Diagnosis and indications for revascularization in Takayasu's arteritis (original) (raw)

Diagnosis and indications for revascularization in Takayasu’s Arteritis: Report of two cases and literature review

Takayasu’s arteritis (TA) is an inflammatory disease of large vessels that predominantly affects the aorta and its main branches such as supra-aortic trunks, renal and digestive arteries. The diagnosis is based on criteria proposed by the American College of Rheumatology and modifi ed by Sharma. These vascular lesions present a problem of surgical indications because of their pathogenic particularity. In this work, we report our experience on the diagnosis and management of two cases of TA. The case 1 was a 62-year-old female patient diagnosed with stenosis of the common carotid artery and the right subclavian artery. A bypass between the carotid artery and the subclavian artery was indicated but not performed. The second patient was a 23-year-old female patient diagnosed with renovascular hypertension. Investigations showed a significant stenosis of the left renal artery. She underwent angioplasty-stenting of the left renal artery and the result was good. Her echocardiography showed left ventricular and atrial hypertrophy and both. The two patients had no indirect signs of myocardial ischemia and arterial pulmonary injuries

Takayasu's Arteritis: An Uncommon Cause of Renal Artery Stenosis and Therapeutic Considerations

The Open Urology & Nephrology Journal, 2013

Takayasu's arteritis is a rare disorder characterized by granulomatous and necro-inflammatory disease of the aorta and its major branches. Its etiology remains unknown. We report a young woman with Takayasu's arteritis affecting the aortic arch, carotid, mesenteric, celiac and bilateral renal arteries resulting in severe hypertension, unilateral renal atrophy and renal insufficiency. The immunosuppressive therapy did not halt the progression of her vascular disease, which required revascularization procedures on numerous occasions. Here, the clinical manifestations and histopathological features of Takayasu's arteritis are reviewed. In addition, the available medical treatment options including glucocorticoids, cytotoxic agents and TNF-alpha inhibitors are discussed. Furthermore, current revascularization procedures such as percutaneous transluminal angioplasty and reconstructive vascular surgery in the treatment of occlusive vasculopathy due to Takayasu's arteritis are discussed. Although the prognosis of this debilitating disease has improved over the past two decades, a better understanding of its etiology and pathogenesis will facilitate the discovery of effective target-specific treatment strategies with a narrow adverse effects profile.

Takayasu’s arteritis: Operative results and influence of disease activity

Journal of Vascular Surgery, 2006

To determine the short-and long-term outcomes of patients treated operatively for Takayasu's arteritis and the effect of disease activity on results. Methods: Forty-two (17%) of the 251 patients enrolled in our Takayasu's arteritis registry between 1975 and 2002 required operation for symptomatic disease. Data were obtained from the registry, patient records, phone correspondence, and written surveys. Results: There were 38 females and 4 males with a median age of 29 years (range, 12 to 56 years), and 32 (76%) were white. Sixty operations were performed for symptomatic disease. The mean duration of symptoms before operation was 5.6 months (range, 0 to 25 months). Thirteen (31%) patients had active disease and underwent operation for acute presentation or failure of medical management. Thirty-nine patients (93%) had operation for occlusive disease. Twenty-two (52%) patients had involvement of both the great and abdominal aortic branch vessels; 10 (24%) had great vessel disease alone; 9 (21%) had involvement of abdominal arteries; and 1 (2%) had coronary artery disease. There was no operative death, myocardial infarction, major stroke, or renal failure. Three patients had early graft thrombosis, two had a minor stroke, and two developed hyperperfusion syndrome. The median follow-up was 6.7 years (range, 1 month to 19.3 years). Eleven (26%) patients required 15 graft revisions; five of the patients had active disease at the time of initial operation. All early revisions (<1 year) were in patients with active disease. By Kaplan-Meier analysis, freedom from revision at 5 and 10 years was 100% in patients with quiescent disease not requiring steroids (group I, n ‫؍‬ 5, 12%), 95% and 81% in patients whose disease was quiescent on steroids (group II, n ‫؍‬ 24, 57%), 57% in patients with active disease on steroids (group III, n ‫؍‬ 7, 17%), and 33% in patients with active disease and no long-term steroids (group IV, n ‫؍‬ 6, 14%) (P < .006). The rate of revision or progression of disease at another site in 5 years was 0% in group 1, 10% in group 2, 57% in group 3, and 67% in group 4 (P < .001) The differences were even more pronounced when an analysis was done on the basis of disease activity alone, irrespective of steroid use. During the follow-up period, 3 of 39 great vessel, 2 of 18 mesenteric/renal, and 1 of 9 aortofemoropopliteal reconstructions occluded. The predicted mortality for patients was 4% at both 5 and 10 years (95% CI) respectively (confidence interval [CI], 0% to 11%) and 10 (CI, 0% to 14%) years, respectively. Conclusions: The minority of patients with Takayasu's arteritis require operation. In our predominantly white female patient population, occlusive symptoms were the most common indication for operation. Operation for these selected patients was safe, with no operative mortality, myocardial infarction, major stroke, or renal failure. Patients with active disease requiring operation are more likely to require revision or develop progressive symptomatic disease at another site. Long-term survival is excellent, regardless of disease activity at the time of operation. ( J Vasc Surg 2006;43:64-71.) From the Divisions of Vascular Surgery, a and Vascular Medicine, b and the Section

