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Harris G, Chuen J, Farouque O, Hare DL, Hoi A. Case report: Lipoprotein (a) related accelerated atherosclerosis in a young patient: An important differential when considering Takayasu arteritis. Int J Rheum Dis 2024; 27:e15087. [PMID: 38375750 DOI: 10.1111/1756-185x.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Georgia Harris
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
| | - Jason Chuen
- Department of Vascular Surgery, Austin Health, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Alberta Hoi
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Cáceres Medina JL, Gamboa Meza A, Hernández Padilla IE. Two types of abdominal pain as the initial presentation of Takayasu arteritis: A case report. Int J Rheum Dis 2023; 26:2076-2079. [PMID: 37098726 DOI: 10.1111/1756-185x.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Takayasu arteritis (TA) is a chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. Diagnosis is usually delayed in most patients owing to the absence of typical clinical manifestations in the acute phase until the development of substantial arterial symptoms. The purpose of this case report is to describe abdominal pain being an uncommon symptom in TA. LEARNING OBJECTIVE The clinical presentation of TA can be non-specific and can have serious consequences if the diagnosis is delayed, helping the clinicians who can treat with such patients (emergency medicine, cardiologist, or medical personnel).
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Affiliation(s)
- José Luis Cáceres Medina
- Internal Medicine Department, University Hospital "Dr. José Eleuterio González", Monterrey, Nuevo León, Mexico
| | - Alan Gamboa Meza
- Internal Medicine Department, University Hospital "Dr. José Eleuterio González", Monterrey, Nuevo León, Mexico
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3
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van der Geest KS, Slijkhuis BG, Tomelleri A, Gheysens O, Jiemy WF, Piccolo C, Nienhuis P, Sandovici M, Brouwer E, Glaudemans AW, Mulder DJ, Slart RH. Positron Emission Tomography Imaging in Vasculitis. Cardiol Clin 2023; 41:251-265. [PMID: 37003681 DOI: 10.1016/j.ccl.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Systemic vasculitides comprise a group of autoimmune diseases affecting blood vessels. [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) plays an important role in the diagnosis and therapeutic monitoring of vasculitides affecting large-sized and medium-sized vessels. FDG-PET/CT also provides complementary information to other vascular imaging tools. The resolution and sensitivity of newer generation scanners continues to increase, hereby improving the ability of FDG-PET/CT to accurately assess the full disease extent in patients with vasculitis. Novel tracers targeting specific immune cells will allow for more detailed detection of vascular infiltrates.
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4
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Liao H, Zhang N, Pan L, Du J, Liu J, Zheng Y. Predictors for pulmonary artery involvement in Takayasu arteritis and its cluster analysis. Arthritis Res Ther 2023; 25:9. [PMID: 36639641 PMCID: PMC9840297 DOI: 10.1186/s13075-022-02987-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the clinical characteristics and the site of pulmonary involvement in Takayasu arteritis (TAK) patients with pulmonary artery involvement (PAI). METHODS We retrospectively investigated data of 141 TAK patients. The clinical and image data of the patients with and without PAI were analyzed and compared. The patients were followed up. The major outcome was all-cause mortality. The minor outcome was exacerbation or new occurrence of PAI, which leads to disease progression events. RESULTS For the 141 TAK patients considered, PAI was detected in 65 (46.1%) patients. TAK patients with PAI had a significantly higher cumulative incidence of events than those without PAI (P < 0.001). The frequencies of the following were significantly higher in TAK with PAI than those in TAK without PAI: disease duration [median 96 months (IQR: 24-174) vs. median 42 months (IQR: 6-120); P = 0.012], hemoptysis (10.8% vs. 1.32%; P = 0.040), oppression in the chest (40.0% vs. 21.1%; P = 0.014), fever (23.1% vs. 9.21%; P = 0.024), Mycobacterium tuberculosis infection (21.5% vs. 6.57%; P = 0.010), pulmonary hypertension (PAH) (21.5% vs. 2.6%; P < 0.001), pulmonary infarction (41.5% vs. 0%; P < 0.001), and hypoxemia (18.5% vs. 1.3%; P < 0.001). Multivariate logistic regression analysis of data of TAK patients with symptom presentation showed that oppression in the chest (OR: 2.304; 95% CI: 1.024-5.183; P = 0.044) and thoracic aorta involvement (OR: 2.819; 95% CI: 1.165-6.833; P = 0.022) were associated with PAI. The cluster analysis performed for data of TAK patients with PAI revealed that the cluster characterized as the upper lobe of the right lung (Cluster1) had the worst prognosis. CONCLUSION In TAK, PAI is associated with thoracic aorta involvement. In TAK patients with PAI, the involvement of the upper lobe of the right lung is characterized with the worst prognosis.
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Affiliation(s)
- Hua Liao
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lili Pan
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiayi Liu
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Zheng
- Departments of Rheumatology, Beijing Chaoyang Hospital, Capital Medical University, #8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, China.
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5
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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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6
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Choi E, Mathews LM, Paik J, Corretti MC, Wu KC, Michos ED, Hays AG, Mukherjee M. Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases. Front Cardiovasc Med 2022; 9:874242. [PMID: 35497991 PMCID: PMC9039512 DOI: 10.3389/fcvm.2022.874242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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Affiliation(s)
- Eunjung Choi
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, United States
| | - Lena M. Mathews
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Julie Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Monica Mukherjee
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Mirouse A, Deltour S, Leclercq D, Squara PA, Pouchelon C, Comarmond C, Kahn JE, Benhamou Y, Mirault T, Mekinian A, Lambert M, Chiche L, Koskas F, Cluzel P, Redheuil A, Cacoub P, Biard L, Saadoun D. Cerebrovascular Ischemic Events in Patients With Takayasu Arteritis. Stroke 2022; 53:1550-1557. [PMID: 35354303 DOI: 10.1161/strokeaha.121.034445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Takayasu arteritis (TA) is a large vessel vasculitis that may complicate with cerebrovascular ischemic events. The objective was to describe clinical and vascular features of TA patients with cerebrovascular ischemic events and to identify risk factors for these events. METHODS We analyzed the prevalence and type of stroke/transient ischemic attack (TIA), factors associated with cerebrovascular ischemic events, and stroke-free survival in a large cohort fulfilling the American College of Rheumatology or Ishikawa criteria of TA. RESULTS Among 320 patients with TA (median age at diagnosis, 36 [25-47] years; 261 [86%] women), 63 (20%) had a stroke (n=41; 65%) or TIA (n=22; 35%). Ischemic event localized in the carotid territory for 55 (87%) patients and the vertebral artery territory in 8 (13%) patients. Multiple stenosis were observed in 33 (52%) patients with a median number of stenosis of 2 (minimum, 0 to maximum, 11), and aneurysms were observed in 10 (16%) patients. A history of stroke or TIA before TA diagnosis (hazard ratio [HR], 4.50 [2.45-8.17]; P<0.0001), smoking (HR, 1.75 [1.01-3.02]; P=0.05), myocardial infarction history (HR, 0.21 [0.05-0.89]; P=0.039), thoracic aorta involvement (HR, 2.05 [1.30-3.75]; P=0.023), time from first symptoms to diagnosis >1 year (HR, 2.22 [1.30-3.80]; P=0.005), and aspirin treatment (HR, 1.82 [1.04-3.19]; P=0.035) were associated with cerebrovascular ischemic event. In multivariate analysis, time from first symptoms to TA diagnosis >1 year (HR, 2.16 [1.27-3.70]; P=0.007) was independently associated with cerebrovascular ischemic events in patients with TA. The HR for cerebrovascular ischemic event in patients who already experienced a stroke/TIA was 5.11 (2.91-8.99; P<0.0001), compared with those who had not. CONCLUSIONS Carotid stroke/TIA is frequent in TA. We identified factors associated with cerebrovascular ischemic events.
