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Huang Z, Zhang H, Wang M, Yang W, Qiao S, Hu F. Revascularization Versus Medical Therapy in Takayasu's Arteritis Patients with Coronary Artery Involvement. Rheumatol Ther 2020; 8:119-133. [PMID: 33230786 PMCID: PMC7991006 DOI: 10.1007/s40744-020-00251-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Treatment strategies to improve clinical outcomes in Takayasu's arteritis (TA) with coronary lesions have ranged from pharmacological therapy to invasive procedures, such as coronary angioplasty, stenting, and surgery. However, the therapeutic strategy for this kind of patient is still unclear. This study aimed to investigate the clinical characteristics and influence of revascularization versus medical therapy in TA patients with coronary artery involvement. Methods We analyzed the medical records of 806 TA patients between January 2008 and December 2019. Clinical features and treatment were analyzed, and patients were categorized into medical treatment and revascularization. Additionally, patients were sorted as percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) based on the strategy of revascularization. Results Ninety cases with coronary lesions induced by TA were enrolled. Among 90 cases, 39 patients adopted conservative treatment, and 51 patients received revascularization (28 subjects with PCI, 23 participants with CABG). The median follow-up time was 63 (45–91) months. There is no significant difference in cardiovascular death between medical treatment and revascularization (2/39, 5.1% vs. 5/51, 9.8%, P = 0.971). The analysis of subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI (2/28, 7.1% vs. 3/23, 13.0%, P = 0.772). However, the proportion of restenosis is much higher in the PCI compared with that of CABG (39.3%, 8.7%, P = 0.022, respectively). Heart failure is an independent predictor of death in these patients. Conclusions There is no significant difference in cardiovascular death between medical treatment and revascularization. The analysis of the subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI, but the restenosis is much higher in the PCI compared with that of CABG. Heart failure is an independent predictor of death in these patients.
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Affiliation(s)
- Zhiwei Huang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Hongliang Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Man Wang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Weixian Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Fenghuan Hu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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Minh TL, Hoang AD, Dupont P, Motte S, Douaihy ME, Ferreira J, Michel P, Dehon P, Dereume JP. Abdominal Aortic Coarctation with Splanchnic Arterial Occlusion. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1999.12098493] [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]
Affiliation(s)
- T. Le Minh
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
| | - A. D. Hoang
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
| | - P. Dupont
- Department of Nephrology, Centre Hospitalier de Tivoli, La Louvière, Belgium
| | - S. Motte
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
| | - M. El Douaihy
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
| | - J. Ferreira
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
| | - P. Michel
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
| | - P. Dehon
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
| | - J. P. Dereume
- Department of Vascular Pathology, Erasme Hospital, University clinics of Brussels
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Jariwala P, Irlapati RV, Giragani S, Shaikh S. Percutaneous transluminal angioplasty of complex aortoiliac occlusive disease secondary to Takayasu's aortoarteritis in a young female. Indian J Radiol Imaging 2020; 30:405-408. [PMID: 33273781 PMCID: PMC7694727 DOI: 10.4103/ijri.ijri_225_20] [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: 04/10/2020] [Revised: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022] Open
Abstract
As the initial treatment of patients with the iliac occlusive disease, percutaneous transluminal angioplasty (PTA) became common. Though not supported by the latest TransAtlantic Inter-Society Consensus (TASC) II guidelines, percutaneous treatment of complex aortoiliac lesions is possible and provides comparable angiographic and clinical outcomes compared to open surgery at both short- and long-term follow-up, also in complex lesion settings. TASC C and D lesions with the latest instruments, procedures, and modalities may also be managed endovascularly. It provides new opportunities for a population of highly comorbid patients. We assume that the outcomes of endovascular therapy for aortoiliac lesions in the setting of Takayasu's arteritis will be further enhanced through continuous technological progress and new advances in materials. In light of the current progression towards minimally invasive procedures, a growing number of skilled centres should be able to treat by endovascular intervention the great majority of all arterial pathologies.
