Takayasu Arteritis with Multivessel Occlusion: Staged Revascularization and Cerebral Perfusion Management: A Case Report

Background: Takayasu arteritis is a rare large-vessel vasculitis that typically affects young women, but it is also diagnosed in older patients with severe vascular occlusions. Case Presentation: We report a case of a 67-year-old female with Takayasu arteritis, presenting with extensive multivessel occlusions involving the brachiocephalic, carotid, subclavian, mesenteric, and iliac arteries, resulting in severe bilateral limb ischemia. Due to persistent rest pain in both limbs, surgical management involved multi-branch revascularization using a prosthetic graft from the brachiocephalic artery to both the axillary and femoral arteries, along with a bypass to the right common carotid artery. Postoperatively, the patient developed cerebral hyperperfusion syndrome complicated by intracerebral hemorrhage, necessitating surgical flow reduction of the carotid bypass. The patient recovered with resolution of limb ischemia and no persistent neurological deficits. Conclusion: This case underscores the complexities of surgical management in Takayasu arteritis, highlighting the critical role of staged revascularization, thorough cerebral perfusion evaluation, and careful perioperative blood pressure control in minimizing hyperperfusion-related risks.