a 59-year - old woman who had pre - existing hypertension presented with chest pain and dyspnea . she reported claudication and coldness of the lower extremities that had been becoming more severe . her medical history included a diagnosis of hypertension . on physical examination , she was found to be hypertensive in the right arm ( 170/100 mmhg ) , normotensive in the left arm ( 100/60 mmhg ) , and hypotensive in the thighs ( 76/45 mmhg ) . both femoral pulses were weak and the ankle - brachial index ( abi ) was 0.56 . there were no remarkable findings in the laboratory tests including the c - reactive protein level and erythrocyte sedimentation rate . the chest x - ray revealed cardiomegaly ( cardiothoracic ratio 57.4% ) and left ventricular enlargement . the computed tomography findings , such as diffuse concentric wall thickening , and luminal narrowing of the aorta from the thoracoabdominal junction to the infrarenal level along with diffuse stenosis of the left renal artery , were compatible with the presumed diagnosis of takayasu 's arteritis . , bypass grafting was performed between the right axillary artery and the right femoral artery using an 8 mm ringed gore - tex graft ( fig . 1 ) . warfarin ( 2 mg / day ) was administered postoperatively . at the time of discharge , the patient showed marked improvement of the dyspnea and chest pain . 2 ) . echocardiography showed early improvement of the left ventricular ejection fraction ( range , 23% to 41% ) and dimensions ( range , 61/69 mm to 52/62 mm ) compared with the preoperative values . at 11 months , these indices had improved further according to the echocardiogram ; the left ventricular ejection fraction was 57% and the dimensions were 37/52 mm . takayasu 's arteritis is a chronic inflammatory disease affecting the aorta and its main branches . hypertension can increase systemic resistance , causing increased after - load and resulting in heart failure . surgery is generally warranted because the prognosis is poor if left untreated . the first successful resection and end - to - end anastomosis of stenosis of the aorta first of all , aortic restenosis can occur with the reported incidence between 1.5% and 43% . in addition , the intercostal arteries can be injured due to anatomical distortion caused by the surrounding scar tissue , and spinal cord ischemia can also occur as the result of aortic cross - clamping . in 1973 , weldon et al .   reported bypass grafting as an alternative to resection and anastomosis because it avoids dissection of the scar tissue and aortic cross - clamping . since then , tube bypass grafting has been performed in various ways with the proximal anastomosis on the axillary artery or the ascending aorta , and the distal anastomosis on the descending aorta or the femoral artery . axillofemoral bypass has been a widely accepted management approach that carries a low risk of mortality and morbidity . martin and katz   reported a 30-day mortality rate of 4.9% and schneider et al .   described a 30-day mortality rate of 9% . this procedure reduces the hemodynamic disturbances that accompany aortic resection and end - to - end anastomosis . this benefit appears to be the result of the reduction of cardiac after - load , reduction of spinal cord ischemia by avoiding cephalic hypertension and caudal hypotension , and preservation of renal and mesenteric perfusion , thus avoiding the need for heparin in many patients . the patency of a bypass graft can be affected by multiple factors including the surgeon 's experience , surgical method , and the material and size of the prosthetic grafts . martin and katz   reported patency rates of 88% at 1 year , 79% at 3 years , and 69% at 5 years . it is unlikely that aortoaortic and axillofemoral bypass will be subjected to the rigors of a prospective and randomized study to compare their relative merits , and the current studies describing the results of these bypass operations have had dissimilar patient cohorts . in the majority of series , patients undergoing axillofemoral grafting were older , had more medical comorbidities , and had a higher number of operations for limb salvage than patients undergoing an aorto - aortic bypass . as the age of the population increases and the healthcare system suffers greater economic restraints , these factors will become increasingly important when determining treatment options . we believe that axillofemoral bypass grafting is a viable alternative to direct aortic reconstruction in the treatment of patients with severe cardiac and pulmonary disease , with highly reproducible 3-year and 5-year patency rates . although aortofemoral bypass remains the procedure of choice in good - risk patients , axillofemoral grafting remains an excellent therapeutic option for surgeons encountering elderly or debilitated patients with diffuse aortic disease .
takayasu 's arteritis is an inflammatory vasculitis that primarily affects the aorta and its major branches . 
 involvement of the thoracic and abdominal aortas , although rare , causes marked hypertension and may lead to severe heart failure . 
 we report the improvement of cardiac function after axillofemoral bypass grafting in a 59-year - old woman who had this condition .