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Affiliation(s)
- Adrien Mirouse
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Sandrine Deltour
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Service de Neurologie, Hôpital Raymond Poincaré, APHP, Université Versailles Saint Quentin en Yvelines, Garches, France (S.D.)
| | - Delphine Leclercq
- Service de Neuro-Radiologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (D.L.)
| | - Pierre-Alexandre Squara
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - Clara Pouchelon
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.)
| | - Cloé Comarmond
- Département de Médecine Interne et Immunologie Clinique, Hôpital Lariboisière APHP, Paris, France. (C.C.)
| | - Jean-Emmanuel Kahn
- Service de Médecine Interne, Hôpital Ambroise Paré, APHP, Boulogne, France (J.-E.K.)
| | - Ygal Benhamou
- Service de Médecine Interne, Vasculaire et Thrombose, CHU de Rouen, France (Y.B.)
| | - Tristan Mirault
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, APHP, Paris, France. (T.M.)
| | - Arsène Mekinian
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France. (A. Mekinian).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Marc Lambert
- Service de Médecine Interne, CHRU de Lille, France (M.L.)
| | - Laurent Chiche
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.)
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Philippe Cluzel
- Service de Radiologie Interventionnelle, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (P. Cluzel).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Alban Redheuil
- Service de Radiologie et Imagerie Cardio-Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (A.R.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Lucie Biard
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - David Saadoun
- Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
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Lee S, Kang S, Eun Y, Kim H, Lee J, Koh EM, Kim DK, Cha HS. Clinical characteristics and radiographic outcomes of vascular Behçet’s disease involving the aorta or its major branches. Clin Rheumatol 2022; 41:1769-1777. [DOI: 10.1007/s10067-021-06031-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 02/02/2023]
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9
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Jimenez D, Tian T, Gendelman I, Salehi P. Refractory renovascular hypertension secondary to Takayasu’s arteritis treated with aorto-mesenteric bypass. Rheumatol Adv Pract 2022; 6:rkac005. [PMID: 35169676 PMCID: PMC8841204 DOI: 10.1093/rap/rkac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Tina Tian
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - Isaac Gendelman
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center, Boston, MA, USA
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10
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Le Joncour A, Desbois AC, Leroyer AS, Tellier E, Régnier P, Maciejewski-Duval A, Comarmond C, Barete S, Arock M, Bruneval P, Launay JM, Fouret P, Blank U, Rosenzwajg M, Klatzmann D, Jarraya M, Chiche L, Koskas F, Cacoub P, Kaplanski G, Saadoun D. Mast cells drive pathologic vascular lesions in Takayasu arteritis. J Allergy Clin Immunol 2022; 149:292-301.e3. [PMID: 33992671 DOI: 10.1016/j.jaci.2021.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Takayasu arteritis (TAK) is a large vessel vasculitis resulting in artery wall remodeling with segmental stenosis and/or aneurysm formation. Mast cells (MCs) are instrumental in bridging cell injury and inflammatory response. OBJECTIVES This study sought to investigate the contribution of MCs on vessel permeability, angiogenesis, and fibrosis in patients with TAK. METHODS MC activation and their tissue expression were assessed in sera and in aorta from patients with TAK and from healthy donors (HDs). In vivo permeability was assessed using a modified Miles assay. Subconfluent cultured human umbilic vein endothelial cells and fibroblasts were used in vitro to investigate the effects of MC mediators on angiogenesis and fibrogenesis. RESULTS This study found increased levels of MC activation markers (histamine and indoleamine 2,3-dioxygenase) in sera of patients with TAK compared with in sera of HDs. Marked expression of MCs was shown in aortic lesions of patients with TAK compared with in those of noninflammatory aorta controls. Using Miles assay, this study showed that sera of patients with TAK significantly increased vascular permeability in vivo as compared with that of HDs. Vessel permeability was abrogated in MC-deficient mice. MCs stimulated by sera of patients with TAK supported neoangiogenesis (increased human umbilic vein endothelial cell proliferation and branches) and fibrosis by inducing increased production of fibronectin, type 1 collagen, and α-smooth muscle actin by fibroblasts as compared to MCs stimulated by sera of HD. CONCLUSIONS MCs are a key regulator of vascular lesions in patients with TAK and may represent a new therapeutic target in large vessel vasculitis.
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Affiliation(s)
- Alexandre Le Joncour
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Anne-Claire Desbois
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Aurélie S Leroyer
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France
| | - Edwige Tellier
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France
| | - Paul Régnier
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anna Maciejewski-Duval
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cloé Comarmond
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Stéphane Barete
- Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France; Department of Dermatology DMU3ID, Unité Fonctionnelle de Dermatologie, Groupe Hospitalier Pitié-Salpêtrière-C. Foix, Paris, France
| | - Michel Arock
- Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France; Laboratoire d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrick Bruneval
- Laboratoire d'anatomopathologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Pierre Fouret
- Laboratoire d'Anatomopathologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ulrich Blank
- Center of Research on Inflammation, INSERM UMR S1149 and Centre National de la Recherche Scientifique Experimental Research Laboratory 8252, Universite de Paris, Sorbonne Paris Cite, Laboratoire d'Excellence INFLAMEX, Paris, France
| | - Michelle Rosenzwajg
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - David Klatzmann
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Mohamed Jarraya
- Banque des Tissus Humains, Hôpital Saint Louis, Paris, France
| | - Laurent Chiche
- Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrice Cacoub
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Gilles Kaplanski
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France; Service de Médecine Interne, Centre Hospitalier Universitaire Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - David Saadoun
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France.
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11
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Aeschlimann FA, Raimondi F, Leiner T, Aquaro GD, Saadoun D, Grotenhuis HB. Overview of imaging in adult- and childhood-onset Takayasu arteritis. J Rheumatol 2021; 49:346-357. [PMID: 34853087 DOI: 10.3899/jrheum.210368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
Takayasu Arteritis is an idiopathic large vessel vasculitis, that affects young adults and children and can lead to ischemia and end-organ damage. Vascular imaging is crucial for diagnosis, assessment of disease extent and management of the disease. In this article, we critically review evidence for the clinical use of the different imaging modalities conventional angiography, magnetic resonance imaging, computed tomography, Doppler ultrasound and 18fluorodeoxyglucose positron emission tomography. We thereby focus on their clinical applicability, challenges and specific use in children.
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Affiliation(s)
- Florence A Aeschlimann
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Francesca Raimondi
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Tim Leiner
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Giovanni Donato Aquaro
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - David Saadoun
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Heynric B Grotenhuis
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
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Astuti A, Kartamihardja AHA, Ilhamy MA, Fahlavi MD, Kusumawardhani NY, Hasan M, Hamijoyo L. Myocardial dissection complicating left sinus of Valsalva aneurysm in silent takayasu arteritis. BMC Cardiovasc Disord 2021; 21:464. [PMID: 34565345 PMCID: PMC8474797 DOI: 10.1186/s12872-021-02271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myocardial dissection (MD) in a left sinus of Valsalva aneurysm (LSVA) is a rare condition that may lead to a fatal complication. Determining the MD etiology is challenging because of various possibilities ranging from congenital to acquired diseases. Here, we discuss an approach for determining the etiology of MD complicating LSVA in Takayasu arteritis (TA) and its treatment. CASE PRESENTATION A 41-year-old man presented with dyspnea on heavy activities and a history of consciousness loss at the age of 24 years. He was diagnosed with dilated cardiomyopathy and MD complicating LSVA in TA based on combined clinical and pathognomonic diagnostic criteria of TA evaluated using vascular Doppler and computed tomography angiography of the aorta. The patient refused to undergo surgery and received an optimal dose of chronic heart failure therapy, a high-dose steroid, and azathioprine. The patient experienced some improvements in clinical condition, functional outcome, and inflammatory markers at 1-year follow-up. CONCLUSIONS Clinical criteria and various imaging modalities may be used to determine the etiology of MD complicating LSVA in silent TA. As an alternative to surgery, the optimal medical treatment might result in a satisfactory outcome.
