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Vats V, Patel K, Sharma DD, Almansouri NE, Makkapati NSR, Nimal S, Ramteke P, Mohammed Arifuddin B, Jagarlamudi NS, Narain A, Raut YD. Exploring Cardiovascular Manifestations in Vasculitides: An In-Depth Review. Cureus 2023; 15:e44417. [PMID: 37791229 PMCID: PMC10543473 DOI: 10.7759/cureus.44417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Systemic vasculitides encompass a cluster of autoimmune diseases that affect blood vessels, and are characterized by immune-mediated injury to either small- or large-sized blood vessels. Individuals afflicted with systemic vasculitides experience notable morbidity and mortality attributable to cardiovascular manifestations. Noteworthy among these are ischemic heart disease, venous thromboembolism, aortic involvement, valvular irregularities, myocarditis, and pericarditis. This narrative review investigated and evaluated the prevalent cardiovascular disturbances commonly associated with different types of vasculitides. This review also discusses the mechanisms that underlie these manifestations. It also provides a thorough explanation of the many diagnostic techniques essential for detecting the disease at its occult stage. It is essential for healthcare professionals to have knowledge of the cardiovascular complications caused by vasculitides, as this enables them to promptly recognize these symptoms and employ suitable diagnostic techniques early on. By doing so, timely detection can be ensured, which will subsequently aid in initiating appropriate treatment strategies that are vital for decreasing morbidity and mortality in patients with systemic vasculitides.
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Affiliation(s)
- Vaibhav Vats
- Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, IND
| | - Kriyesha Patel
- Internal Medicine, MP Shah Medical College, Jamnagar, IND
| | | | | | | | - Simran Nimal
- Internal Medicine, Byramjee Jeejeebhoy (BJ) Government Medical College, Pune, IND
| | - Palash Ramteke
- Medical School, NKP Salve Institute of Medical Sciences, Nagpur, IND
| | | | | | - Archit Narain
- Internal Medicine, Lala Lajpat Rai Memorial Medical College, Meerut, IND
| | - Yogesh D Raut
- Miscellaneous, NKP Salve Institute of Medical Sciences, Nagpur, IND
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Direct aortic access for endovascular thoracoabdominal aneurysm repair using a bifurcated endograft as a branched device. J Vasc Surg Cases Innov Tech 2022; 9:101056. [PMID: 36747604 PMCID: PMC9898790 DOI: 10.1016/j.jvscit.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Aortic aneurysms (AA) are a common complication in patients with large-vessel vasculitis, such as chronic phase Takayasu arteritis, that often require surgical management to prevent a lethal rupture. Historically, mainstay of treatment for AA in the setting of arteritis was traditional open repair. However, in this case study an alternative surgical approach was devised to successfully treat an extent III thoracoabdominal AA in a patient with a diagnosis of Takayasu arteritis and a complex surgical history that made her high risk for an open surgical intervention. This case study summarizes a hybrid surgical approach that successfully excluded a thoracoabdominal AA and revascularized the superior mesenteric artery and left renal artery, by directly accessing the infrarenal aorta and using a bifurcated abdominal aortic endograft as a two-vessel branched device.
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3
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The Treatment Dilemma of Arteriopathy in Takayasu Arteritis- A State-of-the-Art Approach. Curr Probl Cardiol 2022; 48:101359. [PMID: 36037926 DOI: 10.1016/j.cpcardiol.2022.101359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022]
Abstract
Takayasu Arteritis (TA) is a chronic idiopathic granulomatous pan-arteritis affecting the pulmonary artery, the aorta, and its principal derived branches. The majority of TA patients are female (82.9-97.0 percent). Due to the inflammatory character of the illness, arterial stenosis therapy must be treated differently than the atherosclerosis process. In this review paper, we outline a strategy using real-world challenging cases.
