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Background Special consideration may be required for surgical treatment in Takayasu arteritis because inflammation may cause serious complications such as valve detachment or dilatation of the residual aorta. We evaluated our surgical outcome of treatment for aortic regurgitation and aortic root dilatation in Takayasu arteritis. Methods Between December 1983 and January 2013, 22 cardiac operations were performed in 20 patients with aortic regurgitation due to Takayasu arteritis. Aortic valve replacement was carried out in 6 patients, and aortic root replacement in 16. Of these 16 patients, composite graft replacement was undertaken in 6, composite graft replacement plus coronary artery bypass grafting in 2, composite graft replacement plus total or partial arch replacement in 7, and valve-sparing aortic root replacement with hemiarch replacement in one. Results The operative mortality (within 30 days) was 4.5% and the 5-year survival rate was 90.9%. Early surgical reintervention was not required in any patient. Neither valve detachment nor composite graft detachment was noted. Two patients required redo aortic root replacement due to pseudoaneurysm formation and severe aortic regurgitation during follow-up. Late dilatation of the residual thoracoabdominal or abdominal aorta was observed in 2 patients, and both were treated surgically. Conclusions The early surgical outcome was acceptable but surgical reintervention was required because of late dilatation of the residual aorta or recurrent aortic regurgitation due to annular dilatation, and longstanding careful follow-up will be needed.

Cases of mural aortic arch thromboses are generally associated with diffuse atherosclerosis of the aortic arch and have primarily been detected in elderly patients. However, the presence of mural thrombi in the aortic arch in young patients without diffuse atherosclerosis has rarely been reported. We describe a case of a hypercoagulable young patient with arterial embolism in whom investigations revealed a mural pedunculated aortic arch thrombosis without clear diffuse atherosclerotic lesions.

A technique for anatomical positioning of a synthetic aortoaxillary bypass tube graft is described. A tunnel is created with the help of a Roberts clamp and intercostal tube drain. There is no need to open the pleura because the graft is tunneled parallel to the subclavian vessels outside the chest cavity.

The clinical and angiographic features of 12 patients showing a significant reduction in the diameters of the distal aorta and the common iliac arteries are described. All the patients were women aged between 23 and 63 years (average age: 49 years), heavy smokers in the majority. An associated aortic arch syndrome was observed in 5 patients. Type IV dyslipidemia was found in 5. In 10 patients the erythrocyte sedimentation rate was increased. Claudication of the lower limbs, without dystrophic phenomena, was the most frequent symptom. Intraoperative biopsies of the distal aorta at the level of the aortic bifurcation were performed in 9 patients who underwent vascular surgery. In all the specimens an extensive fibrosis of the arterial wall was noted, but diffuse or focal lymphoplasmacellular infiltrates were also detected in 7 of them, with giant cells in 2 of the 7. The profile of small aorta and iliac arteries has recently been identified as an autonomous morbid process due to a developmental deficit with superimposition of atherosclerotic phenomena ("hypoplastic aorto-iliac syndrome" — HAIS). The clinical data and the histopathologic findings suggest, however, that several cases of HAIS can claim an acquired rather than a congenital origin. An arteritic process, causing an extensive fibrosis of the arterial wall, might be able to give rise to a noteworthy reduction in the aortic diameter. Among the possible inflammatory causes, Takayasu's disease (aspecifc aortoarteritis) seems to play an important role. The denomination HAIS seems, however, to be too restrictive. It should be replaced by "small aorto-iliac syndrome" (SAIS), which is noncommittal as regards the pathogenesis and applicable in any case.

Takayasu's disease, a condition with unusual clinical symptoms and peculiar radiologic manifestations is described. The clinical and physiopathological implications are discussed together with a literary review.