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Affiliation(s)
- Astri Astuti
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur no.38, Bandung, West Java, Indonesia.
| | - Achmad Hafiedz Azis Kartamihardja
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur no.38, Bandung, West Java, Indonesia
| | - Muhammad Adniel Ilhamy
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur no.38, Bandung, West Java, Indonesia
| | - Muhammad Dinnar Fahlavi
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur no.38, Bandung, West Java, Indonesia
| | - Nuraini Yasmin Kusumawardhani
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur no.38, Bandung, West Java, Indonesia
| | - Melawati Hasan
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur no.38, Bandung, West Java, Indonesia
| | - Laniyati Hamijoyo
- Division of Rheumatology, Department of Internal Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
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Cem S, Berkan A, Alper S, Abdulsamer E, Levent K, Ali A. Fecal S100A12 in Takayasu arteritis predicts disease activity and intestinal involvement. Rheumatol Int 2021; 42:737-742. [PMID: 34514516 DOI: 10.1007/s00296-021-04981-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/26/2021] [Indexed: 12/04/2022]
Abstract
Gastrointestinal involvement in Takayasu Arteritis (TA) requires invasive or expensive diagnostic studies. Instead a fecal biomarker can be used as an initial screening test. In this context, S100A12 is promising as an established biomarker in intestinal inflammation and its role in TA pathogenesis. As such we aimed to test the feasibility of fecal S100A12 as a means of the fecal biomarker in gastrointestinal involvement in TA in this pilot study. Our study population consisted of 30 TA patients and 14 control patients with non-inflammatory arthralgia. Patients with inflammatory or infectious gastrointestinal tract diseases, or used oral antibiotics or NSAIDs for the 3 weeks were excluded. Vasculitis involvements were determined with cross-sectional radiologic studies. TA disease activity was evaluated per Indian Takayasu's Activity Score (2010) criteria and vascular involvements were classified according to Numano classification. ELISA test was used to determine fecal S100A12 levels. Fecal S100A12 levels were higher in TA patients when compared to the controls (37.9 ng/ml vs. 12.5 ng/ml p = 0.038). ESR and CRP levels were also higher in the TA group, however not correlated with fecal S100A12. Among TA patients, fecal S100A12 levels were higher inactive ones with ITAS2010 > 1 (72.9 ng/ml vs. 16.7 ng/ml p = 0.016) correlated with total ITAS2010 scores. (R = 0.52 p = 0.003). TA patients with abdominal symptoms had higher fecal S100A12 levels when compared to the remaining TA population (327.8 ng/ml vs. 28.0 ng/ml p = 0.003). However, fecal S100A12 levels in patients with or without mesenteric vessel involvement did not differ. Fecal S100A12 shows promise as a fecal biomarker to screen intestinal ischemia and inflammatory bowel disease in TA patients.
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Affiliation(s)
- Simsek Cem
- Division of Gastroenterology, Hacettepe University Faculty of Medicine, 06100, Sihhiye, Turkey.
| | - Armagan Berkan
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Sihhiye, Turkey
| | - Sari Alper
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Sihhiye, Turkey
| | - Emet Abdulsamer
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Sihhiye, Turkey
| | - Kilic Levent
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Sihhiye, Turkey
| | - Akdogan Ali
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Sihhiye, Turkey
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14
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Sarma K, Handique A, Phukan P, Daniala C, Chutia H, Barman B. Magnetic Resonance Angiography and Multidetector CT Angiography in the Diagnosis of Takayasu's Arteritis: Assessment of Disease Extent and Correlation with Disease Activity. Curr Med Imaging 2021; 18:51-60. [PMID: 34238165 DOI: 10.2174/1573405617666210707154059] [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] [Received: 11/12/2020] [Revised: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Takayasu's arteritis (TA) is a large vessel vasculitis with diverse clinical presentations and arterial vascular bed involvement. It is characterized by chronic, nonspecific inflammation of all layers of the vessel wall, which results in stenosis, occlusion, dilatation, or aneurysm formation in the involved blood vessels. METHODS The study included 36 patients of TA. All patients fulfilled the modified Ishikawa's diagnostic criteria for TA. All patients were evaluated for clinical presentation, angiographic findings, and severity of the disease. The disease activity was assessed based on Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and also by CT angiography (CTA)/Magnetic resonance angiography (MRA) imaging. The angiographic types were classified based on the International TA Conference in Tokyo, 1994 angiographic classification. RESULTS A total of 36 patients were included in the study, 86% were females and a mean age of 21.6 years. Hypertension (78%) was the most common clinical presentation. Type V was the most common angiographic type (42%), followed by type III (25%), type IV (14%), type IIb (11%), type I (5%) and type IIa (3%). Among the aortic arch branches, the left subclavian artery (50%), right subclavian artery (38.8%), left vertebral artery (33.3%) and left common carotid artery (27.7%) were the most commonly involved arteries. Disease activity based on CT/MR imaging showed a significant statistical correlation with elevated ESR and positive CRP (p < 0.0001). Mediastinal lymphadenopathy was seen in 21 patients, out of which 11 had active disease. However, no significant correlation was found between mediastinal lymphadenopathy and disease activity. CONCLUSIONS TA presents varied symptomatology and differing vascular involvement. CT/MR angiography is effective in diagnosis and accurately predicted the active stage of the disease.
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Affiliation(s)
- Kalyan Sarma
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Akash Handique
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Pranjal Phukan
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - C Daniala
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Happy Chutia
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences(NEIGRIHMS), Shillong, India
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences(NEIGRIHMS), Shillong, India
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15
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Kee TP, Venkatanarasimha N, Mohideen SMH, Chan LL, Gogna A, Schaefer PW, Chia GS, Choi YS, Chen RC. A Tale of Two Organ Systems: Imaging review of diseases affecting the thoracic and neurological systems. Part 1. Curr Probl Diagn Radiol 2021; 51:589-598. [PMID: 34304949 DOI: 10.1067/j.cpradiol.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/01/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
In an era of rapidly expanding knowledge and sub-specialization, it is becoming increasingly common to focus on one organ system. However, the human body is intimately linked, and disease processes affecting one region of the body not uncommonly affect the other organ systems as well. Understanding diseases from a macroscopic perspective, rather than a narrow vantage point, enables efficient and accurate diagnosis. This tenet holds true for diseases affecting both the thoracic and neurological systems; in isolation, the radiologic appearance of disease in one organ system may be nonspecific, but viewing the pathophysiologic process in both organ systems may markedly narrow the differential considerations, and potentially lead to a definitive diagnosis. In this article, we discuss a variety of disease entities known to affect both the thoracic and neurological systems, either manifesting simultaneously or at different periods of time. Some of these conditions may show neither thoracic nor neurological manifestations. These diseases have been systematically classified into infectious, immune-mediated / inflammatory, vascular, syndromic / hereditary and neoplastic disorders. The underlying pathophysiological mechanisms linking both regions and radiologic appearances in both organ systems are discussed. When appropriate, brief clinical and diagnostic information is provided. Ultimately, accurate diagnosis will lead to expedited triage and prompt institution of potentially life-saving treatment for these groups of complex disorders.
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Affiliation(s)
- Tze Phei Kee
- Singapore General Hospital, Singapore 169608; National Neuroscience Institute, Singapore 308433.
