Carotidobrachial bypass in a Takayasu's disease patient - 7yrs follow up.

The surgical treatment of Takayasu's disease is complicated due to many reasons. It has been complicated by the extensive nature of the lesions, lack of accurate knowledge regarding the preferred sites and extent of the lesions, presence of skip lesions, and chances of reactivation. These patients are usually young, with an otherwise normal vascular system beyond the diseased area. Previously published reports expressing reservations about the efficacy of surgical treatment do not seem justified. Careful assessment of each patient as to his residual disability after conservative treatment and the haemodynamic status will make surgical treatment safe and rewarding for a large number of patients. Immunological investigations indicate the possibility of a mechanism  involving immune complex formation on a background of defective T-lymphocyte function in Takayasu's disease. Whereas the original antigenic trigger could be any one of a number of different possibilities, parasitic infestation and chronic infection in the intestines along with protein energy malnutrition may be possible etiological factors. The figure shows the patent right carotid brachial bypass with saphenous vein graft after 7 years, and she developed occlusive disease in the left subclavian artery in the recent past with symptoms of claudication in the left arm.