Aortic valve replacement concomitant with multiple extra-anatomical bypasses for a patient with aortic valve insufficiency having Takayasu's arteritis

A 58-year-old woman, who had suffered from Takayasu's arteritis, presented heart failure and abdominal angina due to severe aortic insufficiency, stenosis of the abdominal aorta and bilateral subclavian arteries. Simultaneous aortic valve replacement and multiple extra-anatomical bypasses led to an improvement in cardiac function and a relief of digestive symptom (Figs. 1 and 2). Preoperative magnetic resonance angiographies showed severe stenosis of the bilateral subclavian arteries (A) (white arrows), and the abdominal aorta at the level of the superior mesenteric artery to the terminal aorta (B). A postoperative three-dimensional computed tomography scan at two months after operation demonstrated a 16-mm Dacron graft anastomosed to the ascending aorta and the right external iliac artery placed through the pre-peritoneal space, and 8-mm ringed Dacron grafts anastomosed to the 16-mm Dacron graft and the bilateral axillary arteries. Developed complex arterial connections among the branches of visceral arteries were described (white arrows).