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Shchetynska-Marinova T, Amendt K, Sadick M, Keese M, Sigl M. Aortitis - An Interdisciplinary Challenge. In Vivo 2021; 35:41-52. [PMID: 33402448 DOI: 10.21873/invivo.12230] [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] [Received: 10/03/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
The term 'aortitis' comprises a heterogeneous spectrum of diseases, with varied etiology and clinical presentations, whose common characteristic is the inflammation of the aortic wall. Since aortitis can mimic almost all common cardiovascular disorders, its clinical recognition remains a challenge. Some cases of aortitis remain undetected for a long time and may be diagnosed after severe life-threatening complications have already arisen. The diagnosis of aortitis is based on the presence of homogeneous circumferential thickening of the aortic wall detected on aortic imaging, or typical histological features in combination with clinical findings and laboratory parameters. Management of aortitis is usually conservative (immunosuppressive drugs in noninfectious aortitis; antimicrobial drugs in infectious). However, if vascular complications such as aortic aneurysm, rupture, or steno-occlusive events appear, aortic surgery or endovascular therapy may be required. This review article summarizes the current knowledge regarding the etiology, clinical presentation, diagnosis, and treatment of inflammatory diseases of the aorta to promote better clinical management of these entities.
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Affiliation(s)
- Tetyana Shchetynska-Marinova
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Klaus Amendt
- Vascular Center Oberrhein, Internal Medicine I, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Keese
- Department of Vascular Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Sigl
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
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17
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Numano type V Takayasu arteritis patients are more prone to have coronary artery involvement. Clin Rheumatol 2020; 39:3439-3447. [DOI: 10.1007/s10067-020-05123-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
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18
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The value of interleukin-6 in predicting disease relapse for Takayasu arteritis during 2-year follow-up. Clin Rheumatol 2020; 39:3417-3425. [DOI: 10.1007/s10067-020-05066-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 12/25/2022]
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Multiple occlusions in extracranial arteries in patients with aortic arch syndrome: is minimally invasive treatment still possible? Technical aspects of the treatment based on our own experience and a review of the literature. Wideochir Inne Tech Maloinwazyjne 2020; 16:183-190. [PMID: 33786133 PMCID: PMC7991926 DOI: 10.5114/wiitm.2020.94517] [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: 02/24/2020] [Accepted: 03/08/2020] [Indexed: 11/21/2022] Open
Abstract
Takayasu arteritis is a large vessel vasculitis of granulomatous nature and unknown aetiology affecting predominantly the aorta and its major branches, which may lead to ischaemic symptoms of many organs including the central nervous system. To decrease the risk of neurological complications and improve the quality of life, an arterial revascularisation may be necessary. The treatment options include pharmacotherapy as well as both open surgical and endovascular procedures, which has to be carefully chosen to obtain clinical success. There is an ongoing debate on the advantages, possibilities, and indications for implementing endovascular and open surgical methods, especially in high-risk patients. In this article we present our own experience in the treatment of an unusually complex and high-risk patient with multiple occlusion of supra-aortic branches, focusing on the technical aspects of the procedures and the decision-making process, as well as to confront with contemporary medical knowledge.
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Rullo J, Mehraban Far P, Farmer JF, Clements-Baker M, Ten Hove M. A curious case of arteritis: infectious, inflammatory, or both. Can J Ophthalmol 2019; 54:e288-e292. [PMID: 31836116 DOI: 10.1016/j.jcjo.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/18/2022]
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Ma L, Yu W, Dai X, Yin M, Wang Y, Sun Y, Kong X, Cui X, Wu S, Ji Z, Ma L, Chen H, Lin J, Jiang L. Serum leptin, a potential predictor of long-term angiographic progression in Takayasu's arteritis. Int J Rheum Dis 2019; 22:2134-2142. [PMID: 31595672 PMCID: PMC6916353 DOI: 10.1111/1756-185x.13718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/01/2019] [Accepted: 09/10/2019] [Indexed: 11/27/2022]
Abstract
Aim In patients with Takayasu's arteritis (TA), current biomarkers that properly reflect the progression of the vascular structure remain absent. We aimed to determine the serum leptin level to investigate its relationship with imaging changes and assess its value as a predictor for long‐term radiological progression. Method This study included 34 untreated TA patients and 40 age‐matched healthy controls. At baseline and during the 5‐year follow‐up, we assessed disease activity using Kerr's criteria and Indian Takayasu Clinical Activity Score (ITAS2010) and monitored laboratory biomarkers as well as imaging findings. Serum leptin levels were measured by enzyme‐linked immunosorbent assay. Results The baseline serum leptin levels were significantly higher in TA patients than in healthy controls. Leptin was significantly positively correlated with triglyceride and high‐density lipoprotein cholesterol levels and negatively correlated with fibrinogen and C‐reactive protein levels. Patients were subdivided into three groups based on their baseline leptin level. During a 5‐year follow‐up, patients in the high and medium leptin groups showed more radiological progression compared to those in the low leptin group. Cox proportional hazard regression analysis showed that a high serum leptin level was a positive predictor of radiological progression. Conclusion Leptin is a potential biomarker for assessing TA structural progression. Untreated patients with elevated serum leptin levels are at a higher risk of progression in the aorta. Thus, the leptin level can be a predictor of long‐term radiological progression.
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Affiliation(s)
- Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-based medicine center, Fudan University, Shanghai, China
| | - Wensu Yu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomin Dai
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengmeng Yin
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yujiao Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomeng Cui
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sifan Wu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongfei Ji
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingying Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-based medicine center, Fudan University, Shanghai, China
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Ghouri MA, Gupta N, Bhat AP, Thimmappa ND, Saboo SS, Khandelwal A, Nagpal P. CT and MR imaging of the upper extremity vasculature: pearls, pitfalls, and challenges. Cardiovasc Diagn Ther 2019; 9:S152-S173. [PMID: 31559161 DOI: 10.21037/cdt.2018.09.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Imaging is needed for diagnosis, treatment planning, and follow-up of patients with pathologies affecting upper extremity vasculature. With growth and evolution of imaging modalities [especially CT angiography (CTA) and MR angiography (MRA)], there is need to recognize the advantages and disadvantages of various modalities and obtain the best possible imaging diagnostic test. Understanding various limitations and pitfalls as well as the best practices to minimize and manage these pitfalls is very important for the diagnosis. This article reviews the upper extremity arterial vascular anatomy, discusses the CTA and MRA imaging, various pitfalls, and challenges and discuss imaging manifestations of upper extremity arterial pathologies.
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Affiliation(s)
- Maaz A Ghouri
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nishant Gupta
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Ambarish P Bhat
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | | | - Sachin S Saboo
- Department of Radiology, UT Health Science Center, San Antonio, TX, USA
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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23
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Yanai A, Uchiyama K, Ishibashi Y. Long-term peritoneal dialysis followed by kidney transplantation for Takayasu arteritis: a case report. BMC Nephrol 2019; 20:131. [PMID: 30999953 PMCID: PMC6471901 DOI: 10.1186/s12882-019-1302-5] [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: 11/09/2018] [Accepted: 03/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Takayasu arteritis (TA) is a chronic vasculitis of unknown etiology that primarily affects large vessels. Although renal involvement is frequent in TA, patients with TA undergoing renal replacement therapy, especially long-term peritoneal dialysis (PD) and kidney transplantation (KTx), are rarely reported. We herein present the case of an elderly patient with TA treated by PD for more than 5 years and underwent KTx thereafter. Case presentation A 69-year-old female diagnosed with TA at the age of 19 was treated by PD for seven and a half years for end-stage renal disease due to TA. Dialysate-to-plasma ratio of creatinine, which was well maintained during this period, reflected the efficacy of long-term PD. However, her residual renal function declined; she developed malnutrition, inflammation, and atherosclerosis syndrome and underwent living-related KTx from her husband. Due to the total occlusion of the external iliac arteries with compensatory development of the internal iliac arteries, the right internal iliac artery was used as the anastomosis site. After KTx, the patient developed chronic active antibody-mediated rejection; however, the graft function was maintained throughout the follow-up period. Despite severe aortic calcification and intermittent claudication in the legs, her condition did not worsen, and the blood flow of the graft was preserved. Conclusions The current case illustrating the success of long-term PD and living-related KTx in maintaining kidney function in an elderly patient with TA is the first to demonstrate the potential of PD and KTx as feasible options for renal replacement therapy in TA accompanied by severe cardiac involvement.