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Nakaoka Y, Yanagawa M, Hata A, Yamashita K, Okada N, Yamakido S, Hayashi H, Jayne D. Vascular imaging of patients with refractory Takayasu arteritis treated with tocilizumab: post hoc analysis of a randomized controlled trial. Rheumatology (Oxford) 2021; 61:2360-2368. [PMID: 34528074 PMCID: PMC9157117 DOI: 10.1093/rheumatology/keab684] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Tocilizumab, an anti-interleukin-6 receptor antibody, was investigated in patients with refractory Takayasu arteritis (TAK) in a phase 3 randomized controlled trial. In this post hoc analysis, we investigated whether tocilizumab treatment inhibited the progression of vascular lesions caused by TAK in these patients. METHODS Included patients received at least one dose of tocilizumab and underwent computed tomography (CT) at baseline and at week 48 after tocilizumab initiation. Three radiologists not involved in the original trial independently evaluated the CT images. Twenty-two arteries from each patient were assessed for change from baseline in wall thickness (primary end point), dilatation/aneurysm, stenosis/occlusion or wall enhancement for at least 96 weeks after tocilizumab initiation. Patient-level assessments were also conducted. RESULTS In 28 patients, 86.7% of 22 arteries had improved/stable wall thickness at week 96. Proportions of patients with improved/stable, partially progressed or newly progressed lesions were 57.1%, 10.7% and 28.6% for wall thickness; proportions with improved/stable lesions were 92.9% for dilatation/aneurysm and 85.7% for stenosis/occlusion. Patients with newly progressed lesions, reflecting more refractory disease, were prescribed glucocorticoids at dosages that could not be reduced below 0.1 mg/kg/day at week 96. CONCLUSIONS ∼60% of patients with TAK did not experience progression in wall thickness within 96 weeks after initiation of tocilizumab treatment. Few patients experienced progressed dilatation/aneurysm or stenosis/occlusion. Wall thickness progression likely resulted from refractory TAK. Patients who experience this should be monitored regularly by imaging, and additional glucocorticoid or immunosuppressive treatment should be considered to avoid vascular progression.
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Affiliation(s)
- Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Centre Research Institute, Suita, Japan.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Yanagawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akinori Hata
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Katsuhisa Yamashita
- Medical Science Department, Medical Affairs, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Norihiro Okada
- Biometrics Department, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Shinji Yamakido
- Primary Clinical Development, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | | | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Sebastian A, Tomelleri A, Dasgupta B. Current and innovative therapeutic strategies for the treatment of giant cell arteritis. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1932458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Alwin Sebastian
- Rheumatology Department, Mid and South Essex University Hospitals NHS Foundation Trust, Southend University Hospital, Westcliff on sea, UK
| | - Alessandro Tomelleri
- Rheumatology Department, Mid and South Essex University Hospitals NHS Foundation Trust, Southend University Hospital, Westcliff on sea, UK
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Bhaskar Dasgupta
- Rheumatology Department, Mid and South Essex University Hospitals NHS Foundation Trust, Southend University Hospital, Westcliff on sea, UK
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
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Pulse wave velocity, carotid intima media thickness and flow-mediated dilation in Takayasu arteritis: a systematic review. ACTA ACUST UNITED AC 2021; 6:e79-e84. [PMID: 34027216 PMCID: PMC8117071 DOI: 10.5114/amsad.2021.105390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
Introduction Takayasu arteritis (TA) is a chronic vasculitis associated with an increased cardiovascular risk. The measurement of pulse wave velocity (PWV), carotid artery intima-media thickness (CIMT) and flow-mediated dilatation (FMD) are generally used for evaluating the cardiovascular risk. The application of these measurements to TA patients remains undetermined. Material and methods Clinical studies that reported the PWV, CIMT and FMD levels in TA patients, which were published prior to 2021, were summarized using PubMed. Results Fifteen studies were eligible. Overall, in TA patients, the PWV and CIMT levels were significantly higher and the FMD levels were significantly lower compared to controls. Part of the studies showed that the disease activity of TA was significantly associated with the PWV, CIMT or FMD levels. Conclusions The PWV, CIMT and FMD measurements could be useful for evaluating the cardiovascular risk in TA patients. Further studies to determine the proper use of these measurements are warranted.
