Case Report: Disappearance of Coronary Anastomotic Aneurysm by Steroid Therapy in Takayasu Arteritis: Pseudorepair of Pseudoaneurysm?

Background: Takayasu arteritis (TA) is a large vessel vasculitis of unknown etiology characterized by chronic inflammatory changes of the aorta and its major branches. Complications such as anastomotic aneurysm and valve detachment have been reported in active TA patients who received aortic valve replacement and graft replacement of aorta.Case Summary:A 61-year-old man with a history of emergency aortic valve replacement and patch closure of the noncoronary sinus of Valsalva due to acute heart failure induced by acute aortic regurgitation and ruptured sinus of Valsalva 4 years ago was referred for exertional dyspnea. Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva and ostial stenosis of the left coronary artery were newly found by computed tomography (CT). A Bentall operation with concomitant coronary artery bypass grafting was successfully performed with a composite graft. Diagnosis of TA was made on the basis of histological analyses of the resected sinus of Valsalva, though other arterial manifestations were not detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography. Three months later, a follow-up study revealed left coronary ostial pseudoaneurysm at the anastomotic site together with strong 18F-FDG uptake, leading to commencement of steroid therapy. Eight months later, disappearance of left coronary ostial pseudoaneurysm was found by a follow-up CT scan.Conclusion: This is a rare TA case in whom spontaneous resolution of coronary anastomotic aneurysm by steroid therapy was found without reconstructive surgery.

Transdural Anastomotic Aneurysm in Association with Moyamoya Disease: A Rare and Troublesome Neurosurgical Entity

Moyamoya disease (MMD) is an idiopathic progressive steno-occlusive disease in the internal carotid artery (ICA) bifurcation. In rare circumstances, transdural anastomotic aneurysm (TAA) could develop during the progression of MMD. We present an illustrative case of TAA in association with MMD. To further explore this rare entity, a comprehensive literature review was also conducted. Our illustrative patient experienced spontaneous remission of the aneurysm during follow-up. By literature review, 12 patients with 13 TAAs, including our case, were identified. The patients aged from 10 to 74 years (46.3 ± 17.4). Eleven (92%) of the patients presented with intracranial hemorrhage, and 1 TAA (8%) was incidentally found. The responsible transdural collaterals were from the middle meningeal artery, occipital artery, internal maxillary artery, and ophthalmic artery in 8 (66.7%), 2 (16.7%), 1 (8%), and 2 (17%) patients, respectively. The anastomosed cerebral arteries were middle cerebral artery, anterior cerebral artery, posterior cerebral artery, and ICA in 5 (42%), 3 (25%), 3 (25%), and 1 (8%) patient, respectively. Eight (67%) patients underwent open surgeries. Two (17%) patients underwent transarterial embolization (TAE) only. Two (17%) patients experienced spontaneous remission of the aneurysm. Seven (58%) patients died or had neurologic deficits. TAAs rarely occur in the progression of MMD, which often presents with intracranial bleeding. Invasive management through open surgery or endovascular treatment is warranted to prevent catastrophic rebleeding. As some individuals might experience spontaneous aneurysm remission, conservative treatment and close imaging follow-up could be considered as an alternative when invasive treatment is risky.

Surgical treatment for brachiocephalic artery aneurysm with Takayasu arteritis using isolated cerebral perfusion: a case study

Background Takayasu arteritis (TA) is a chronic inflammatory disease that induces stenosis, occlusion, or aneurysmal degeneration of the aorta and its major branches. Though rarely reported, proximal aneurysmal lesions from the aortic root to the arch are more common in Asian populations than in Western populations. In the surgical treatment of TA, anastomotic aneurysm can be problematic. Furthermore, atherosclerotic complications should be considered in surgical treatment for elderly TA patients. Case presentation Here, we report a case of brachiocephalic artery (BCA) aneurysm with TA for which surgical treatment was successful. Though it was solely a lesion of the brachiocephalic artery, after considering the patient’s clinical background and the features of TA, we chose a partial arch replacement. Further, for avoidance of anastomotic aneurysm, both distal and proximal anastomosis were reinforced with Teflon felt strips. Preoperative computed tomography detected severe atherosclerotic changes in the arch vessels. The patient underwent partial arch replacement using isolated cerebral perfusion (ICP) for brain protection and recovered without any neurological deficits. Conclusions In avoidance with anastomotic aneurysm, reinforcement of the anastomosis was introduced. ICP was effective for brain protection in case with severe atherosclerotic changes.

Surgical Treatment for Brachiocephalic Artery Aneurysm with Takayasu Arteritis Using Isolated Cerebral Perfusion

Background: Takayasu arteritis (TA) is a chronic inflammatory disease that induces stenosis, occlusion, or aneurysmal degeneration of the aorta and its major branches. In the surgical treatment of TA, anastomotic aneurysm can be problematic. Furthermore, atherosclerotic complications should be considered in surgical treatment for elderly TA patients. Case presentation: Here, we report a case of brachiocephalic artery (BCA) aneurysm with TA for which surgical treatment was successful. For avoidance of anastomotic aneurysm, both distal and proximal anastomosis were reinforced with Teflon felt strips. Preoperative computed tomography detected severe atherosclerotic changes in the arch vessels. The patient underwent partial arch replacement using isolated cerebral perfusion (ICP) for brain protection and recovered without any neurological deficits.Conclusions: In avoidance with anastomotic aneurysm, reinforcement of the anastomosis was introduced. ICP was effective for brain protection in case with severe atherosclerotic changes.