Management of Takayasu arteritis: a systematic review (original) (raw)
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Objective: To analyse the clinical presentation, angiographic findings and outcome following intervention (endovascular and open surgical) in patients with Takayasu?s arteritis. Methods: This is a retrospective observational study of 28 patients who were diagnosed with Takayasu?s Arteritis and who presented to the department of Vascular Surgery, between January 2012 to January 2018. Their clinical presentation , angiographic findings, and outcome following intervention was analyzed. Results: 28 patients were analysed during study period. Among 28 patients, 25(89%) were female and 3(11%) were male. Average age of presentation was 29.34 years. Constitutional symptoms were reported in 13 patients(46.43%) and claudication in 11 patients(32%) .The commonest finding was hypertension in (57%) followed by absent pulses in 10 patients (42%). Major organ involvement was seen as cerebrovascular accident in 1 patient(7.14%) and cardiac findings included - chest pain 2(10.71%), aortic regurgitation 4(14.29%), mitral regurgitation or valve prolapse 2(7%) and pulmonary hypertension 2(7%) . According to the new angiographic classification,type I(32.14%) was encountered most frequently, followed by type III (25%), type IV (21.4%), type V (14%) and type IIb(7%) .The commonly involved vasculature was abdominal aorta(32%) , renal artery(25%) ,left subclavian (25%) followed by thoracic aorta(14%) and right subclavian (10%). Renal artery angioplasty was done in 5 patients and aneurysm repair was done in 1 patient with good outcome. Conclusion:-Takayasu?s Arteritis is a rare disease, with female predominance and varied clinical presentation. Angiography findings and clinical symptoms are integrated to decide management. Angiographic evaluation and percutaneous transluminal angioplasty with stenting is useful in selected cases; while majority of the patients are managed medically.
Takayasu's arteritis: vascular interventions and outcomes
The Journal of rheumatology, 2004
To provide an analysis of outcomes of vascular interventions in 20 patients with Takayasu's arteritis (TA) who received care at the Cleveland Clinic Foundation between 1979 and 2001. We performed a retrospective chart review. The primary outcome measure of our review was patency of vessels as assessed by repeat invasive angiography or magnetic resonance angiography. The secondary outcome measures included periprocedural complications, morbidity, and mortality. Interventions included bypass grafts, patch angioplasty, endarterectomy, percutaneous transluminal angioplasty (PTA), or stent placement. Sixty-two revascularization procedures were performed in 20 patients. Followup evaluations were available for 52 procedures. Eleven of 31 bypass grafts restenosed or occluded between one day to 168 months after surgery. Three of 7 PTA and 5 of 7 stents restenosed or became occluded after 1-72 months and 2-45 months of followup, respectively. There were no deaths associated with revascula...
Rheumatology International, 2010
In this retrospective longitudinal cohort study we included 52 patients with Takayasu arteritis (TA) who were on regular follow-up at the Vasculitis Unit of Universidade Federal de São Paulo between 2003 and 2009. The mean age at study was 38 years and the mean age at diagnosis was 29 years. Patients were followed for a mean 74.3 months. A relapse-remitting course was observed in 41 patients (78.8%) whereas 9 (17.3%) had a monophasic course and only 2 (3.8%) patients were chronic-active. Disease remission was achieved in 50 patients (96.2%). Angiographic type V was observed in 42.3% of TA patients at diagnosis and in 61.5% during follow-up. The most aVected arteries were the abdominal aorta (63.5%) and left subclavian (60.6%). Prednisone was used by 94% of TA patients and immunosuppressive agents were prescribed for 51 (98%) patients. Methotrexate was used by 82.7%, followed by cyclophosphamide (26.9%), azathioprine (25.0%), anti-TNF agents (5.8%) and leXunomide (5.8%). Although, forty patients (76.9%) used prednisone and methotrexate as initial treatment, 75% of them developed new vascular lesions along follow-up. Eighteen TA patients (34.6%) needed to change immunosuppressive therapy due to failure or toxicity, among them 83.3% presented new lesions. Surgical treatment was performed in 34.6% of patients and restenosis was observed in 13.5% in a median time of 11 months after surgery. In conclusion besides prednisone and methotrexate is largely used in TA, the majority of patients still develop new arterial lesions along time.