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Keleşoğlu Dinçer AB, Kılıç L, Erden A, Kalyoncu U, Hazirolan T, Kiraz S, KaradaĞ Ö. Imaging modalities used in diagnosis and follow-up of patients with Takayasu’s arteritis. Turk J Med Sci 2021; 51:224-230. [PMID: 33155792 PMCID: PMC7991884 DOI: 10.3906/sag-2005-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim Takayasu’s arteritis (TA) is a rare, large-vessel vasculitis of unknown etiology, affecting aortic arch, and its main branches. Noninvasive imaging methods are frequently used in diagnosis and follow-up in Takayasu’s arteritis. Studies investigating optimal timing of follow up imaging are rare. This study is aimed to investigate the radiologic changes in vascular involvements of Takayasu’s arteritis patients one year after diagnosis. Materials and methods Database of our Vasculitis Center was analyzed retrospectively and 97 patients were included into the study. Demographic, clinical, radiological, and therapeutic findings of patients were recorded. Patients with follow-up imaging after approximately one year of diagnosis were recruited into further analysis. Radiological changes and the effect of different immunosuppressive agents on vascular involvements were investigated. Results Mean age and disease duration of patients were 43.0 and 9.0 years. The most commonly used imaging methods/modalities for the diagnosis of TA were computer tomography-angiography (CT-Ang) (58.8%), magnetic resonance-angiography (MR-Ang) (29.9%), and doppler ultrasonography (11.3%). Subclavian and common carotid arteries were the most frequently involved vessels. Fifty-three patients underwent follow-up imaging after one year of diagnosis and, in 64% of patients, same imaging method had been used. MR-Ang (62.3%) and CT-Ang (35.9%) were the most preferred follow-up imaging studies. Sixty-eight percent of patients had stable vascular involvement, 28% had progression, and 4% had regression. No difference was found in radiological changes regarding patients with usage of different immunosuppressive agents (P = 0.634). There was no association between the change in serum acute phase reactants and radiological disease activity. Conclusion The most commonly used imaging modality for the diagnosis of TA was CT-Ang, whereas MR-Ang was the most preferred for follow-up. Almost 30% of TA patients in our Vasculitis Center had progression at around one year concordant with previous literature. A follow-up imaging at around one year of treatment seems feasible in management of TA.
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Affiliation(s)
| | - Levent Kılıç
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Abdulsamet Erden
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sedat Kiraz
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ömer KaradaĞ
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Shumy F, Anam A, Choudhury M, Shahin M, Haq S, Amin M, Minhaj S. Rate and predictors of response to glucocorticoid therapy in patients of takayasu arteritis at a tertiary level hospital of Bangladesh: A longitudinal study. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_40_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sánchez-Vicente JL, Molina-Sócola FE, De Las Morenas-Iglesias J, Espiñeira-Periñán MA, Franco-Ruedas C, López-Herrero F. Takayasu's arteritis: Ischaemic retinal arterial occlusion as a possible initial presentation. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:400-403. [PMID: 32493635 DOI: 10.1016/j.oftal.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Ocular manifestations are observed in 25% of patients with Takayasu's arteritis. Its signs and symptoms can be very variable. The case is presented of a 41-year-old woman with progressive vision loss in her right eye secondary to ischaemic retinal arterial occlusion. After a systematic study, a protein purified derivative (PPD) skin test compatible with tuberculosis was found to be the only alteration. After ruling out other causes, and based on the initial suspicion of tuberculous retinal vasculitis, treatment was started with antimicrobial agents and systemic corticosteroids, without any therapeutic response. Eighteen months later, the patient developed acute kidney failure, secondary to right renal artery stenosis. The CT-angiography revealed a thickening of the aortic arch and its branches, and Takayasús arteritis was finally diagnosed. Therefore, emphasis is made on the importance of the ophthalmologist in the diagnosis of Takayasús arteritis, in which its ophthalmological manifestations can be an early sign of the disease.
