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. 2013:2013:618910.
doi: 10.1155/2013/618910. Epub 2013 Aug 6.

Takayasu arteritis: criteria for surgical intervention should not be ignored

A H Perera  1 , J C Mason, J H Wolfe
Affiliations

Takayasu arteritis: criteria for surgical intervention should not be ignored

A H Perera et al. Int J Vasc Med. 2013.

Abstract

Takayasu aortoarteritis is a rare, chronic granulomatous panarteritis with significant morbidity amongst young patients. Current challenges include a lack of awareness about the condition, delays in diagnosis due to its varied presentation, and suboptimal methods for assessing disease activity. The development of noninvasive imaging including magnetic resonance angiography and positron emission tomography is aiding earlier diagnosis. Early initiation of immunosuppressive treatment is crucial to control active inflammation and minimize arterial injury. Recent studies investigating biological agents such as tumour necrosis factor- α antagonists are encouraging. Surgical revascularization should only be undertaken following careful consideration, as restenosis is common. The indications for considering intervention include uncontrolled hypertension due to renal artery stenosis, severe symptomatic coronary artery or cerebrovascular disease, severe aortic regurgitation, stenotic or occlusive lesions resulting in critical limb ischemia, and aneurysms at risk of rupture. In these cases, the risk benefit ratio for intervention is good. Open surgery, at present, has better outcomes compared to endovascular techniques. However, technological advances in endovascular treatment are continually improving. Controlling disease activity prior to and following revascularization is key to preventing complications. A multidisciplinary approach to the diagnosis and management of Takayasu arteritis is essential to achieve satisfactory patient outcomes.

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Figures

Figure 1
Figure 1
Magnetic resonance angiography in Takayasu arteritis. Contrast-enhanced magnetic resonance angiogram revealing the extent of arterial disease in a young woman with Takayasu arteritis. The left subclavian artery is occluded (arrow) and this has led to collateral formation. There is a long stenosis in the left common carotid artery (arrowhead). The lower thoracic and abdominal aorta is narrow and irregular down to the aortic bifurcation (star).
Figure 2
Figure 2
Fluorodeoxyglucose positron emission tomography. (a) An 18F-FDG-PET scan in a young woman with active Takayasu arteritis demonstrating homogeneous linear uptake of FDG in the arch of the aorta and the subclavian arteries, suggestive of active disease. (b) Coregistered 18F-FDG-PET-CT image demonstrating increased uptake localised to the wall of the thoracic aorta of a man of 26 years with active disease.
Figure 3
Figure 3
Indications for surgical intervention in Takayasu arteritis. Surgery should not be undertaken lightly in patients with TA. However, the outcome of intervention in those with serious complications is good and improved if disease activity can be controlled prior to surgery. The figure shows MRA studies. (a) A right renal artery stenosis subsequently successfully treated by percutaneous angioplasty with resolution of hypertension. (b) Severe disease of the great vessels including stenoses of the right subclavian and common carotid arteries (arrows) and occlusion of the left subclavian and left common carotid arteries (stars). The patient suffered severe cerebrovascular symptoms and underwent successful bypass surgery. (c) A dilated ascending aorta with associated severe aortic regurgitation in a young female patient who required aortic valve replacement. (d) Although patients commonly suffer claudication symptoms as a consequence of subclavian artery stenosis (arrow), these often improve following the development of collaterals (stars) as shown here, precluding the need for intervention.
See this image and copyright information in PMC

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