Takayasu arteritis with a giant ascending aortic pseudoaneurysm followed by a postoperative anastomotic pseudoaneurysm: a life-saving case report

Takayasu arteritis is a rare, chronic large-vessel vasculitis that predominantly affects young women, involving the aorta and its major branches. Pseudoaneurysm formation is uncommon in this disease, particularly in the ascending aorta, with only a few such cases having been reported.

A 20-year-old Asian man presented with fever, cough, and haemoptysis. Contrast-enhanced computed tomography revealed a giant ascending aortic pseudoaneurysm (57 mm in diameter) compressing the pulmonary artery. Emergency total arch replacement was performed because the patient was in a pre-shock state and the risk of imminent rupture was high. Histopathology confirmed a diagnosis of Takayasu arteritis. The patient was discharged on postoperative Day 13 but returned 6 days later with a persistent low-grade fever, fatigue, and back pain. Repeat imaging revealed an anastomotic pseudoaneurysm between the left common carotid artery and the branch of the prosthetic graft. Emergency endovascular repair was performed using a stent graft. Corticosteroid therapy was initiated the following day, and the patient was transferred to the rheumatology department on postoperative Day 15 following the second intervention.

A giant pseudoaneurysm from Takayasu arteritis can cause pulmonary artery compression and acute haemodynamic compromise, requiring prompt surgical intervention. In such cases, adequate control of vascular inflammation may be important for reducing the risk of postoperative anastomotic complications. Endovascular stent grafting may serve as a viable treatment option for arch branch anastomotic pseudoaneurysms in the postoperative setting.