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Affiliation(s)
- J L Sánchez-Vicente
- Licenciado en Medicina y Cirugía. Servicio de Oftalmología, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, España; Hospital Universitario Virgen del Rocío. Oftalmología, sección de Retina Quirúrgica. Sevilla, Sevilla, España
| | - F E Molina-Sócola
- Licenciado en Medicina y Cirugía. Servicio de Oftalmología, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, España; Hospital Juan Ramón Jiménez. Oftalmología, sección General. Huelva, Huelva, España
| | - J De Las Morenas-Iglesias
- Licenciado en Medicina y Cirugía. Servicio de Oftalmología, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, España; Hospital Universitario Virgen del Rocío. Oftalmología, sección General. Sevilla, Sevilla, España.
| | - M A Espiñeira-Periñán
- Licenciado en Medicina y Cirugía. Servicio de Oftalmología, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, España; Hospital Universitario Virgen del Rocío. Oftalmología, sección General. Sevilla, Sevilla, España
| | - C Franco-Ruedas
- Licenciado en Medicina y Cirugía. Servicio de Oftalmología, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, España; Hospital Universitario Virgen del Rocío. Oftalmología, sección General. Sevilla, Sevilla, España
| | - F López-Herrero
- Licenciado en Medicina y Cirugía. Servicio de Oftalmología, Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, España; Hospital Universitario Virgen del Rocío. Oftalmología, sección de Retina Médica. Sevilla, Sevilla, España
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Garcia-Cazares R, Merlos-Benitez M, Marquez-Romero JM. Role of the physical examination in the determination of etiology of ischemic stroke. Neurol India 2020; 68:282-287. [PMID: 32415006 DOI: 10.4103/0028-3886.284386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The actual investigation of the body of a patient by the clinician in search for the signs of the disease beginning with the primary vital signs and continues with the careful and attentive observation of the patient. This article reviews the key findings in the physical examination of patients with ischemic stroke that have the potential to indicate the etiology of the infarct and to help to choose the use of ancillary tests. Through a systematic search of articles published in English related to the physical examination of patients with stroke, we identified key findings in the vital signs and classic components of the physical exam (appearance of the patient, auscultation, and eye examination) that have shown clinical significance when determining ischemic stroke etiology. We further suggest that the prompt identification of such findings can translate into better use of diagnostic tools and selection of ancillary confirmatory tests, thus, reducing the time to etiology based treatment and secondary prevention of ischemic stroke. in this manuscript, we aim to show that even though nowadays the clinical skills tend to be overlooked due to the overreliance on technology, the physical exam continues to be a valuable tool in the clinician armamentarium when facing the challenge of a patient with ischemic stroke.
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Macedo LM, Lima NDA, de Castro Junior RL, Bannon SF. Takayasu arteritis with multiple coronary involvement and early graft relapse. BMJ Case Rep 2019; 12:12/4/e229383. [PMID: 31040146 DOI: 10.1136/bcr-2019-229383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Coronary artery disease (CAD) due to Takayasu arteritis (TA) is rare. This article reports a case of severe involvement of multiple coronary arteries in a young woman. She was treated with coronary artery bypass grafting and had an early venous graft stenosis despite immunosuppressants. She became asymptomatic one year after a drug-eluting stent placement. This report shows the complexity of the diagnostic and therapeutic approach to TA with complex CAD.
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Affiliation(s)
| | - Neiberg de Alcantara Lima
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | | | - Susan Faragher Bannon
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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12
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Analysis of predictive factors for treatment resistance and disease relapse in Takayasu’s arteritis. Clin Rheumatol 2018; 37:2789-2795. [DOI: 10.1007/s10067-018-4094-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/10/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
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Sim HT, Kim JW, Yoo JS, Cho KR. Hybrid Coronary Artery Revascularization for Takayasu Arteritis with Major Visceral Collateral Circulation from the Left Internal Thoracic Artery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:105-109. [PMID: 28382269 PMCID: PMC5380203 DOI: 10.5090/kjtcs.2017.50.2.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/22/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022]
Abstract
Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation.