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Affiliation(s)
- Pankaj Jariwala
- Department of Cardiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
| | - Rajendra V Irlapati
- Department of Rheumatology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
| | - Suresh Giragani
- Interventional Radiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
| | - Sikandar Shaikh
- Department of Radiodiagnosis, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
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Granit D, Tinazli M, Tinazli R, Akpinar S, Cerit L. Late diagnosis of Takayasu disease might be fatal. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.18.03976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shankarrao Dekate P, Reddy S, Prasad VSV, Boda S, Saini L, Patil P. An Uncommon Cause of Hypertensive Urgency in Young Adolescent: Case Report. Indian J Crit Care Med 2019; 23:339-341. [PMID: 31406445 PMCID: PMC6686575 DOI: 10.5005/jp-journals-10071-23210] [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] [Indexed: 11/23/2022] Open
Abstract
Mid aortic syndrome is rare cause of hypertensive urgency in children with poor outcome if left untreated, high index of suspicion with prompt management is the key to survival with good outcome. A 12-year-old boy was presented with fever, puffiness of face, and breathing difficulty. Clinically, he had hypertension with differential pulsation and BP in upper and lower limbs. He had peak systolic gradient of 80 mm Hg between upper and lower limb. His echocardiography and CT angiography was suggestive of significant isolated 80% narrowing of abdominal aorta without involvement any other large vessels. Percutaneous balloon dilatation of aorta was done considering multiple parameters. Post procedure, there was significant improvement in BP and we could wean his multiple anti-hypertensive drugs to keep his blood pressures below 95th centile. His BP remained control with minimum upper and lower limb gradient on follow up of almost 1 year. HOW TO CITE THIS ARTICLE Dekate PS, Reddy S, Prasad VSV, Boda S, Saini L, Patil P. An Uncommon Cause of Hypertensive Urgency in Young Adolescent: Case Report. Indian J Crit Care Med 2019;23(7):339-341. KEY MESSAGE Mid aortic syndrome is most uncommon amongst them. With prompt diagnosis and proper selection of therapeutic options like balloon dilatation or surgical correction, it has good prognosis. Aortic narrowing because of different diseases is an uncommon cause of HT urgency in children.
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Affiliation(s)
- Parag Shankarrao Dekate
- Department of Pediatrics, PICU, Lotus Hospital for Women and Children, Lakdikapool, Hyderabad, Telangana, India
| | - Satyanarayana Reddy
- Department of Pediatrics, PICU, Lotus Hospital for Women and Children, Lakdikapool, Hyderabad, Telangana, India
| | - VSV Prasad
- Department of Pediatrics, PICU, Lotus Hospital for Women and Children, Lakdikapool, Hyderabad, Telangana, India
| | - Sudha Boda
- Department of Pediatrics, PICU, Lotus Hospital for Women and Children, Lakdikapool, Hyderabad, Telangana, India
| | - Lokesh Saini
- Department of Pediatrics, PICU, Lotus Hospital for Women and Children, Lakdikapool, Hyderabad, Telangana, India
| | - Prashant Patil
- Department of Pediatrics, PICU, Lotus Hospital for Women and Children, Lakdikapool, Hyderabad, Telangana, India
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Vijayvergiya R, Jindal AK, Pilania RK, Suri D, Gupta A, Sharma A, Sinha SK, Singhal M, Bahl A, Singh S. Complex interventions of abdominal aorta and its branches in children with Takayasu arteritis: Clinical experience from a tertiary care center in north-west India. Int J Rheum Dis 2018; 22:140-151. [PMID: 30398008 DOI: 10.1111/1756-185x.13420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/04/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ankur K. Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Rakesh K. Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Deepti Suri
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Anju Gupta
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Ashish Sharma
- Department of Renal Transplant Surgery; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Saroj K. Sinha
- Department of Gastroenterology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ajay Bahl
- Department of Cardiology, Advanced Cardiac Centre; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
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8
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Jeong HS, Jung JH, Song GG, Choi SJ, Hong SJ. Endovascular balloon angioplasty versus stenting in patients with Takayasu arteritis: A meta-analysis. Medicine (Baltimore) 2017; 96:e7558. [PMID: 28723782 PMCID: PMC5521922 DOI: 10.1097/md.0000000000007558] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Symptomatic or significant vascular lesions of Takayasu arteritis (TA) need interventions. Although percutaneous transluminal angioplasty with balloon is a less invasive and safe method, stent implantation in TA can be an alternative option. However, superiority between balloon angioplasty and stenting in TA is not conclusive. METHODS A meta-analysis comparing balloon angioplasty and stenting outcomes was performed using the MEDLINE and EMBASE databases. RESULTS A total of 7 studies on 266 patients and 316 lesions were included. Balloon angioplasty was performed in 186 lesions and stenting in 130 lesions. There were no significant differences in the incidence of both restenosis and other complications between balloon angioplasty and stenting [odds ratio (OR) = 2.39, 95% confidence interval (CI) = 0.66-8.66, P = .18; OR = 1.80, 95% CI = 0.49-6.65, P = .38, respectively]. In the renal arteries, the risk of restenosis in stenting was significantly higher than that in balloon angioplasty (OR = 4.40, 95% CI = 2.14-9.02, P < .001). The clinical efficacy of improving renal hypertension between balloon angioplasty and stenting at the renal artery lesions was similar (OR = 0.65, 95% CI = 0.28-1.51, P = .31); however, acute vascular complications were significantly fewer in stenting than in balloon angioplasty (OR = 0.07, 95% CI = 0.02-0.29, P < .001). CONCLUSION This meta-analysis found that balloon angioplasty can yield better results in renal artery interventions than stenting. Nonetheless, it is desirable to avoid vessel dissections during balloon angioplasty, which can eventually require stent implantations.