Outcomes and Effectiveness of Percutaneous Intervention in Patients with Takayasu’s Arteritis
Russian Journal of Cardiology, 2014
Aim. Takayasu's arteritis (TA) is a chronic inflammatory disease that affects predominantly the aorta. Percutaneous intervention (PI) may be use the TA. In this manuscript, we studied the outcomes (in-hospital and 6 months later) and effectiveness of PI in patients with TA. Material and methods. The study was performed on 24 consecutive patients (39.3±11.8 (20-61) years; 4 men and 20 women) with TA who were treated with PI, surgical or medical therapy. Nine patients (7 females, 2 male) underwent PI. PI was performed after the erythrocyte sedimentation rate had been normalized in patients with TA. Results. Although 9 patients received PI with stent for subclavian, carotid, renal and coronary artery, 1 patient received PI with only balloon for brachial artery. One percutaneous transluminal angioplasty and 10 stentings were performed. There was not any complication during interventional procedure. The patients were followed for 6 months. After 6 month, the arteries treated were patent and showed no proliferative lesions in Doppler ultrasound at 8 patients. At a woman patient, left subclavian artery restenosis was determined in Doppler ultrasound and confirmed by angiography. During angiography the stenotic lesion has been successfully treated with balloon angioplasty. Conclusions. Takayasu's patients with active systemic disease must receive immunosuppressive therapy before PI. PI was performed after the active period such as during normal erythrocyte sedimentation rate. In these circumstances, PI in patient with TA may be safely and much less traumatic. Also, recurrence of stenosis in patient with TA has been treated successfully by reintervention without significant complications.
Case Report Multivessel Percutaneous Treatment of Takayasu Arteritis
2016
extracardiac interventional. The chest radiograph showed enlarged cardiac silhouette, elongated and dilated ascending aorta, with no signs of pulmonary congestion. Laboratory tests showed: BUN 53mg/dl (15-45), creatinine 1.39mg/dl (0.6-1.4), erythrocyte sedimentation rate (ESR) 101mm/h (10-20mm/h), C-reactive protein 30 (up to 6.0), mucoprotein tyrosine 8.8 mg/dl (1.7 a 5.1). Carotid ultrasound revealed diffuse and extensive thickening of the walls, causing a 70 % stenosis of the lumen of the left common carotid artery. Takayasu disease was suspected, and to confirm the hypothesis of other arterial lesions the patient underwent coronary angiography, aortography, and peripheral arteriography, which demonstrated normal coronary arteries,
Takayasu arteritis: a comprehensive review of literature
International Journal of Research in Medical Sciences
Takayasu arteritis is an inflammatory pulseless disease of large arteries with unknown etiology which advances in three stages i.e. early systemic, vascular, and burnout stage. It is more prevalent in Asian women of childbearing age. Hypertension, fever, weight loss, arthralgia, limb claudication, light-headedness, and arterial pain are common manifestations. Angiography is a gold standard test to evaluate TA. There is no reliable serological marker has been identified. Control on the inflammatory process and hypertension are two imperative angles to treat the disease. Steroids are most used. Reconstructive surgeries are limited to severe and stenotic lesions. This review aims to report comprehensive evidence about Takayasu arteritis. We conducted an integrative review of theoretical and empirical publications reporting epidemiology, etiopathogenesis, classification, diagnostic evaluation, and management of TA. The authors searched PubMed, Embase, and Scopus until March 2020. A tot...
TAKAYASU ARTERITIS: CLINICAL FEATURES AND MANAGEMENT: REPORT OF 272 CASES
Anz Journal of Surgery, 2005
Background: Takayasu's arteritis is a condition of unknown aetiology with an unpredictable natural history. Most of the literature available has originated from Asia, with a few contributions from Africa where the pattern of the disease may be different. This is a single institution's experience review. Methods: Data were obtained retrospectively from the angiographic and medical records of patients treated at Groote Schuur Hospital over the period 1952-2002. The criteria for inclusion were those proposed by the Aortitis Syndrome Research Committee of Japan and the American College of Rheumatology. Results: Two hundred and seventy-two patients were identified. The mean age at presentation was 25 years (range 14-66 years) and 75% were female. Only 8% were Caucasian. Hypertension was the most common presentation (77%) and was usually a consequence of renal artery stenosis or aortic coarctation. Cardiac failure was the most common problem. Cerebrovascular symptoms were recorded in 20%. Convincing evidence of tuberculosis was present in 20%. The entire aorta was involved in 70% of cases. Thirty per cent had aortic bifurcation involvement. Occlusions were noted in 93% and aneurysms in 46%. Vascular reconstruction was performed on 115 occasions in 99 patients, with an operative mortality of 4%. Cardiac failure was the usual cause of death. One hundred and six patients (39%) were followed for a minimum of 5 years. No further progression of disease was noted in 70 patients. Conclusion: The natural history and prognosis of Takayasu's arteritis still remain poorly defined.