Perioperative Management and Surgical Approaches in a Rare Case of Coronary Artery Bypass Grafting Surgery in a Patient with Takayasu’s Arteritis with Acute Atypical Presentation: A Case Report

ABSTRACT: Coronary artery disease is a rare involvement in Takayasu's arteritis (TA) and a fatal one, and poses multiple challenges both surgically and medically. Surgical intervention may be required, but there is no consensus on the best way of optimal revascularization strategy. The use of venous grafts is recommended because of possible inflammation of the internal mammary artery and subsequent graft failure. However, proximal anastomosis on a fragile aorta may result in occlusion too. Only very limited case reports suggest against performing proximal anastomosis directly to the native aorta in such patients. We report a 23-year-old male patient of acute TA having both right and left coronaries severely involved who was treated with off-pump coronary artery bypass grafting. Perioperative challenges include measures to prevent stroke, coronary ischemia, and control of inflammation. The patient had an uneventful recovery.