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Affiliation(s)
- Han Saem Jeong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital
| | - Jae Hyun Jung
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital
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9
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Kuijer A, van Oosterhout MFM, Kloppenburg GTL, Morshuis WJ. Coronary artery bypass grafting in Takayasu's disease--importance of the proximal anastomosis: a case report. J Med Case Rep 2015; 9:283. [PMID: 26666882 PMCID: PMC4678760 DOI: 10.1186/s13256-015-0767-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Treatment of coronary artery involvement in Takayasu's arteritis is challenging. Coronary artery bypass grafting may be required. The use of saphenous vein grafts is recommended because of possible inflammatory involvement of the internal thoracic arteries. However, inserting the proximal anastomosis on inflamed aortic tissue may give rise to stenosis. Only a few cases of inserting a proximal anastomosis in patients with Takayasu's arteritis have been reported in the literature. To date, no consensus has been reached on the best way to perform this procedure in patients with Takayasu's arteritis. CASE PRESENTATION We report a case of a 25-year-old white woman with Takayasu's arteritis who had recurrent angina after two previous treatments had failed, due to left main stem stenosis. She was successfully treated by coronary artery bypass grafting using a Dacron patch to insert the proximal anastomosis. CONCLUSIONS We are the first to report an uncomplicated case in which a Dacron (Vascutek®, Renfrewshire) prosthetic patch was used to insert the proximal anastomosis on an inflamed aorta in a patient with Takayasu's arteritis. The patch prevents contact between inflamed tissue and the graft, which we believe reduces the risk of graft failure. This case might inspire other thoracic surgeons in the challenging task of performing revascularization techniques in patients with an inflamed and fragile aorta.
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Affiliation(s)
- Anne Kuijer
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands.
| | - Matthijs F M van Oosterhout
- Department of Pathology, Sint Antonius Hospital Nieuwegein, Koekoekslaan 1, mailbox 2500, 3430 EM, Nieuwegein, The Netherlands.
| | - Geoffrey T L Kloppenburg
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, Koekoekslaan 1, mailbox 2500, 3430 EM, Nieuwegein, The Netherlands.
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, Koekoekslaan 1, mailbox 2500, 3430 EM, Nieuwegein, The Netherlands.
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Samal P, Bhagwat K, Panigrahi T, Gopinathan N. Bilateral discoid medial menisci: a rare phenomenon. Singapore Med J 2015; 55:e139-41. [PMID: 25273941 DOI: 10.11622/smedj.2014126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Discoid medial meniscus is a relatively rare pathology of the knee joint, with bilateral cases even rarer. Herein, we report the case of a 25-year-old man diagnosed with discoid medial meniscus in the right knee with a horizontal tear. Increased cupping of the medial condyle of the tibia, widening of the medial joint space and the presence of discoid meniscus in the right knee prompted investigation of the asymptomatic left knee with magnetic resonance imaging. The contralateral asymptomatic knee also showed evidence of discoid medial meniscus. The symptomatic knee was successfully treated by arthroscopic partial meniscectomy, with excellent functional outcome.
