affecting the aorta and its branches. Our case report describes the duplex ultrasound findings in a 16-year-old Hispanic woman after a hybrid endovascular procedure. Patient Description. - TA in this patient was diagnosed in 2005 after a pulsatile neck mass developed on the right side of her neck. To date, she has required four vascular interventions in less than 3 years. The first procedure was an aortic root, ascending aorta and aortic arch replacement with Dacron graft replacement of the left common carotid and innominate arteries. She then developed a pseudoaneurysm in the distal left common carotid artery replacement graft, which was excluded with a stent-graft. The third procedure was a balloon angioplasty of an anastomotic stenosis of the aorto-innominate artery graft. This, however, recurred and there was also a small anastomotic pseudoaneurysm at this site. Revascularization was complicated by the fact that the left subclavian artery was occluded, with reversed flow in the left vertebral artery. Consequently, preservation of antegrade flow in the right vertebral artery was a priority. Transposition of the right common carotid artery to the subclavian artery with placement of a balloon expandable stent graft from the aortoinnominate artery graft into the subclavian artery (proximal to the vertebral artery) was performed. Methods. - All available imaging exams and operative reports were reviewed. Bilateral carotid duplex evaluation in addition to duplex examination of all bypasses and the distal native arteries were performed using high resolution ultrasound equipment and probes of varying frequency. Results. - Normal caliber wall thickness was identified in bilateral common carotid arteries. No evidence of intimai hyperplasia could be detected in stented areas. All open surgical or endovascular repair sites were well visualized, with the exception of only the proximal most innominate artery bypass graft and the aortic arch. Primarily retrograde left vertebral artery flow feeds the left subclavian artery. There was no evidence of restenosis or pseudoaneurysm formation. Discussion. - Long-term follow-up of the patient with TA after open surgical or endovascular procedures is extremely important because of the chronic nature of the disease process. Duplex ultrasound is a safe, effective adjunct to the standard radiologic arsenal usually used to follow these high-risk patients.

AB - Introduction. - Takayasu's arteritis (TA), a rare condition occurring primarily in young women, is a granulomatous vasculitis usually affecting the aorta and its branches. Our case report describes the duplex ultrasound findings in a 16-year-old Hispanic woman after a hybrid endovascular procedure. Patient Description. - TA in this patient was diagnosed in 2005 after a pulsatile neck mass developed on the right side of her neck. To date, she has required four vascular interventions in less than 3 years. The first procedure was an aortic root, ascending aorta and aortic arch replacement with Dacron graft replacement of the left common carotid and innominate arteries. She then developed a pseudoaneurysm in the distal left common carotid artery replacement graft, which was excluded with a stent-graft. The third procedure was a balloon angioplasty of an anastomotic stenosis of the aorto-innominate artery graft. This, however, recurred and there was also a small anastomotic pseudoaneurysm at this site. Revascularization was complicated by the fact that the left subclavian artery was occluded, with reversed flow in the left vertebral artery. Consequently, preservation of antegrade flow in the right vertebral artery was a priority. Transposition of the right common carotid artery to the subclavian artery with placement of a balloon expandable stent graft from the aortoinnominate artery graft into the subclavian artery (proximal to the vertebral artery) was performed. Methods. - All available imaging exams and operative reports were reviewed. Bilateral carotid duplex evaluation in addition to duplex examination of all bypasses and the distal native arteries were performed using high resolution ultrasound equipment and probes of varying frequency. Results. - Normal caliber wall thickness was identified in bilateral common carotid arteries. No evidence of intimai hyperplasia could be detected in stented areas. All open surgical or endovascular repair sites were well visualized, with the exception of only the proximal most innominate artery bypass graft and the aortic arch. Primarily retrograde left vertebral artery flow feeds the left subclavian artery. There was no evidence of restenosis or pseudoaneurysm formation. Discussion. - Long-term follow-up of the patient with TA after open surgical or endovascular procedures is extremely important because of the chronic nature of the disease process. Duplex ultrasound is a safe, effective adjunct to the standard radiologic arsenal usually used to follow these high-risk patients.

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VL - 33

SP - 80

EP - 87

JO - Journal for Vascular Ultrasound

JF - Journal for Vascular Ultrasound

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ID: 2528437