Takayasu's arteritis in children : a review

Takayasu's arteritis is an inflammatory disease of unknown origin involving aorta, its primary branches and pulmonary artery. This article briefly reviews the pathology, clinical features and treatment of Takayasu's arteritis, focusing mainly on the disease in children.peer-reviewe

Takayasu arteritis in childhood: retrospective experience from a tertiary referral centre in the United Kingdom.

Takayasu arteritis (TA) is an idiopathic large-vessel vasculitis affecting the aorta and its major branches. Although the disease rarely affects children, it does occur, even in infants. The objective of this study was to evaluate the clinical features, disease activity, treatment and outcome of childhood TA in a tertiary UK centre

Maternal and fetal outcomes in pregnant women with Takayasu aortoarteritis: Does optimally timed intervention in women with renal artery involvement improve pregnancy outcome?

AbstractObjectiveTakayasu aortoarteritis (TA) is common in the Southeast Asian and Indian subcontinent regions with a female-to-male ratio of 8:1. Age at diagnosis is < 30 years in 90% of the cases. Because the disease is common in women of child-bearing age, management of pregnancy in these patients becomes an important issue. The purpose of this study is to evaluate the maternal and fetal outcomes in pregnancies with TA and also to evaluate whether early intervention for renal artery involvement is associated with improved outcomes.Materials and methodsWe collected data of 12 patients with 18 pregnancies prospectively from 2006 to 2012. The patients were divided into three groups and their outcomes were noted: (1) without renal artery involvement; (2) with renal artery involvement without intervention; and (3) with renal artery involvement for which intervention has been done.ResultsBody mass index of patients was between 18.5 kg/m2 and 23.2 kg/m2. Renal artery involvement and hypertension were seen in four patients. One patient had percutaneous transluminal balloon angioplasty and another had renal artery stenting. In patients without renal artery involvement, gestational hypertension was seen in 50%, pre-eclampsia in 10%, abortion in 10%, and intrauterine growth restriction (IUGR) in 40% of pregnancies. In patients with renal artery involvement without intervention, gestational hypertension was seen in 90%, pre-eclampsia in 20%, abortion in 60%, preterm in 20%, IUGR in 20%, fetal demise in 20%, and neonatal death in 20% of pregnancies. In patients with renal artery involvement for which intervention has been carried out, gestational hypertension was seen in 66%, and abortion and IUGR were seen in 33% of pregnancies.ConclusionPatients with renovascular involvement without intervention are at high risk of having maternal and fetal complications. Early intervention prior to conception in these women is recommended to prevent pregnancy complications

Renal revascularization in Takayasu arteritis–induced renal artery stenosis

AbstractPurposeThis study was undertaken to define the long-term effects of renal revascularization on blood pressure, and renal and cardiac function in patients with Takayasu arteritis–induced renal artery stenosis (TARAS).MethodsTwenty-seven patients (25 women; mean age, 27 years) with TARAS underwent intervention. Primary, primary assisted, and secondary patency rates were determined, and the late effects on blood pressure, renal and cardiac function, and survival were analyzed.ResultsAll patients had hypertension (mean blood pressure, 167/99 mm Hg; 2.5 antihypertensive medications per patient). Mean estimated glomerular filtration rate in patients not receiving hemodialysis was 76 mL/min, and in five patients serum creatinine concentration was greater than 1.5 mg/dL. Three patients were hemodialysis-dependent, and two had intractable congestive heart failure. Forty interventions were performed, including 32 aortorenal bypass procedures, two repeat implantations, four nephrectomies, and two transluminal angioplasty procedures. Postoperative morbidity was 19%. There were no deaths. During follow-up (mean, 68 months), three graft stenoses, all due to intimal hyperplasia, and three graft occlusions occurred. Two of three graft stenoses were successfully revised. At 1, 3, and 5 years of follow-up, primary patency was 87%, 79%, and 79%, respectively; primary assisted patency was 93%, 89%, 89%, respectively; and secondary patency was 93%, 89%, and 89%, respectively. Intervention resulted in a decrease in blood pressure to a mean of 132/79 mm Hg (P < .0001), and the need for antihypertensive medications was reduced to one per patient (P < .01). Mean glomerular filtration rate increased to 88 mL/min (P < .005), and two patients no longer required hemodialysis. Congestive heart failure resolved in both patients, and did not recur. There were three deaths during follow-up, with 5-year and 10-year actuarial survival of 96% and 80%, respectively.ConclusionsRenal revascularization to treat TARAS is durable, has a salutary effect on blood pressure, and enhances long-term renal and cardiac function. This response establishes renal revascularization as a successful and durable intervention for TARAS, and a benchmark to which other therapies should be compared