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Affiliation(s)
- Puspak Samal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RSV, Vrints CJM. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2873-926. [PMID: 25173340 DOI: 10.1093/eurheartj/ehu281] [Citation(s) in RCA: 2827] [Impact Index Per Article: 282.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Pilati M, Pongiglione G, Gagliardi MG. Percutaneous treatment of abdominal coarctation in children using a covered stent. Pediatr Cardiol 2014; 34:2080-5. [PMID: 23515761 DOI: 10.1007/s00246-013-0690-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/08/2013] [Indexed: 11/25/2022]
Abstract
Coarctation of the abdominal aorta is extremely rare. It generally involves a long segment of the descending aorta and causes uncontrolled and unexplainable hypertension in children. The therapeutic choice is very challenging because acute and chronic complications are reported for both the surgical and the percutaneous approaches. The two reported cases of abdominal coarctation were treated primarily and successfully through the use of covered stents. Three covered stents were implanted in two children. No complication occurred with either procedure. At this writing, an 18-month follow-up assessment has found the patients in good health with no restenosis at the coarctation site. Covered stent implantation in children with abdominal coarctation is a feasible, safe, and effective procedure. It provides adequate relief of symptoms and reduces the risk of aneurysm formation. To avoid covering important side branches with polytetrafluoroethylene, this type of procedure must be preceded by precise study of the aorta and its branches.
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Affiliation(s)
- Mara Pilati
- Medical and Surgical Department of Pediatric Cardiology, Ospedale Pediatrico Bambino Gesù, IRCCS Piazza S. Onofrio 4, 00165, Rome, Italy,
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Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. Rheumatology (Oxford) 2013; 53:793-801. [DOI: 10.1093/rheumatology/ket320] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Midaortic syndrome: 30 years of experience with medical, endovascular and surgical management. Pediatr Nephrol 2013; 28:2023-33. [PMID: 23775038 PMCID: PMC3822337 DOI: 10.1007/s00467-013-2514-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/09/2013] [Accepted: 05/13/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Midaortic syndrome is often associated with refractory hypertension. The aim of our study was to better understand the short- and medium-term outcomes in this patient population utilizing a multidisciplinary management approach. METHODS We conducted a review of patients with midaortic syndrome treated at our institution over the past 30 years. RESULTS Fifty-three patients presented at a median age of 6.7 years (birth to 28.7 years). Thirty-five patients (66 %) underwent invasive management (percutaneous techniques: 21; surgical techniques: 5; both: 9). Percutaneous interventions were acutely successful in decreasing the gradient across the obstruction and degree of luminal stenosis. However, freedom from reintervention was 58 % at 1 year and 33 % at 5 years. Freedom from reintervention after a surgical procedure was longer: 83 % at 1 year and 72 % at 10 years. At the most recent follow-up, the majority of patients (69 %) were normotensive. The median duration between time of presentation and achievement of blood pressure control was 5.7 (0.4-21.1) years. The median number of anti-hypertensive medications was 1 (0-5). CONCLUSIONS A multidisciplinary management strategy which couples comprehensive medical management with catheter-based and surgical interventions can lead to adequate blood pressure control and preservation of end-organ function in patients with midaortic syndrome.
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Na KJ, Lee KH, Oh SJ, Hwang HY, Kim KB. Anaortic Off-pump Coronary Artery Bypass Grafting in Patients with Takayasu's Arteritis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:274-8. [PMID: 24003408 PMCID: PMC3756158 DOI: 10.5090/kjtcs.2013.46.4.274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/05/2013] [Accepted: 03/07/2013] [Indexed: 11/16/2022]
Abstract
Background Coronary involvement in Takayasu's arteritis is a rare but fatal disease. The aim of this study was to evaluate the early and mid-term results of Takayasu's arteritis patients who underwent coronary artery bypass grafting (CABG). Materials and Methods Of 2,280 patients who underwent isolated CABG from January 1998 to June 2012, Takayasu's arteritis was identified in 5 patients. There were 3 female patients, and the mean age was 58±9 years. Takayasu's arteritis was diagnosed during preoperative evaluation for coronary artery disease in 4 patients, and the initial manifestation was angina pectoris in 4 patients. All of the patients underwent anaortic off-pump CABG (OPCAB) using the in situ left or right internal thoracic arteries (ITA); 3 patients had severe stenosis of the proximal left subclavian artery and the in situ right ITA was used instead. Medical treatment for inflammatory arteritis during the perioperative and follow-up period was performed if indicated. Early, 1-year, and 5-year angiographic results and clinical outcomes were analyzed. Results There was no surgical mortality, and all of the patients were discharged without complications on postoperative 8±2 days. Early postoperative (postoperative 2±1 days) angiography demonstrated a graft patency of 100% (12 of 12 distal anastomoses). One-year (13±3 months) angiography was performed in 4 patients, and all of the grafts were patent (100%, 9 of 9 distal anastomoses). Conclusion By performing anaortic OPCAB in patients with Takayasu's arteritis, we were able to avoid complications associated with manipulating an atherosclerotic and severely calcified ascending aorta. The early and mid-term graft patency of OPCAB in Takayasu's arteritis was maintained when concomitant with medical treatment.