CLINICAL PROFILE, ANGIOGRAPHIC FINDINGS AND OUTCOMES FOLLOWING INTERVENTION IN PATIENTS WITH TAKAYASU?S ARTERITIS.

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.

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,

Refractory Takayasu’s Arteritis with Severe Coronary Involvement—Case Report and Literature Review

Journal of Clinical Medicine

This report presents the case of a female patient diagnosed with Takayasu arteritis from childhood, with severe, refractory coronary involvement, leading to two acute coronary syndromes and multiple anginous episodes. Consequently, the patient suffered aorto-bicarotid bypass two times, multiple interventional procedures with stent implantation, balloon angioplasty, and up to ten repeated in-stent restenosis that required reinterventions, despite being on maximal immunosuppressive treatment. In recent years, various studies have been reported that aim to best characterize this particular type of vascular damage and to indicate optimal therapeutic options for treatment. The latter should be based on the activity of the underlying disease; however, no reliable markers are available in TA. The management of TA patients with coronary involvement continues to be a challenge and requires both drug and interventional techniques to avoid life-threatening events.

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...

Balloon angioplasty of the aorta in Takayasu's arteritis: Initial and long-term results

American Heart Journal, 1992

Balloon angioplasty of the aorta in Takayasu's arteritis: Initial and long-term results Percutaneous transluminal balloon angioplasty for stenosis of the aorta was performed in 36 patients with Takayasu's arteritis (age range, 6 to 36 years; mean, 19.1 f 7.7 years). Balloon dilatation was successful in 34 patients and resulted in a decrease in the mean peak systolic pressure gradient (PSG) from 75.2 + 29.1 mm Hg to 24.8 f 19 mm Hg (p < 0.001) and a mean increase in the diameter of the stenosed segments from 4.5 + 2.2 mm to 9.6 f 3.8 mm (p < 0.001). Hemodynamic and angiographic restudy, which was performed in 20 patients at a mean follow-up period of 7.7-t 4.1 months (range, 3 to 24 months), showed a further decrease in PSG (~15 mm Hg) in seven patients (from 40.0 t 11.2 mm Hg to 15.7 f 10.2 mm Hg; p < O.Ol), no significant change in PSG in 12 patients (17.1 + 13.6 mm Hg vs 16.6 f 12.7 mm Hg; p = NS), and an increase in PSG from 15 mm Hg to 85 mm Hg in one patient. The patient who showed restenosis underwent successful redilatation. Six patients who underwent late recatheterization and angiography at 36 to 60 months (mean, 43 2 9.4 months) show continued relief of stenosis (mean PSG, 8.8 k 7.8 mm Hg). Patients with short-segment (<4 cm) stenosis experience more relief than patients with long-segment (z=4 cm) stenosis (residual PSG, 18.6 f 8.2 mm Hg vs 40 ? 16 mm Hg; p < 0.01). All successfully treated patients experienced improvement in their symptoms and hypertension. There were no significant complications. No patient showed evidence of an aneurysm immediately after percutaneous transluminal balloon angioplasty or during follow-up aortography. Percutaneous transluminal balloon angioplasty for stenosis of the aorta in patients with Takayasu's arteritis is safe and highly effective and produces sustained improvement. (AM HEART J 1992;124:876.