Surgical approach to left common carotid arterial dissection complicated during endovascular intervention in a patient with takayasu disease: Case report and review of literature

Özet

Takayasu arteritis is a rare vasculitis of unknown etiology. Inflammation primarily involves aorta and its branches in this disease. In ourcase, multislice computerized tomographic angiography showed total occlusion of right, and critical stenosis of left internal carotid andproximal part of left subclavian arteries. A conventional angiography was planned to implant a stent to left internal carotid artery, and toscreen any coronary lesions. There was osteal stenosis of left anterior descending artery (LAD) on coronary angiography. Takayasu arteritiswas diagnosed regarding Ishikawa criteria, and the patient was administered corticosteroids. After 3 weeks of corticosteroid treatment, it wasdecided to implant a stent to LAD and left internal carotid artery. Although coronary intervention was successful, the carotid interventionwith stent was unsuccessfully due to rupture of the intimal plaque. The patient was taken into operating room urgently due to stent failure.First, saphenous vein was prepared from upper segment of knee of left leg. However diameter of the vein was insufficient to be used as avascular graft. Left internal carotid artery was reconstructed with a patch of saphenous vein. Additionally, a cross over bypass was performedfrom right common carotid artery to left common carotid artery using a 7 mm polytetrafluoroethylene graft over saphenous vein.