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Affiliation(s)
- Akane Yanai
- Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Kiyotaka Uchiyama
- Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.,Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshitaka Ishibashi
- Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
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24
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Li Z, Zheng Z, Ding J, Li X, Zhao Y, Kang F, Li Y, Pang L, Du W, Wu Z, Zhu P. Contrast-enhanced Ultrasonography for Monitoring Arterial Inflammation in Takayasu Arteritis. J Rheumatol 2019; 46:616-622. [PMID: 30824642 DOI: 10.3899/jrheum.180701] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the utility of contrast-enhanced ultrasound (CEUS) compared with 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in assessing vessel inflammation of Takayasu arteritis (TA). METHODS This is a retrospective analysis of 71 patients with TA who had undergone carotid CEUS. Twenty-two of 71 patients underwent FDG-PET after CEUS. Clinical disease activity was assessed by Kerr criteria and the Indian Takayasu Clinical Activity Score 2010 (ITAS2010). We investigated the correlation between carotid vascularization on CEUS and clinical data. The consistency of carotid CEUS and PET data has been analyzed for TA disease activity. RESULTS There was a statistically significant correlation between the results of CEUS and ITAS2010 (p = 0.004) or Kerr criteria (p < 0.001). According to ITAS2010, thirty-four of 71 patients with TA were clinically inactive. Assessment of 34 TA patients with clinically inactive disease yielded 11 CEUS scans that showed active lesions (visual grade ≥ 2) in the left or right carotid artery. In 22 cases that underwent CEUS and FDG-PET, 12 were active and 10 were inactive on the basis of ITAS2010. Moreover, bilateral carotid CEUS vascularization score positively correlated with vascular FDG uptake in these patients with TA (p = 0.004). When vascular inflammation was defined as FDG uptake with visual grade ≥ 2, carotid CEUS showed sensitivity of 100% and specificity of 80%. CONCLUSION For TA patients with clinically inactive disease, CEUS could help clinicians to identify active lesions in the carotid vascular region. Carotid CEUS may be a rapid and cost-effective imaging tool in the followup of patients with TA.
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Affiliation(s)
- ZhiQin Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - ZhaoHui Zheng
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Jin Ding
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - XiaoFeng Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - YongFeng Zhao
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Fei Kang
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Ying Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - LinXuan Pang
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - WangLei Du
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - ZhenBiao Wu
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Ping Zhu
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China. .,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work.
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25
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Clinical and imaging manifestations of Takayasu's arteritis with pulmonary hypertension: A retrospective cohort study in China. Int J Cardiol 2019; 276:224-229. [DOI: 10.1016/j.ijcard.2018.08.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/15/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
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26
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Syed MBJ, Fletcher AJ, Dweck MR, Forsythe R, Newby DE. Imaging aortic wall inflammation. Trends Cardiovasc Med 2018; 29:440-448. [PMID: 30611605 PMCID: PMC6853180 DOI: 10.1016/j.tcm.2018.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/10/2018] [Accepted: 12/22/2018] [Indexed: 12/17/2022]
Abstract
Inflammation affects the aortic wall through complex pathways that alter its biomechanical structure and cellular composition. Inflammatory processes that predominantly affect the intima cause occlusive disease whereas medial inflammation and degeneration cause aneurysm formation. Aortic inflammatory pathways share common metabolic features that can be localized by smart contrast agents and radiolabelled positron emission tomography (PET) tracers. 18F-Fluorodeoxyglucose (18F-FDG) is a non-specific marker of metabolism and has been widely used to study aortic inflammation in various diseased aortic states. Although useful in detecting disease, 18F-FDG has yet to demonstrate a reliable link between vessel wall disease and clinical progression. 18F-Sodium fluoride (18F-NaF) is a promising biological tracer that detects microcalcification related to active disease and cellular necrosis within the vessel wall. 18F-NaF shows a high affinity to bind to diseased arterial tissue irrespective of the underlying inflammatory process. In abdominal aortic aneurysms, 18F-NaF PET/CT predicts increased rates of growth and important clinical end-points, such as rupture or the requirement for repair. Much work remains to be done to bridge the gap between detecting aortic inflammation in at-risk individuals and predicting adverse clinical events. Novel radiotracers may hold the key to improve our understanding of vessel wall biology and how this relates to patients. Combined with established clinical and morphological assessment techniques, PET imaging promises to improve disease detection and clinical risk stratification.
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Affiliation(s)
- Maaz B J Syed
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
| | - Alexander J Fletcher
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Marc R Dweck
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Rachael Forsythe
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - David E Newby
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
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Diagnosis and differential diagnosis of large-vessel vasculitides. Rheumatol Int 2018; 39:169-185. [PMID: 30221327 DOI: 10.1007/s00296-018-4157-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
There are no universally accepted diagnostic criteria for large-vessel vasculitides (LVV), including giant cell arteritis (GCA) and Takayasu arteritis (TAK). Currently, available classification criteria cannot be used for the diagnosis of GCA and TAK. Early diagnosis of these two diseases is quite challenging in clinical practice and may be accomplished only by combining the patient symptoms, physical examination findings, blood test results, imaging findings, and biopsy results, if available. Awareness of red flags which lead the clinician to investigate TAK in a young patient with persistent systemic inflammation is helpful for the early diagnosis. It should be noted that clinical presentation may be highly variable in a subgroup of GCA patients with predominant large-vessel involvement (LVI) and without prominent cranial symptoms. Imaging modalities are especially helpful for the diagnosis of this subgroup. Differential diagnosis between older patients with TAK and this subgroup of GCA patients presenting with LVI may be difficult. Various pathologies may mimic LVV either by causing systemic inflammation and constitutional symptoms, or by causing lumen narrowing with or without aneurysm formation in the aorta and its branches. Differential diagnosis of aortitis is crucial. Infectious aortitis including mycotic aneurysms due to septicemia or endocarditis, as well as causes such as syphilis and mycobacterial infections should always be excluded. On the other hand, the presence of non-infectious aortitis is not unique for TAK and GCA. It should be noted that aortitis, other large-vessel involvement or both, may occasionally be seen in various other autoimmune pathologies including ANCA-positive vasculitides, Behçet's disease, ankylosing spondylitis, sarcoidosis, and Sjögren's syndrome. Besides, aortitis may be idiopathic and isolated. Atherosclerosis should always be considered in the differential diagnosis of LVV. Other pathologies which may mimic LVV include, but not limited to, congenital causes of aortic coarctation and middle aortic syndrome, immunoglobulin G4-related disease, and hereditary disorders of connective tissue such as Marfan syndrome and Ehler-Danlos syndrome.
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Padalia KJ, Muehlberger MJ. Successful Bypass Surgery in a Healthy 24-Year-Old Male with Peripheral Artery Disease. Cureus 2018; 10:e3010. [PMID: 30254800 PMCID: PMC6150762 DOI: 10.7759/cureus.3010] [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: 07/06/2018] [Accepted: 07/20/2018] [Indexed: 11/24/2022] Open
Abstract
Approximately 40% of peripheral artery disease cases occur in individuals less than 50 years old. Diagnosis is often delayed due to fewer risk factors, atypical presentation, and symptoms attributed to a benign cause. We present an unusual case of an otherwise healthy 24-year-old male presenting with unilateral, intermittent claudication (IC) due to diffuse atherosclerotic disease in his left femoral arteries. Lifestyle-limiting symptoms caused by a four-year delay in diagnosis were improved with successful left femoropopliteal bypass. We use this case to review the differential diagnosis for IC and recommend early revascularization in young patients with severe disease and few comorbidities.
