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

## TL;DR

A 34-year-old pregnant woman with Takayasu arteritis and aortic dissection underwent successful emergency surgery, highlighting the challenges and strategies for managing such high-risk cases.

## Contribution

This case report presents a rare successful outcome of emergent aortic surgery in a patient with active Takayasu arteritis and pregnancy.

## Key findings

- The patient underwent hybrid aortic repair followed by TEVAR, achieving stable aortic imaging results.
- Multidisciplinary strategies, including hypothermia and cerebral perfusion, were critical for managing complications.
- Despite multiple postoperative complications, the patient showed favorable functional recovery.

## 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.