Takayasu's Arteritis (TA) is a rare systemic inflammatory disease of unknown etiology and pathogenesis, characterized by progressive chronic inflammation, occlusive thrombotic aortopathy, and aneurysmal degeneration of the aorta and its major branches. Among them, type I TA is a rare form of large vessel vasculitis of unknown etiology. Type I TA is most commonly seen in women in their 30s. Here, we report the case of a 26-year-old female patient who presented with severe long-segment stenosis of the right brachiocephalic artery to the right common carotid artery, right subclavian artery, and left common carotid artery, and complete occlusion of the origin of the left subclavian artery. The patient had cerebral ischemic symptoms accompanied by syncope, and after a detailed examination, she was diagnosed with TA and was followed up under oral corticosteroid therapy. The severe stenosis and symptoms did not improve, and to address these complications, a surgical bypass using an artificial graft was performed. In a small-incision minimally invasive surgery, the graft was inserted into the thoracic cavity and extended from the patient's ascending aorta to both the left common carotid artery and the left distal subclavian artery and the right distal subclavian artery. This case highlights the importance of surgical intervention to relieve ischemia and explores potential surgical alternatives for treating patients with Takayasu's arteritis affecting the supra-aortic territory.

Tomohiro Imazuru is a Japanese cardiovascular surgeon who completed his PhD at the University of Tsukuba at the age of 38. He is currently a professor in the Department of Cardiovascular Surgery at Teikyo University. He specializes in aortic disease treatment, stent graft treatment, and peripheral vascular treatment. He serves on the editorial board of several reputed journals.