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Affiliation(s)
- Kishan J Padalia
- College of Medicine, University of Central Florida College, Orlando, USA
| | - Michael J Muehlberger
- Vascular Specialists of Central Florida, Orlando Regional Medical Center, Orlando, USA
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Tombetti E, Mason JC. Takayasu arteritis: advanced understanding is leading to new horizons. Rheumatology (Oxford) 2018; 58:206-219. [DOI: 10.1093/rheumatology/key040] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Enrico Tombetti
- Department of Immunology, Transplantation and Infections Disease, Vita-Salute San Raffaele University and San Raffaele Scientific Institute, Milan, Italy
- Vascular Sciences and Rheumatology, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Justin C Mason
- Vascular Sciences and Rheumatology, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
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Ogino H. Surgical strategy for refractory aortitis. Gen Thorac Cardiovasc Surg 2018; 67:25-31. [PMID: 29404904 DOI: 10.1007/s11748-018-0885-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/07/2018] [Indexed: 01/16/2023]
Abstract
In some instances, we encounter cases suffered from inflammatory aortic diseases (aortitis) in Japan, some of which are at the active stages with systemic inflammation. Most of them are refractory with some technical difficulties of surgical treatment. The aortic wall, particularly, at the active stage, is too fragile to hold the surgical sutures. Consequently, the suture reinforcement with Teflon felt is required. In the late stage after surgery, false aneurysms on the suture line, that is, suture detachment potentially occur. To prevent such sequelae in the early and late phases, continuous (life-long) as well as perioperative inflammation control using corticosteroid as an initial drug and/or other immunosuppression agents. This decade, instead of the conventional open surgical repairs, endovascular treatments have widely spread, predominantly for stenotic aortic/arterial lesions. In particular, for more difficult patients suffered from more troublesome Behçet disease, endovascular treatments would have greater advantages to avoid more occasionally occurred pseudo-aneurysm on the other parts as well as the surgical suture lines. The key issues on surgical treatment for refractory aortitis are perioperative inflammation control including the long term with corticosteroid and/or immunosuppressive agents, appropriate open surgical or endovascular treatment approaches, and sufficient reinforcement of surgical suture lines.
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Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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Barra L, Kanji T, Malette J, Pagnoux C. Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis. Autoimmun Rev 2018; 17:175-187. [DOI: 10.1016/j.autrev.2017.11.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tombetti E, Mason JC. Application of imaging techniques for Takayasu arteritis. Presse Med 2017; 46:e215-e223. [PMID: 28757178 DOI: 10.1016/j.lpm.2017.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/07/2017] [Indexed: 11/26/2022] Open
Abstract
Arterial injury with subsequent remodelling and predisposition to arterial stenosis and/or dilation are the hallmarks of Takayasu arteritis. The degree of arterial damage closely aligns with prognosis and therefore its prevention is the predominant aim of therapy. Non-invasive imaging has greatly improved our ability to identify the extent and severity of disease and to monitor its progress. However, many questions remain concerning the optimal use of individual modalities at different stages of disease. Imaging methods for the quantification of arterial damage are lacking. Likewise, no single technique can accurately determine disease activity within the arterial wall or distinguish inflammatory and non-inflammatory disease progression. The aim of this review is to outline current imaging strategies in Takayasu arteritis, their individual roles in diagnosis and disease monitoring and potential future advances.
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Affiliation(s)
- Enrico Tombetti
- San Raffaele Scientific Institute, Department of Immunology, Transplantation and Infectious Diseases, Milano, Italy.
| | - Justin C Mason
- Hammersmith Hospital, Imperial College London, Rheumatology and Vascular Science, London, UK
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Mammeri A, Guermaz R, Hatri A, Kessal F, Taharboucht S, Hamrour F, Ammi M, Zekri S, Brouri M. [Hypertension during Takayasu's disease: An Algerian single center experience of 279 patients]. Ann Cardiol Angeiol (Paris) 2017; 66:154-158. [PMID: 28554696 DOI: 10.1016/j.ancard.2017.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Takayasu arteritis (TA) is an uncommon large vessel arteritis. Lesions produced by the inflammatory process can be stenotic, occlusive, or aneurysmal. Vascular changes lead to the main complications, including hypertension, most often due to renal artery stenosis or, more rarely, stenosis of the suprarenal aorta. AIM OF STUDY Our study will assess the prevalence of hypertension during TA and describe its clinical profile. MATERIAL AND METHODS Among 279 patients with TA resulting from single center study over a period of 35 years, we collected 128 hypertensive patients. All have benefited from a vascular exploration. Renal angiography was performed in 85 patients. The classification of Lupi Herrera allowed us to distribute our patients according to the topography of their lesions. Patients are classified according to the degree of severity of their hypertension. Results are statistically analyzed with SPSS 10.0 database. RESULTS The prevalence of hypertension is 45.8%, mainly affecting young women (87%). It is indicative of arteritis in 24.7%. Its diagnosis is difficult and delayed when arterial stenosis exist: inter-arm blood pressure difference (53.8%), inverse coarctation (30.4%) or unmeasurable blood pressure at the 4 limbs (6.8%). In 54% of cases, hypertension was due to a renal artery stenosis. The presence of arterial hypertension was associated to a poor prognosis: it was severe in 54% of patients and was linked to 70% of deaths observed. CONCLUSION Arterial hypertension is common during TA. It remains a factor of bad prognosis specially when renovascular hypertension is present.
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Affiliation(s)
- A Mammeri
- Service de médecine interne, clinique Arezki Kehal, 17, rue Lamamri-Elbiar, Alger, Algérie.
| | - R Guermaz
- Service de médecine interne, hôpital El Biar, Alger, Algérie
| | - A Hatri
- Service de médecine interne, hôpital El Biar, Alger, Algérie
| | - F Kessal
- Service de médecine interne, hôpital El Biar, Alger, Algérie
| | - S Taharboucht
- Service de médecine interne, hôpital El Biar, Alger, Algérie
| | - F Hamrour
- Service de médecine interne, hôpital El Biar, Alger, Algérie
| | - M Ammi
- Service de médecine interne, hôpital El Biar, Alger, Algérie
| | - S Zekri
- Service de médecine interne, hôpital El Biar, Alger, Algérie
| | - M Brouri
- Service de médecine interne, hôpital El Biar, Alger, Algérie
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Transradial retrograde percutaneous transluminal angioplasty with stenting of long segment occlusion of subclavian artery. J Cardiol Cases 2017; 15:119-121. [DOI: 10.1016/j.jccase.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/03/2016] [Accepted: 12/04/2016] [Indexed: 11/22/2022] Open
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Luo XY, Wu QH, Zhang FX. Open and Endovascular Management of Severe Cerebral Ischemia in Takayasu's Arteritis. Ann Vasc Surg 2017; 42:101-110. [PMID: 28258019 DOI: 10.1016/j.avsg.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/18/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Severe cerebral ischemia in patients with Takayasu's arteries was caused by occlusion of most supra-aortic arteries. Arterial revascularization is necessary to decrease the incidence of stroke and improve the quality of life but may be complicated with multiple occlusive lesions and inflammation condition of this disease. This study was to assess options and long-term outcomes of surgical and endovascular treatment. METHODS Twenty-nine patients with severe cerebral ischemic symptoms underwent surgical or endovascular treatment from January 1991 to July 2015. Demographic characteristics, surgical and endovascular procedures, and follow-up outcomes were reviewed. Risk factors associated with primary patency of surgical treatment and assisted primary patency of endovascular treatment was identified by Cox regression analyses. RESULTS There were 29 patients with a median age of 24 (range 9-37 years), 9 in active and 20 in inactive phase. Seventeen patients underwent a variety of bypass procedures. Fourteen endovascular procedures were performed in 12 patients. No death occurred within 30 days after both procedures. Complications within 30 days after bypass included stroke in 1 patient, infection in 2 patients, and heart failure in 1 patient. Nine patients developed brain hyperperfusion after bypass. Transient hemiplegic paralysis occurred in 1 patient during dilation of the carotid artery. During a median follow-up time of 41 months, primary and secondary patency rate of bypass at 1 and 3 years was 93.75% and 100% and 87.5% and 100%, respectively. Assisted primary and secondary patency rate of endovascular treatment at 1 and 3 years was 85.71% and 92.86% and 68.18% and 75.66%, respectively. There was no independent risk factor associated with either primary patency of surgical treatment or assisted primary patency of endovascular treatment. Disease activity was independent risk factor associated with combined rate of primary patency of surgical treatment and assisted primary patency of endovascular treatment (HR: 0.17, 95% CI: 0.03-0.93, P = 0.04). CONCLUSIONS Bypass is the preferred treatment in majority of patients with good long-term patency, even has a higher propensity for postoperative complications. Endovascular treatment should be preserved for short lesions in inappropriate or high-risk surgical patients but needs more reintervention and close monitoring of lesion for better outcomes. Long-term patency of surgical and endovascular treatment is related with disease activity. Combination of surgical or endovascular treatment and medical therapy may improve the efficacy of interventions.