Insights into Imaging of Aortitis

Background: Aortitis is a subtype of the more general term “vasculitis”, an inflammatory condition of infectious or noninfectious origin involving the vessel wall. The term “vasculitis” refers to a broad spectrum of diseases with different aetiologies, pathophysiologies, clinical presentations and prognoses. The clinical manifestations are nonspecific, as are the laboratory findings such as pain, fever, weight loss, vascular insufficiency and elevated levels of acute phase reactants, as well as other systemic manifestations, and sometimes may mimic other entities. Thus, if not suspected as part of the initial differential diagnosis, aortitis can be overlooked during the workup of patients with constitutional symptoms and systemic disorders. Methods: Imaging is rarely used for the primary diagnosis, but imaging findings, although nonspecific, can help in the assessment of these patients and is often required for making the final diagnosis. Imaging can be critical in the initiation of appropriate management and therapy. Results: Noninvasive cross-sectional imaging modalities such as contrast-enhanced CT, magnetic resonance (MR) imaging, nuclear medicine and in particular positron emission tomography (PET) are the leading modalities in modern diagnostic imaging of aortitis for both the initial diagnosis and follow-up. Conclusion: This review focusses on the most common manifestations of aortitis with which radiologists should be familiar

Multiple isolated aneurysms in a case of “burned out” Takayasu aortitis

AbstractTakayasu aortitis (TA) is a chronic inflammatory disease predominantly seen in young Asian women. The disease is idiopathic and largely affects the aorta and its major branches. The basic pathologic changes in TA are fibrosis and subsequent occlusion of the large arteries. TA is classically termed “pulseless” disease, with manifestations during the occlusive stage including limb ischemia, renovascular hypertension, and heart failure. Arterial dilation and aneurysm are largely unappreciated manifestations of TA, but they occur in as many as 32% of affected patients. We report chronic “burned out” TA in a 23-year-old Hispanic woman with isolated aneurysms of the descending thoracic aorta, abdominal aorta, and common iliac arteries, without occlusive disease. (J Vasc Surg 2003;37:1094-7.

Recurrent stroke in Takayasu arteritis: a case report and review of literature

Takayasu Arteritis is a rare inflammatory vasculitis affecting medium to large blood vessels. Neurologic complications are seen in 10-20% of cases. A 28 year old female came in due to acute onset left sided weakness and numbness, with absent arterial pulses and blood pressure on the left extremities. She had a history of recurrent right-sided weakness and numbness. Imaging showed an infarct on the right thalamus and multiple chronic infarcts. CT aortogram was consistent with Takayasu Arteritis Type V. The patient was started dual antiplatelet consisting of Aspirin and Clopidogrel, and was started on Prednisone and Methotrexate with good clinical response

Takayasu arteritis: a comprehensive review of literature

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 total of 1104 records found, we included 37 papers for review after reading the articles. Remaining was excluded because of no innovative content, insufficient details, and no clear endpoints. This review of the literature presents comprehensive evidence in all fields of TA. Still, large areas need to be studied for better management of patients with TA

Pregnancy in Takayasu arteritis - maternal and fetal outcome

Background: Takayasu arteritis is a rare medical disorder of primary vasculitis of unknown etiology. It affects reproductive age women. It is rare disease and associated with serious maternal and fetal complications and long term morbidity.Methods: Retrospective analysis of patients with diagnosed Takayasu arteritis, to know the impact of disease on maternal status and evaluate fetal outcome. The objective of this study was to know the maternal and fetal outcome in pre-diagnosed cases of Takayasu arteritis. The necessity of accurate measurement of pulse and blood pressures in all the limbs in a suspected case of hypertension in antenatal women at any period of gestation and TYPE the disease accordingly. 3. To evaluate the typing of TA on maternal and fetal outcome.Results: All the 4 patients with TA had medical complication like hypertension in the form of chronic hypertension and pre eclampsia that needed good monitoring of BP in all 4 limbs.Conclusions: As the typing of disease increased, more medical and obstetric complications were noticed

Management of a pregnant woman with fibromuscular dysplasia

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