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Affiliation(s)
- Hyung Tae Sim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital
| | - Jeong-Won Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital
| | - Kwang Ree Cho
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital
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Okazaki T, Shinagawa S, Mikage H. Vasculitis syndrome-diagnosis and therapy. J Gen Fam Med 2017; 18:72-78. [PMID: 29263994 PMCID: PMC5689388 DOI: 10.1002/jgf2.4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 10/05/2015] [Indexed: 01/25/2023] Open
Abstract
In patients with connective tissue disease, vascular injury induced by primary or secondary vasculitis syndromes can lead to organ dysfunction due to the loss of nutrient supply from the blood. Such vasculitis syndromes can be refractory to treatment and fatal. The nomenclature and the definition of vasculitis syndromes have recently been revised, and clinical practice guidelines for diseases associated with vasculitis syndrome are evolving. The present review provides an overview of vasculitis syndromes from the viewpoint of diagnosis and treatment.
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Affiliation(s)
- Takahiro Okazaki
- Division of Rheumatology and Allergology Department of Internal Medicine St. Marianna University School of Medicine Miyamae-ku, Kawasaki Japan
| | - Shoshi Shinagawa
- Division of Rheumatology and Allergology Department of Internal Medicine St. Marianna University School of Medicine Miyamae-ku, Kawasaki Japan
| | - Hidenori Mikage
- Division of Rheumatology and Allergology Department of Internal Medicine St. Marianna University School of Medicine Miyamae-ku, Kawasaki Japan
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Jain A, Misra DP, Ramesh A, Basu D, Jain VK, Negi VS. Tuberculosis mimicking primary systemic vasculitis: not to be missed! Trop Doct 2017; 47:158-164. [PMID: 28092221 DOI: 10.1177/0049475516687432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infections are an important differential diagnosis in patients presenting with features of systemic vasculitis. We report a young lady with constitutional features, leg ulcers, digital gangrene and absent peripheral pulses with cervical adenopathy. Chest imaging revealed multiple necrotic lung lesions and involvement of left subclavian artery at its origin from the aorta, Histopathology from cervical lymph nodes showed multiple caseated lymph nodes, which in the context of a positive Mantoux test led us to diagnose tuberculosis and institute appropriate therapy. This is only the second report of tuberculosis presenting as peripheral gangrene, cutaneous ulcers and absent pulses, and serves to educate rheumatologists regarding the need to consider infections as mimics of vasculitis, especially in the developing countries.
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Affiliation(s)
- Ankit Jain
- 1 Senior Resident, Department of Clinical Immunology, JIPMER, Puducherry, India
| | - Durga Prasanna Misra
- 2 Assistant Professor, Department of Clinical Immunology, JIPMER, Puducherry, India
| | - A Ramesh
- 3 Associate Professor, Department of Radiodiagnosis, JIPMER, Puducherry, India
| | - Debdatta Basu
- 4 Professor, Department of Pathology, JIPMER, Puducherry, India
| | - Vikramraj K Jain
- 2 Assistant Professor, Department of Clinical Immunology, JIPMER, Puducherry, India
| | - Vir Singh Negi
- 5 Professor and Head, Department of Clinical Immunology, JIPMER, Puducherry, India
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Takayasu arteritis (TA) first presenting with intestinal ischemia: a case report and review of gastrointestinal tract involvement (ischemic and non-ischemic) associated with TA. Rheumatol Int 2016; 37:169-175. [PMID: 27832292 DOI: 10.1007/s00296-016-3600-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis involving the aorta and its major branches. Insidious inflammation usually results in gradual arterial narrowing; however, critical organ ischemia is rare. We describe a young male with TA who presented with acute mesenteric ischemia requiring intestinal resection, followed by critical limb ischemia. In our literature review, we identified intestinal gangrene as a rare manifestation of TA. However, intestinal ischemia as the first manifestation of TA has been scarcely reported in the literature. Also, ischemia of the intestine occurring together with critical limb ischemia is extremely unusual. Rheumatologists should be aware of TA as a rare cause of gastrointestinal vasculitis in young adults, which can be easily suspected by routinely examining all the peripheral pulses.