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Affiliation(s)
- Xiao Yun Luo
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qing Hua Wu
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Fu Xian Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Aminde LN, Noubiap JJN, Takah N, Njim T, Dzudie A. Takayasu's arteritis in an adult female from Cameroon: diagnosis via Doppler echocardiography. JRSM Open 2016; 7:2054270416654646. [PMID: 27536379 PMCID: PMC4971596 DOI: 10.1177/2054270416654646] [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] [Indexed: 11/28/2022] Open
Abstract
Takayasu arteritis is rare in black people. Doppler echocardiography may assist in its diagnosis with good response to steroids.
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Affiliation(s)
- Leopold N Aminde
- Clinical Research Education, Networking and Consultancy, Douala, Cameroon; Faculty of Medicine & Biomedical Sciences, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jean Jacques N Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Noah Takah
- School of Medicine, University of Glasgow, UK
| | - Tsi Njim
- Regional Hospital Bamenda, Bamenda, Cameroon
| | - Anastase Dzudie
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Internal Medicine, Faculty of Health Sciences, University of Buea and Cardiology Unit, General Hospital Douala, Cameroon
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37
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Muratore F, Pipitone N, Salvarani C, Schmidt WA. Imaging of vasculitis: State of the art. Best Pract Res Clin Rheumatol 2016; 30:688-706. [DOI: 10.1016/j.berh.2016.09.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/05/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022]
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38
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Husainy MA, Sayyed F, Puppala S. Acute aortic syndrome—pitfalls on gated and non-gated CT scan. Emerg Radiol 2016; 23:397-403. [DOI: 10.1007/s10140-016-1409-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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39
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Mekinian A, Djelbani S, Viry F, Fain O, Soussan M. Place de l’imagerie dans l’évaluation des vascularites de gros vaisseaux. Rev Med Interne 2016; 37:245-55. [DOI: 10.1016/j.revmed.2015.10.353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/08/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022]
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40
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Guedes BF, Valeriano RP, Puglia P, Arantes PR, Conforto AB. Pearls & Oy-sters: Symptomatic innominate artery disease. Neurology 2016; 86:e128-31. [PMID: 27001994 DOI: 10.1212/wnl.0000000000002483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bruno F Guedes
- From Departamento de Neurologia (B.F.G., R.P.V., A.B.C.); and Departamento de Radiologia (P.P., P.R.A.), Faculdade de Medicina-Universidade de São Paulo (USP); LIM 44 (P.R.A.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.B.C.).
| | - Rafael P Valeriano
- From Departamento de Neurologia (B.F.G., R.P.V., A.B.C.); and Departamento de Radiologia (P.P., P.R.A.), Faculdade de Medicina-Universidade de São Paulo (USP); LIM 44 (P.R.A.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.B.C.)
| | - Paulo Puglia
- From Departamento de Neurologia (B.F.G., R.P.V., A.B.C.); and Departamento de Radiologia (P.P., P.R.A.), Faculdade de Medicina-Universidade de São Paulo (USP); LIM 44 (P.R.A.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.B.C.)
| | - Paula R Arantes
- From Departamento de Neurologia (B.F.G., R.P.V., A.B.C.); and Departamento de Radiologia (P.P., P.R.A.), Faculdade de Medicina-Universidade de São Paulo (USP); LIM 44 (P.R.A.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.B.C.)
| | - Adriana B Conforto
- From Departamento de Neurologia (B.F.G., R.P.V., A.B.C.); and Departamento de Radiologia (P.P., P.R.A.), Faculdade de Medicina-Universidade de São Paulo (USP); LIM 44 (P.R.A.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.B.C.)
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Abstract
Acute disorders of the abdominal aorta are potentially lethal conditions that require prompt evaluation and treatment. Computed tomography (CT) is the primary imaging method for evaluating these conditions because of its availability and speed. Volumetric CT acquisition with multiplanar reconstruction and three-dimensional analysis is now the standard technique for evaluating the aorta. MR imaging may be useful for select applications in stable patients in whom rupture has been excluded. Imaging is indispensable for diagnosis and treatment planning, because management has shifted toward endoluminal repair. Acute abdominal aortic conditions most commonly are complications of aneurysms and atherosclerosis.
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Affiliation(s)
- Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
| | - Jay P Heiken
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
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Park BW, Park SJ, Park H, Hwang JC, Seo YW, Cho HR. Stenosis or Occlusion of the Right Subclavian and Common Carotid Arteries Is More Common than That of the Innominate Artery in Takayasu Arteritis. Vasc Specialist Int 2016; 31:120-4. [PMID: 26719838 PMCID: PMC4694183 DOI: 10.5758/vsi.2015.31.4.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/12/2015] [Accepted: 09/14/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study was to introduce the phenomenon that stenosis or occlusion occurs less frequently in the innominate artery than in the right subclavian and common carotid arteries, which are not first-order branches of the aorta, in Takayasu arteritis (TA). MATERIALS AND METHODS We retrospectively reviewed the medical records and image findings of all patients who were diagnosed with TA from 2006 to 2014. Two vascular surgeons and two radiologists interpreted the images by disease character, location, and extent of occlusion based on computed tomography angiography, magnetic resonance angiography, or digital subtraction arteriography. We have also reviewed the literature on arterial involvement in TA. RESULTS A total of 42 patients were diagnosed with TA. The mean age was 43.9 years, and 83.3% (35/42) of the patients were women. The left subclavian artery was the most common stenosis or occlusion site (17, 40.5%) among the aortic branches. The innominate artery was a less common site (3, 7.1%) than the right subclavian artery (4, 9.5%) and the right common carotid artery (9, 21.4%). All innominate artery cases were found after endovascular procedures of the right subclavian or common carotid arteries. CONCLUSION The innominate artery might develop stenosis or occlusion less frequently than the right subclavian and common carotid arteries in Korean TA patients.