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Affiliation(s)
- Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea
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Morbi A, Gohel MS, Hamady M, Cheshire NJ, Bicknell CD. Lower-Limb Ischemia in the Young Patient: Management Strategies in an Endovascular Era. Ann Vasc Surg 2012; 26:591-9. [DOI: 10.1016/j.avsg.2011.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 12/22/2022]
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Minson S, McLaren CA, Roebuck DJ, Tullus K. Infantile midaortic syndrome with aortic occlusion. Pediatr Nephrol 2012; 27:321-4. [PMID: 22057980 DOI: 10.1007/s00467-011-2039-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 09/29/2011] [Accepted: 09/30/2011] [Indexed: 10/15/2022]
Abstract
Mid aortic syndrome (MAS) is a rare condition often presenting with severe hypertension. It is characterized by narrowing of the abdominal aorta. We here describe a case of complete occlusion of the abdominal aorta presenting in infancy. This child presented at four months of age with heart failure and hypertension. CT angiogram showed total narrowing of the abdominal aorta. This was initially felt to be too severe for surgical treatment and he was planned for palliative care. We were however able to improve his blood pressure with antihypertensive agents and he underwent succesful angioplasty at five and a half months of age. He has required three further angioplasty procedures and still needs two antihypertensive agents to control his blood pressure. His renal function remains normal and at age six years he has excellent quality of life with normal growth and development. This case illustrates that the combination of medical treatment and angioplasty can give an excellent long-term treatment response even in children with extremely severe MAS. This boy now has normal blood pressure and has experienced normal growth, development and quality of life.
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Affiliation(s)
- Susan Minson
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK, WC1N 3JH
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Bolin E, Moodie DS, Fraser CD, Guirola R, Warren R, Eldin KW. Takayasu arteritis presenting as severe ascending aortic arch dilation and aortic regurgitation in a 10-year-old female. CONGENIT HEART DIS 2011; 6:630-3. [PMID: 22117861 DOI: 10.1111/j.1747-0803.2011.00592.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Takayasu arteritis (TA) is a large-vessel arteritis affecting the aorta and its major branches. It is a rare disease in children less than 10 years old, and its diagnosis is frequently delayed, likely because of TA's rarity and nonspecific symptoms early in the disease. Females are affected disproportionately, with a female to male ratio of 8.5 to 1. Recently, the European League against Rheumatism published an international consensus statement for making the diagnosis of childhood TA. Criteria include angiographic abnormalities of the aorta and/or its branches, pulse deficit or claudication, blood pressure discrepancy, bruits, hypertension, and elevated acute phase reactants. We described a 10-year-old female with severe TA of the ascending aorta and who presented with classic signs and symptoms of this rare disease.