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Baek WK, Lee M, Kim YS, Yoon YH, Kim JT, Kim DH. Spontaneous Resolution of the Left Subclavian Artery Obstruction in Takayasu's Arteritis. Korean Circ J 2016; 46:730-733. [PMID: 27721867 PMCID: PMC5054188 DOI: 10.4070/kcj.2016.46.5.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/18/2015] [Accepted: 12/08/2015] [Indexed: 11/11/2022] Open
Abstract
Spontaneous resolution of the arterial obstruction in Takayasu's arteritis is rarely reported. We reported a case of spontaneous resolution of an obstruction of the left subclavian artery in a young female. The patient underwent a bilateral coronary patch ostioplasty for both coronary ostial lesions complicated by Takayasu's arteritis at the age of 28. Concomitant left subclavian obstruction was seen at that time but left untreated. Surprisingly, the 10-year follow-up angiogram revealed complete resolution of the left subclavian artery obstruction. Meanwhile, no specific medical treatment was administered.
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Affiliation(s)
- Wan Ki Baek
- Department of Thoracic and Cardiovascular Surgery, Inha University, Incheon, Korea
| | - Mina Lee
- Department of Thoracic and Cardiovascular Surgery, Inha University, Incheon, Korea
| | - Young Sam Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University, Incheon, Korea
| | - Yong Han Yoon
- Department of Thoracic and Cardiovascular Surgery, Inha University, Incheon, Korea
| | - Joung Taek Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University, Incheon, Korea
| | - Dae Hyeock Kim
- Division of Cardiology, Internal Medicine, College of Medicine, Inha University, Incheon, Korea
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Wang J, Lee YZ, Cheng Y, Zheng Y, Gao J, Tang X, Wang T, Zhang C. Sonographic Characterization of Arterial Dissections in Takayasu Arteritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1177-1191. [PMID: 27105948 DOI: 10.7863/ultra.15.07042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/02/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Takayasu arteritis is a relatively rare chronic nonspecific form of large-vessel vasculitis in which the involved vessels develop stenoses, occlusions, dilatations or aneurysms, and dissections. Dissections of the arteries in patients with Takayasu arteritis are not well understood. In this study, we explored the sonographic characterization of these rare complications secondary to Takayasu arteritis. METHODS We evaluated arterial dissections in 72 patients with a clinical diagnosis of Takayasu arteritis by vascular sonography and transthoracic echocardiography. We analyzed the dissection distribution and morphologic characteristics of the dissected intima/layer and lumen of the involved vessels. RESULTS Twelve of 72 patients had arterial dissections, in whom 16 dissected segments were identified. The involved arteries included the carotid, subclavian, vertebral, brachial, celiac, and femoral arteries, aortic arch, and abdominal aorta. The dissection lesions occurred at any age and coexisted with the aforementioned injuries. Evaluation of the dissected intima/layer and the involved lumen by sonography was technically complicated. The morphologic characteristics of the dissected intimae and involved lumens were complex, with most of the dissected intimae/layers having the characteristic "macaroni" sign in the arterial wall. High-frequency and high-resolution sonography, color Doppler flow imaging, and other techniques were useful in elucidating greater lesion details. CONCLUSIONS Arterial dissections in Takayasu arteritis can involve any anatomic vessel location and have complex morphologic characteristics. Sonography is the optimal technique for diagnosis and follow-up of patients with Takayasu arteritis and dissections.
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Affiliation(s)
- Jiong Wang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, ChinaDepartment of Radiology, University of North Carolina Hospital, Chapel Hill, North Carolina USADepartment of Medical Ultrasonography, Peking University International Hospital, Beijing, China
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina Hospital, Chapel Hill, North Carolina USA
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ye Zheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Junyi Gao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaobin Tang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Tian Wang
- Department of Rheumatology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chun Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Chest Pain: The Need to Consider Less Frequent Diagnosis. Case Rep Cardiol 2016; 2016:4294780. [PMID: 27034853 PMCID: PMC4789417 DOI: 10.1155/2016/4294780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/10/2016] [Indexed: 11/18/2022] Open
Abstract
Chest pain is one of the most frequent patient's complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries.
