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The authors analysed herein the results of examination and surgical treatment of patients presenting with Takayasu aortoarteritis with an isolated lesion of the aortic arch branches. Discrepancy between the degree of ischaemia, dissemination, and localization of lesions, as well as ambiguity of neurological manifestations suggests large compensatory possibilities of the cerebral circulation in this disease. The revealed peculiarities of lesions of the brachiocephalic arteries characteristic the pathology concerned were as follows: high incidence of lesions of subclavian arteries (mainly in the second and third segments), utterly rare involvement of the brachiocephalic trunk, a stenosisng pattern of lesion of carotid arteries with predominant localization in the common carotid artery, not involving it into the process of bifurcation. The outcomes of surgical treatment of patients suggest high efficacy of reconstructive operations in the overwhelming majority of the operated patients, also demonstrating considerable advantage of extrathoracic operations as compared with transthoracic ones.

The diagnosis and differential diagnosis of attendant ischemic heart disease (IHD) was conducted in 65 men (age 49-74 years) with Takayashu's syndrome and 59 men (age 39-64 years) with associated atherosclerotic lesions of the arch branches and the abdominal portion of the aorta. The examination was performed using velo- and spiroergometry, echocardiography, drug tests, coronaroventriculography. IHD was diagnosed in 38.4% patients with aortic arch lesions and in 44.1%--in associated lesions. The majority of the patients were referred to functional class III and IV. The above complex use of diagnostic methods allows objective evaluation of diagnostic data, IHD severity, adequate decision on the treatment policy.

In 133 patients with nonspecific aortoarteritis 172 operations were conducted, 83.8% of them--reconstructive interventions. In 29 patients with isolated affection of truncus brachiocephalicus 32 operations were conducted. Good results of up to 13-year follow-up was 77%, mortality--13.8%. For the isolated affection of aortal arch in 26 patients 27 operations were conducted. Five-year survival have constituted 100%, of them in 79.9% good result was observed. For the isolated affection of aorto-femoral segment 38 patients were operated on. Up to 8-year follow-up was achieved in 32 of them, good result was noted in 73.1%. For the combined affection in 40 patients 51 operations were done. Seven-year follow-up was achieved in 36 patients, good result was noted in 74.2%.

Unilateral occlusion of extracranial cerebral arteries results in asymmetric intracranial flow rate against unaffected regional tissue circulation. Multiple occlusions entail reduction of intracranial circulation even in satisfactory collateral circulation. Reduction of tissue cerebral circulation occurs in well-defined occlusive processes with decompensated collateral circulation in the absence of carbogenic vascular responses. Co2 reactivity may serve a criterium of collateral circulation status and a positive prognostic sign in surgery planning.

The authors provide a scheme of a comprehensive diagnosis of the aortic arch syndrome in nonspecific aortoarteritis. It includes the clinical and laboratory data together with the data on the anamnesis, angiography and ultrasound dopplerography. The derangement of the aortic arch was diagnosed in 65 (41%) out of 128 patients. There were 53 (81.5%) women and 12 (18.5%) men. The derangement of the branches of the aortic arch was most frequently (in 33.8% patients) associated with vasorenal hypertension syndrome. The use of modern research methods in combination with the clinical data and findings of objective examinations turned out fairly effective in the diagnosis of the derangement of the aortic arch in nonspecific aortoarteritis.

For 15 years, the authors observed 158 patients with non-specific aortoarteritis. Of them in 37 (23.4%), isolated lesion of the terminal aorta, iliac and femoral arteries was revealed; in 81.1%--severe degree of ischemia of the lower extremities, 39.4% of men had impotency. Associated lesions of the aorta and arteries of the lower extremities was revealed in patients with acute inflammatory process. The extent of vascular occlusion depended on its presence. Surgical treatment was performed in 35 patients; in 30, the reconstructive operations were performed, in 3--lumbar sympathectomy, in 2--amputation of an extremity. At the early postoperative period, a good result has been noted in 82.9%, 5.7% of patients died. Twenty six patients were followed up for 5 years, 60.1% of them have shown a good result.

The potentialities of roentgeno-endovascular dilation (RED) of various types of coarctation and aortic stenoses were studied in 12 patients aged 9 to 27. RED was performed by two Grüntzig's catheters with balloons not less than 7 mm in diameter. The main criterion of RED efficacy was a gradient of systolic pressure which was on the decrease by 25-40 mm Hg after using one catheter, and by 40-70 mm Hg after using both catheters. The same method was applied to dilation of stenosis of the abdominal aorta. The proposed method is low invasive and most effective in patients with aortic segmentation of segmental type, and makes it possible to avoid in many cases surgical intervention.

Ultrasonic examination in occlusion of the abdominal aorta and its visceral branches is effective in 87.7% of cases. In combined lesions of the aorta and its visceral branches the authors suggest one-stage reconstructive operations to correct the blood flow. The mortality rate in such cases reduced by 6.76%.

In 48 patients with non-specific aortoarteritis (NAA) and 32 normal subjects, the immunologic investigations were performed. In patients with NAA, the sharp suppression of the factors of non-specific protection, which manifested itself in decrease in the titer of complement and phagocytic activity of neutrophil granulocytes, deep depression of T-links of the immunity, was revealed. Against the background of decrease in the level of B-lymphocytes, the increase in their functional activity, which manifested itself in increase in the IgG and IgA content, was revealed. A study of the immunologic status in patients with NAA is of great importance for determination of activity of the inflammatory process and choice of a method for treatment. With the aim of increasing the effectiveness of surgical treatment, it is expedient at the preoperative period to perform immunologic correction under guidance of the indices of the immunity.

The results of 110 operations for atypical shunting in occlusions of the aorta and the iliac and femoral arteries are analysed. The authors suggest modifications of operations for transverse femoro-femoral shunting with the use of venous autografts. Shunting of lower limb arteries from the branches of the arch of the aorta made it possible to preserve the limb in 58.8% of patients who otherwise would have to be subjected to amputation. Study of the late-term results shows that atypical reconstructive operations allowed the limb to be preserved by an 8-year follow-up period in 76.1% of patients.

For the 10-year period, 70 patients with occlusion of the abdominal aorta were operated on (10% of the patients operated on for Leriche's syndrome). Severe ischemia of the lower extremities was noted in 25 (35.8%) patients. Low occlusion was diagnosed in 24, middle--in 15, high--in 31 patient. In low and middle occlusion, the end-to-side anastomosis was performed in 17 patients, end-to-end--in 49. In 4 patients, the axillary-femoral shunting was performed. In 32 of 48 cases, the patency of the inferior mesenteric artery was restored. Correction of renal blood flow was performed in 2 patients. Good results were obtained in 92.8% of the cases. The lethality was 7.1%.

The authors made an analysis of the treatment of 112 patients aged over 60 with occlusive lesions of the aorta and main arteries. Unilateral reconstructions were performed in 92 patients with lesions of the aorto-iliac segment, as less traumatic operations with involvement in the blood flow of deep femoral artery with femoro-popliteal occlusions. Total postoperative lethality was 9,8%.