OBJECTIVE: To explore the management of cerebral ischemia caused by Takayasu's arteritis. METHODS: Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Ru...
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OBJECTIVE: To explore the management of cerebral ischemia caused by Takayasu's arteritis. METHODS: Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Affiliated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hospital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses from the ascending aorta to the axillary or subclavian artery and from graft to the carotid artery were performed in 47 cases. Subclavian to carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one. RESULTS: Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2%, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16.3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and recurrence requiring revision in 8.2%. CONCLUSION: Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography. However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasible in most instances, and this can and should be done when the cerebral perfusion is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.
血栓闭塞性脉管炎(thromboangiitis ob literans,TAO)是用[1]。对Ⅰ型和Ⅲ型胶原的的超敏反应已被证实在血液中存在抗胶原和抗弹力蛋白的抗体。最近研究发现,疾病活动期病人体内可检测到抗内皮细胞抗体,而内皮细胞抗体损害了内皮细胞依...
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血栓闭塞性脉管炎(thromboangiitis ob literans,TAO)是用[1]。对Ⅰ型和Ⅲ型胶原的的超敏反应已被证实在血液中存在抗胶原和抗弹力蛋白的抗体。最近研究发现,疾病活动期病人体内可检测到抗内皮细胞抗体,而内皮细胞抗体损害了内皮细胞依赖的血管舒张功能,从而引起血管痉挛闭塞。2治疗近年来,不断有新的技术和方法应用到TAO的治疗中去,TAO的截肢率也有所下降,但遗憾的是,迄今为止TAO的治疗并没有突破性的进展,截肢率仍在9·3%~16·7%。究其原因,动脉闭塞多从肢体远端开始,常缺乏良好的流出道,侧支血管建立困难,血管重建手术指征不多,病变常有周围性恶化的特点。
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