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Suematsu R, Tashiro S, Ono N, Koarada S, Ohta A, Tada Y. Successful golimumab therapy in four patients with refractory Takayasu's arteritis. Mod Rheumatol 2015; 28:712-715. [PMID: 26707139 DOI: 10.3109/14397595.2015.1134393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Recent studies suggested that anti-TNF-α biological therapies are effective in treating Takayasu's arteritis (TA) refractory to conventional immunosuppressive therapy. However, the efficacy of golimumab (GLM) for TA therapy is unknown. We report four women with TA who were successfully treated with GLM. GLM was prescribed as induction therapy for three patients and as maintenance therapy for one patient. GLM showed therapeutic value and might be useful, together with other anti-TNF-α agents, in treating TA.
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Affiliation(s)
| | | | | | | | - Akihide Ohta
- b The Department of Adult & Gerontological Nursing , Saga University School of Medicine , Saga , Japan
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Affiliation(s)
- Fátima Rodriguez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif.
| | | | - Prashant Nagpal
- Department of Radiology, Brigham and Women's Hospital, Boston, Mass
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass
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23
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Shikino K, Suzuki S, Noda K, Ohira Y, Ikusaka M. Fever and Back Pain with Abdominal Aorta Tenderness: Takayasu Arteritis. Am J Med 2015; 128:e17-8. [PMID: 25910789 DOI: 10.1016/j.amjmed.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan.
| | - Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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Baldwin C, Carette S, Pagnoux C. Linking classification and therapeutic management of vasculitides. Arthritis Res Ther 2015; 17:138. [PMID: 26031766 PMCID: PMC4451722 DOI: 10.1186/s13075-015-0654-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Vasculitides are classified by the size, type and location of the predominantly involved vessels and by their primary or secondary nature. Their treatment depends on the type of vasculitis, its etiology (when known), and its severity and must be further adjusted by the individual characteristics and comorbidities of patients. In this paper, we review how the classification and definition of vasculitides have evolved over the past years and how it has affected therapeutic changes. As new genetic markers are being discovered and the pathogenesis of vasculitides continues to be elucidated, further modifications in classification and treatment can be expected.
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Affiliation(s)
- Corisande Baldwin
- Division of Rheumatology, Department of Medicine, University of British Columbia, 1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada. .,Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, 60 Murray Street, Toronto, Ontario, M5T 3L9, Canada.
| | - Simon Carette
- Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, 60 Murray Street, Toronto, Ontario, M5T 3L9, Canada.
| | - Christian Pagnoux
- Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, 60 Murray Street, Toronto, Ontario, M5T 3L9, Canada.
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Gulati AM, Ødegård A. [Aortic aneurysm in a young woman]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:41. [PMID: 25589127 DOI: 10.4045/tidsskr.14.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Kiyohara H, Hisamatsu T, Matsuoka K, Naganuma M, Kameda H, Seta N, Takeuchi T, Kanai T. Crohn's Disease in which the Patient Developed Aortitis during Treatment with Adalimumab. Intern Med 2015; 54:1725-32. [PMID: 26179525 DOI: 10.2169/internalmedicine.54.3853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 23-year-old woman developed aortitis during treatment with adalimumab (ADA) for ileocolic Crohn's disease (CD). The patient complained of a high fever, abdominal pain, diarrhea, hematochezia and arthralgia. Although the ADA therapy resulted in immediate symptom improvement, after six weeks, she again complained of a low-grade fever and abdominal pain, whereas the CD-related symptoms did not worsen. Contrast-enhanced computed tomography revealed thoracoabdominal aortitis, and we therefore started treatment with prednisolone, which immediately improved the fever and abdominal pain. We subsequently tapered the dose of prednisolone and resumed the administration of ADA in order to maintain the CD remission. No further episodes of aortitis relapse were noted after restarting ADA, and the CD currently remains in remission. This is the first report of the onset of aortitis during ADA therapy for CD.
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Affiliation(s)
- Hiroki Kiyohara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
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Fritz Angle J, Nida BA, Matsumoto AH. Endovascular Treatment of Large Vessel Arteritis. Tech Vasc Interv Radiol 2014; 17:252-7. [DOI: 10.1053/j.tvir.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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