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Affiliation(s)
- Elijah Bolin
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
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Qureshi MA, Martin Z, Greenberg RK. Endovascular Management of Patients with Takayasu Arteritis: Stents versus Stent Grafts. Semin Vasc Surg 2011; 24:44-52. [DOI: 10.1053/j.semvascsurg.2011.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Takayasu arteritis, a rare granulomatous vasculitis affecting young people, is associated with considerable morbidity and premature mortality. In most patients the diagnosis is delayed until after the development of substantial arterial injury. Studies of noninvasive imaging techniques suggest that these approaches might facilitate earlier diagnosis and have a role in monitoring disease progress; however, they remain limited in their ability to accurately quantify inflammatory disease activity in the arterial wall. A lack of controlled clinical trial data complicates the choice of therapy for Takayasu arteritis, and clinical indices for monitoring disease activity are currently suboptimal. Increasing knowledge of the pathogenesis of the large vessel vasculitides might eventually lead to novel targeted therapies. Preliminary data from open-label trials of anti-tumor necrosis factor therapy are encouraging, but there is an urgent need for controlled clinical trials to establish optimum therapeutic approaches for this disease. These trials should include a prospective assessment of the use of noninvasive imaging modalities in the diagnosis and subsequent management of Takayasu arteritis.
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Affiliation(s)
- Justin C Mason
- Bywaters Centre for Vascular Inflammation, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK.
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55:e27-e129. [PMID: 20359588 DOI: 10.1016/j.jacc.2010.02.015] [Citation(s) in RCA: 998] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121:e266-369. [PMID: 20233780 DOI: 10.1161/cir.0b013e3181d4739e] [Citation(s) in RCA: 1175] [Impact Index Per Article: 83.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gutiérrez-Martín M, Araji O, Miranda N, Barquero J. Corrección quirúrgica de una coartación aórtica abdominal suprarrenal en una mujer de 56 años. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yoshida RDA, Yoshida WB, Kolvenbach R, Hirga M, Vieira PRB. Lesões complexas supra-aórticas de arterite de Takayasu: como tratá-las? J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000400011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ghazi P, Haji-Zeinali AM, Shafiee N, Qureshi SA. Endovascular abdominal aortic stenosis treatment with the optimed self-expandable nitinol stent. Catheter Cardiovasc Interv 2009; 74:634-41. [DOI: 10.1002/ccd.22175] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gumus B, Cevik H, Vuran C, Omay O, Kocyigit OI, Turkoz R. Cutting balloon angioplasty of bilateral renal artery stenosis due to Takayasu arteritis in a 5-year-old child with midterm follow-up. Cardiovasc Intervent Radiol 2009; 33:394-7. [PMID: 19517163 DOI: 10.1007/s00270-009-9623-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 05/09/2009] [Accepted: 05/14/2009] [Indexed: 02/06/2023]
Abstract
The aim of this report is to demonstrate the successful endovascular treatment of bilateral renal artery stenosis due to Takayasu arteritis by cutting balloon angioplasty in a 5-year-old child with mid-term follow-up.
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Affiliation(s)
- Burcak Gumus
- Department of Radiology, Baskent University Hospital, Oymaci Sok. No. 7, Altunizade, Usküdar, Istanbul, Turkey.
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Abdominal aortic coarctation: Surgical treatment of 53 patients with a thoracoabdominal bypass, patch aortoplasty, or interposition aortoaortic graft. J Vasc Surg 2008; 48:1073-82. [DOI: 10.1016/j.jvs.2008.05.078] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Revised: 05/27/2008] [Accepted: 05/28/2008] [Indexed: 11/20/2022]
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Abstract
Takayasu's disease is a rare chronic vasculitis of unknown aetiology. Initial symptoms and signs are non-specific, and a high index of suspicion is needed to make the correct diagnosis. The disease is associated with a high incidence of morbidity, and a significant risk of premature death. Serological tests have proved unreliable in distinguishing active from quiescent disease, with non-invasive imaging currently offering the best option for early diagnosis, and monitoring the response to treatment. In this review, we detail the epidemiology, pathophysiology, clinical features, imaging characteristics, and currently available treatments.
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Abstract
Abstract Giant cell arterits (GCA) is increasingly being recognized as a systemic vascular disease, not confined to the cranial arteries. Epidemiological studies have shown that almost one-third of the patients with GCA develop serious peripheral vascular complications during long-term follow up, and there is growing evidence that unrecognized extracranial involvement may be even more common. GCA of large- and medium-sized peripheral arteries typically leads to long tapering and occlusion of the arterial lumen due to concentric intimal thickening, sometimes accompanied by spontaneous dissection. Depending on the extent of the arterial obliteration and on the anatomy of the involved arterial segment, this may result in severe ischemia of the limbs during the acute phase of the disease. GCA of the aorta usually remains asymptomatic for many years, and leads to a markedly increased risk of aneurysms and dissections, particularly of the thoracic aorta. Evolving vascular imaging techniques such as duplex ultrasound, computer tomography (CT), magnetic resonance imaging (MRI), and fluorine-18-desoxyglucose positron emission tomography (18F-FDG-PET) have greatly improved our ability to detect and study arterial changes in large-artery vasculitis. Boosted by these advances in vascular imaging, vascular specialists are increasingly involved in the early diagnosis, follow-up and treatment of patients with large-vessel vasculitis.