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Affiliation(s)
- Bong Won Park
- Department of Surgery and, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Jun Park
- Department of Surgery and, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hojong Park
- Department of Surgery and, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae Chol Hwang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Woo Seo
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hong Rae Cho
- Department of Surgery and, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Abstract
PURPOSE OF REVIEW Imaging is becoming a relevant tool for the assessment of patients with systemic vasculitis. This review focuses on recently generated data with potential clinical impact in the diagnosis, evaluation of disease extent and management of systemic vasculitis. RECENT FINDINGS Temporal artery examination by color duplex ultrasonography (CDUS) is a valuable approach to the diagnosis of giant-cell arteritis. Evaluation of additional arteries may increase its diagnostic performance. However, CDUS-specific findings may not be detected in arteries with early inflammation and CDUS-guidance of temporal artery biopsy does not seem to significantly increase its diagnostic yield. Large-vessel involvement detected by computed tomography angiography occurs in two out of three of patients with giant-cell arteritis at diagnosis. Furthermore, significant ascending aortic dilatation can be observed in one out of three of patients after long-term follow-up. Objective cut-offs for detecting large-vessel inflammation by positron emission tomography (PET) are trying to be established through prospective studies. PET may also contribute to the assessment of disease extent in patients with ANCA-associated vasculitis or Behçet's disease. SUMMARY Data generated by existing and emerging imaging techniques are expected to have a major impact in the diagnosis, appraisal of disease extent, evaluation of disease activity and response to treatment in patients with systemic vasculitis.
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Affiliation(s)
- Sergio Prieto-González
- aVasculitis Research Unit, Departments of Systemic Autoimmune Diseases bCenter for Diagnostic Imaging, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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44
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Wang H, Lai B, Wu X, Han T, Chen H. Late diagnosis of Takayasu's arteritis with repeated attacks of heart failure and uncontrolled hypertension due to abdominal aortic thrombosis: Case report and review of the literature. Blood Press 2015; 24:333-9. [DOI: 10.3109/08037051.2015.1049423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Management of the renovascular disease in children with Takayasu arteritis. Pediatr Nephrol 2015; 30:1213-6. [PMID: 25975436 DOI: 10.1007/s00467-015-3093-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/06/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
Takaysu arteritis (TA), together with fibromuscular dysplasia, is the most common cause for renovascular hypertension. The diagnosis of vasculitis is important to make as these children benefit from immunosuppressive treatment. In many cases, however, it is more difficult than commonly realised to differentiate between these two diagnoses. Imaging which allows the inflamed arterial wall to be outlined, such as magnetic resonance or positron emission tomography scans, can be very helpful in this context. Revascularisation, either with angioplasty or surgery, seems to be effective and safe, also in children with TA. Patients with inactive disease have a more successful outcome and experience fewer complications from the intervention than those with active on-going inflammation.
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46
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Sun Y, Ma L, Ji Z, Zhang Z, Chen H, Liu H, Shan Y, Yan F, Jiang L. Value of whole-body contrast-enhanced magnetic resonance angiography with vessel wall imaging in quantitative assessment of disease activity and follow-up examination in Takayasu’s arteritis. Clin Rheumatol 2015; 35:685-93. [DOI: 10.1007/s10067-015-2885-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
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47
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Smith SE. Conventional radiography and computed tomography. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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48
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Wan Y, Li Z, Ji N, Gao J. Comparison of gastric vascular anatomy by monochromatic and polychromatic dual-energy spectral computed tomography imaging. J Int Med Res 2014; 42:26-34. [PMID: 24435514 DOI: 10.1177/0300060513504703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the use of monochromatic and polychromatic dual-energy spectral computed tomography (CT) imaging for preoperative assessment of gastric vascular anatomy. METHODS Patients with suspected gastric cancer underwent spectral CT to generate conventional 140 kVp polychromatic and monochromatic images with energy levels ranging from 40 to 140 keV during the late arterial and portal venous phases. Optimal monochromatic images were selected according to the contrast-to-noise ratio (CNR) for the gastric artery. Image quality was subjectively assessed. Display rates of the arteries were recorded. RESULTS The study included 64 patients. Monochromatic images at 53 ± 3 keV provided the optimum CNR. At this energy level, subjective image scores were significantly higher for monochromatic images than polychromatic images. There were no significant differences in the display rates of arteries between polychromatic and optimal monochromatic images. CONCLUSIONS Monochromatic images obtained with spectral CT can improve the visualization of gastric arteries.
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Affiliation(s)
- Yamin Wan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ammirati E, Moroni F, Pedrotti P, Scotti I, Magnoni M, Bozzolo EP, Rimoldi OE, Camici PG. Non-invasive imaging of vascular inflammation. Front Immunol 2014; 5:399. [PMID: 25183963 PMCID: PMC4135304 DOI: 10.3389/fimmu.2014.00399] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022] Open
Abstract
In large-vessel vasculitides, inflammatory infiltrates may cause thickening of the involved arterial vessel wall leading to progressive stenosis and occlusion. Dilatation, aneurysm formation, and thrombosis may also ensue. Activated macrophages and T lymphocytes are fundamental elements in vascular inflammation. The amount and density of the inflammatory infiltrate is directly linked to local disease activity. Additionally, patients with autoimmune disorders have an increased cardiovascular (CV) risk compared with age-matched healthy individuals as a consequence of accelerated atherosclerosis. Molecular imaging techniques targeting activated macrophages, neovascularization, or increased cellular metabolic activity can represent effective means of non-invasive detection of vascular inflammation. In the present review, novel non-invasive imaging tools that have been successfully tested in humans will be presented. These include contrast-enhanced ultrasonography, which allows detection of neovessels within the wall of inflamed arteries; contrast-enhanced CV magnetic resonance that can detect increased thickness of the arterial wall, usually associated with edema, or mural enhancement using T2 and post-contrast T1-weighted sequences, respectively; and positron emission tomography associated with radio-tracers such as [18F]-fluorodeoxyglucose and the new [11C]-PK11195 in combination with computed tomography angiography to detect activated macrophages within the vessel wall. Imaging techniques are useful in the diagnostic work-up of large- and medium-vessel vasculitides, to monitor disease activity and the response to treatments. Finally, molecular imaging targets can provide new clues about the pathogenesis and evolution of immune-mediated disorders involving arterial vessels.
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Affiliation(s)
- Enrico Ammirati
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy ; Cardiovascular and Thoracic Department, AO Ospedale Niguarda Ca' Granda , Milan , Italy
| | - Francesco Moroni
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
| | - Patrizia Pedrotti
- Cardiovascular and Thoracic Department, AO Ospedale Niguarda Ca' Granda , Milan , Italy
| | - Isabella Scotti
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
| | - Marco Magnoni
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
| | - Enrica P Bozzolo
- Unit of Medicine and Clinical Immunology, Department of Medicine, San Raffaele Scientific Institute and University , Milan , Italy
| | - Ornella E Rimoldi
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy ; CNR Istituto di Bioimmagini e Fisiologia Molecolare , Segrate, Milan , Italy
| | - Paolo G Camici
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
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Abstract
The noninfectious, inflammatory vasculitides include giant cell arteritis, Takayasu disease, Churg-Strauss angiitis, Wegener disease, polyarteritis nodosa, microscopic polyangiitis, Buerger disease, amyloid-β-related angiitis, and isolated vasculitis of the central nervous system. While these disorders are relatively uncommon, they produce a variety of neurologic diseases including muscle disease, mononeuropathy multiplex, polyneuropathy, cranial nerve palsies, visual loss, seizures, an encephalopathy, venous thrombosis, ischemic stroke, and intracranial hemorrhage. The multisystem vasculitides often have stereotypical clinical findings that reflect disease of the kidney, sinuses, lungs, skin, joints, or cardiovascular system. These disorders also usually have abnormalities found on serologic testing. Isolated vasculitis of the central nervous system is more difficult to diagnose because the clinical and brain imaging findings are relatively nonspecific. Examination of the cerebrospinal fluid will demonstrate changes consistent with an inflammatory process. Arteriography often shows areas of segmental narrowing affecting multiple intracranial vessels and brain/meningeal biopsy may be required to establish the diagnosis. Management of patients with a multisystem vasculitis or isolated vasculitis of the central nervous system is centered on the administration of immunosuppressive agents. In many cases, corticosteroids remain the mainstay of medical treatment.
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Affiliation(s)
- Harold P Adams
- Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, University of Iowa Health Care Stroke Center, University of Iowa, Iowa City, IA, USA.
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