Etiologic aspects of coagulopathy in Takayasu's aortitis

Sensorineural hearing loss combined with Takayasu's arteritis

A 49-year-old woman complained of hearing loss and diminution of left radial arterial pulsation. She had been diagnosed with sudden deafness and treated with corticosteroids. Her audibility deteriorated again after the cessation of the therapy. Angiograms showed stenosis in the bilateral carotid arteries, the left vertebral artery, the left subclavian artery, and the pulmonary arteries. She was diagnosed with Takayasu's arteritis. After steroid therapy was restarted, there were improvements in her audibility, radial arterial pulsation, and levels of inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, and gamma-globulin), fibrinogen, interleukin-6, and RANTES (regulated on activation, normal T cell expressed and secreted).

Update on systemic necrotizing vasculitis

The systemic necrotizing vasculitides are classified into vasculitic syndromes on the basis of the pattern of clinical and pathologic involvement. The vasculitides have certain common clinical and laboratory abnormalities. Systemic necrotizing vasculitis is diagnosed on the basis of clinical features, and the vascular nature of the disease is determined by biopsy of involved tissue or angiography. The outcome is dependent on the extent of visceral involvement. Vascular inflammation influences the physiologic features of the vessel and may trigger vasoconstriction. Although glucocorticoids combat the inflammation, they may augment vasoconstriction and platelet aggregation. These effects must be considered in designing a management approach and in evaluating the cause and management of ischemic complications.

Surgical treatment of Takayasu's disease

Thirty-nine patients (mean age: 33 years) with Takayasu's disease were observed over the past 8 years. Among these patients, 33 had surgical intervention with a mean follow-up of 4 years. Lesions of the aortic arch were the most common (29 patients, 69 lesions) and frequently were associated with lesions in another site as well. However, in this group of patients, the infrequent presence of signs of cerebral vascular insufficiency limited the number of suitable surgical candidates to 14 patients. Lesions of the renal arteries were noted in 25 patients (37 lesions) and were associated with coarctation of the thoracoabdominal aorta in 12 patients. In contrast to lesions of the aortic arch, the presence of severe hypertension was a frequent indication for surgery in Takayasu's disease. Twenty-one patients had operation. Twenty of 21 patients were considered cured or improved of hypertension. The one patient who received no benefit was the only operative death of the study. In conclusion, although Takayasu's disease is progressive and the life expectancy is foreshortened, hypertension secondary to aortic and renal artery lesions is a frequent and important indication for aggressive operative treatment.