Aortobilateral Axillary Bypass to Treat Severe Cerebral Ischemia Due to Takayasu's Arteritis

Cerebral ischemia resulting from four cervical arterial occlusions due to Takayasu's arteritis is a rare condition. Ascending aortounilateral/-bilateral internal carotid arterial bypass is a means for relieving it. However, postoperative reperfusion syndrome remains an unsolved severe, even fatal complication. The following case report reveals new findings. The patient presented massive cerebral infarction in the left cerebral hemisphere, four cervical arterial lesions, and bilateral subclavian steal syndrome. An ascending aorta to bilateral axillary bypass resumed the vertebral blood flow, and as a result the patient had a marvelous improvement. Unlike ascending aorta-carotid bypass, which directly increases brain perfusion, our procedure does so indirectly via axillary arteries. Therefore, there is strong reason to recommend ascending aorta to biaxillary bypass for patients with cerebral ischemia due to four cervical arterial lesions accompanying a bilateral subclavian steal phenomenon that has reversed vertebral flow.