Check up on bypass: There is narrowing at the bypass beginning.

[RiviS7]

I went for a check-up a few weeks ago and had an ultrasound of my bypass (mesenteric arteries) and unfortunately there is narrowing at the bypass beginning. I have copied what the report is below:

Ms. ( leaving out my last name)returns to us after her aortomesenteric bypass. This was a bifurcated bypass; one limb was sent to the celiac access. In the post-operative period she closed this off; I feel this is due to the acute angle and shortness of the bypass graft. Even so, we followed her transaminases and they were coming down nicely; I did perform an arteriogram before she left and it showed excellent collateralization of the celiac bed from the superior mesenteric artery. The superior mesenteric artery bypass itself was widely patent.

On duplex ultrasound today, the bypass is patent but at the distal anastomosis there is velocity elevation and turbulence. She has relatively no symptoms of post-prandial abdominal pain. Her left upper quadrant abdominal pain persisted for a time but she says this is now gone over the past week. She brought me a print out of her most recent transaminases done a couple of days ago and they are nearly normal in the 20s; her amylase lipase are also minimally increased above lab normal values. She is able to eat without pain and is currently suffering no ill-effects from the bypass operation. Her wound is completely healed.

After reviewing the ultrasound, I feel very comfortable letting her go for another 3 months, at which point I will bring her back for a CT angiogram of her abdomen and pelvis; this also to just check on the small aneurysm of her gastroduodenal artery. I discussed her case and care with (left out doctor's name)

Impression/Plan:

Superior mesenteric artery, left upper quadrant abdominal pain, celiac access occlusion, transaminases elevation. I will see her back in 3 months’ time with a CT angiogram of the abdomen and pelvis.

12/19/2016

Needless to say I was upset to get this news. I don't know if the narrowing is some anatomical issue or if it is from some other issue. If there is narrowing at my next check up then my doctor said I will need an angioplasty. What if that doesn't work? He said my affected arteries are very hard. I will have my esr checked by my primary doctor in a few weeks and will be going back to my rheumatologist, but the doctors at Cleveland Clinic said they don't want to put me on prednisone and other drugs before finding out if the vasculitis is burned out or not.

Has anyone on here had vasculitis in their mesenteric arteries? I would really appreciate any feedback on anyone who has had that or has had the operation that I had.

Thank you

Rivi

[Hidden]

It looks like at least some of the issues are technical as it says the bypass is at an acute angle and short.

It's difficult for anyone to advise as unless things have changed since your last post you don't have a diagnosis of Vasculitis. Any operation on large vessels where there is still active Inflamation is almost certainly doomed to failure unless you are on medication as well.

I had post prandial abdominal pain and weight loss but thankfully it's settled with Infliximab infusions. I have a dilated thoracic ascending aorta and get yearly MRA's to monitor it. CT/PET scans are the most sensitive for large vessel Inflamation, it's the scan that showed up my Inflamation the best.

[RiviS7 in reply to Hidden]

Thanks for the response Keyes. Would you mind telling me what type of vasculitis you have? The doctors at Cleveland Clinic said they think that I have a burned out vasculitis and said Takyasus. I have disease in my carotid arteries, hepatic artery, superior mesenteric, celiac artery and aneurysm in gastro duendal artery, but \i think the only place they could do a biopsy now would be carotid and they don't want to do that. They said I do not have artherosclerosis or FMD. At least they could rule out that. I will be monitored too indefinitely. I just pray that it is burned out and I won't have any more issues with this. It's weird because my aunt died of scleroderma a few months ago and she had occlusion and stenosis in her intestinal arteries as well.

[Hidden in reply to RiviS7]

Hi Rivi,

My official diagnosis is Ankylosing Spondylitis ( AS ) with features of Behcets syndrome ( BS ). BS is a rare form of Vasculitis and can affect any size of vein or artery. Both AS and BS can affect the aorta, they share a lot of common symptoms and respond to the same biologic medications ( anti TNF's ).

A biopsy is not usually required to conform a diagnosis of Takayasu's Arteritis as its a clinical diagnosis made on the basis of symptoms. Did they not have a good look at the bit of artery they excised to do your graft?

Personally speaking I would want to be very sure of 2 things

1) That you have seen someone with good experience in Takayasu's as its a rare disease. The question to ask them is how many cases have they seen?

2) With your degree of arterial involvement I would want to be very sure that the Takayasu's is burnt out before the graft is damaged and any more damage is done.

[Hidden]

have you ever undergone a pet scan?