New endovascular techniques for treatment of life-threatening Takayasu arteritis

Introduction

Takayasu arteritis (TA) is a medium-size and large artery vasculitis of unknown aetiology affecting mainly the aorta and its major branches, usually in young female patients. Histopathology reveals adventitial thickening, focal lymphocytic infiltration of the tunica media and intimal hyperplasia leading to artery stenosis/occlusion. Less commonly media degeneration presents as aneurysmal dilatation [1]. Clinical symptoms arise from systemic inflammation and local vascular complications. Neurological manifestation of the disease includes headache, dizziness, visual disturbance, transient ischemic attack (TIA) and stroke [2]. Takayasu arteritis may be associated with premature mortality among young patients. Mortality is significant (3–11%) and varies according to geographical location and management strategy. The most frequently reported causes of death include stroke, myocardial infarction, congestive cardiac failure, and peri- and postoperative complications. The majority of patients (23%) are unable to work, and about 60% are limited in everyday activities [3, 4].

Case report

We report the case of a 33-year-old woman who was previously diagnosed on the rheumatology ward in January 2014 due to unexplained weight loss, anaemia and highly elevated systemic inflammation markers (C-reactive protein of 129 ng/ml, erythrocyte sedimentation rate of 107 mm/h). These findings were accompanied by severe dizziness and an extremely low value of systemic blood pressure measured on both arms. Doppler ultrasound (DUS) examination followed by computed tomography angiography (angio-CT; Mar 2014) revealed thickening of the descending aorta wall, near-to-occlusion stenosis of both common carotid arteries (CCA), severe stenosis of the right subclavian artery (RSA) and occlusion of the left subclavian artery (LSA) as well as the right axillary artery. According to the criteria of large vessel vasculitis a diagnosis of TA was made [2] and the patient was initiated on a combination therapy of cyclophosphamide, prednisolone and hydrocortisone. Within the next 6 months, she was hospitalized several times due to persistent neurological symptoms including dizziness and drop attacks. In December 2014 clinical deterioration with increased neurological symptoms occurred. The patient was unable to adopt an upright position because of severe dizziness; moreover, right-hemisphere TIA occurred. She was admitted to our Vascular Surgery Department in...


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