Work

Beating the Odds: Successful Emergent Surgery After Acute Aortic Dissection in Takayasu Arteritis

Year: 2026

Type: article

Abstract: Acute aortic syndromes (AAS) encompass life-threatening conditions that require rapid diagnosis and specialized intervention. Among these, large-vessel vasculitides, such as Takayasu arteritis (TA), pose unique surgical and anesthetic challenges due to active vascular inflammation, tissue fragility, and possible multiorgan involvement. We report the perioperative management of a 34-year-old female, who was 20 weeks pregnant, with TA who presented with rapidly progressive aneurysmal dilation and dissection of the thoracic aorta, complicated by multiorgan failure. She underwent emergent hybrid repair of the aortic arch using a frozen elephant trunk (FET) prosthesis, followed by second-stage thoracic endovascular aortic repair (TEVAR) for a descending aortic aneurysm six months later. The initial perioperative period was complicated by hemodynamic instability, cardiac arrest, ventilatory challenges, renal failure, and fetal loss. Intraoperative management included transesophageal echocardiographic assessment, hemostatic optimization, and prioritization of cerebral and end-organ protection using moderate hypothermia and antegrade cerebral perfusion. The postoperative period was further complicated by severe myopathy, bilateral vocal cord paralysis, and limb ischemia secondary to vasopressor use. Despite the complexity of the surgical case and the subsequent complications, the patient achieved a favorable functional recovery and remains under follow-up with stable aortic imaging findings. This report highlights the multidisciplinary challenges of managing extensive aortic disease, particularly when surgery is required during an active inflammatory phase. Careful preoperative assessment, individualized surgical and anesthetic strategies, advanced intraoperative monitoring, and prolonged postoperative support are essential to maximize outcomes in this high-risk population.

Source: Cureus

DOI: 10.7759/cureus.103053

Authors: Ana Raquel Nunes, Sílvia Morgado, Miguel Roxo, Célia Duarte, Cristina Ramos

Institutions: Unidade Local de Saúde de São José, Unidade Local de Saúde do Alentejo Central

Language: English

Topic: Aortic Disease and Treatment Approaches

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7127911156