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Affiliation(s)
- Federico Tatò
- Gefaesszentrum Muenchner Freihet, Haimhauserstrasse 4, D-80802 Munich, Germany
| | - Ulrich Hoffmann
- Gefaesszentrum Muenchner Freihet, Haimhauserstrasse 4, D-80802 Munich, Germany
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Descending thoracic and abdominal aortic coarctation in the young: Surgical treatment after percutaneous approaches failure. J Vasc Surg 2008; 47:865-7. [DOI: 10.1016/j.jvs.2007.10.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 10/19/2007] [Accepted: 10/24/2007] [Indexed: 11/18/2022]
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Rav-Acha M, Plot L, Peled N, Amital H. Coronary involvement in Takayasu's arteritis. Autoimmun Rev 2007; 6:566-71. [PMID: 17854750 DOI: 10.1016/j.autrev.2007.04.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 04/17/2007] [Indexed: 02/02/2023]
Abstract
Coronary involvement may appear in up to a third of patients with Takayasu's arteritis. This affliction may have a dominant impact on the clinical manifestations of the patient. Occlusion of the ostia of the left main coronary artery and of proximal segments of the coronary arteries is the most frequent finding of the coronary vasculature in patients with Takayasu's arteritis. Beyond the vasculitic process enhanced atherosclerosis has a significant and detrimental impact on the disease development. Revascularizations are often unsuccessful particularly when the inflammatory disease is not under satisfactory control. New techniques have been developed in order to use vessels that have not been damaged by the disease as grafts.
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Affiliation(s)
- Moshe Rav-Acha
- Division of Internal Medicine, Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
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Tanaka R, Higashi M, Naito H. Angioplasty for Non-arteriosclerotic Renal Artery Stenosis: The Efficacy of Cutting Balloon Angioplasty Versus Conventional Angioplasty. Cardiovasc Intervent Radiol 2007; 30:601-6. [PMID: 17437158 DOI: 10.1007/s00270-007-9000-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We examined the efficacy of conventional balloon angioplasty and cutting balloon angioplasty (CBA) for the treatment of non-arteriosclerotic renal artery stenosis (RAS). MATERIALS AND METHODS From 1993 to 2005, 20 patients underwent 27 percutaneous transluminal renalangioplasty (PTRA) for non-arteriosclerotic RAS (men: 8, women: 12, 25.5 +/- 2 years old; 16 fibromuscular dysplasia (FMD), 4 Takayasu disease). We evaluated the efficacy of CBA by comparing the rate of initial technical success and surgical conversion. RESULTS Before the clinical authorization of CBA, three of twelve patients (25 %) underwent surgical bypass due to the failure of PTRA due to the hardness of the lesion. After the approval of cutting balloon, we performed CBA in four cases (2 FMD,2 Takayasu disease) to dilate hard lesions, within which a properly sized balloon could not dilate due to their hardness, or to reduce the risk of local dissection. Initial successes were obtained in all patients (8/8, 100%) and none of the patients underwent surgical conversion. Despite of the good initial result, restenosis was observed in three cases within 6 month (3/4, 75%). Additional interventions were performed in all patients, then, the severity of the restenotic lesion was found not to be exceeded comparing with the initial lesion. CONCLUSION The cutting balloon angioplasty may be safe and useful procedure for hard lesions of RAS caused by non-arteriosclerotic disease? especially fibromuscular dysplasia. The cutting balloon may provide the initial success, but the effect on long-term patency is still controversial.
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Affiliation(s)
- Ryoichi Tanaka
- Department of Radiology, Iwate Medical University, 19-1 Uchimaru Morioka, Iwate, Japan.
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Arterial Interventions. J Vasc Interv Radiol 2005. [DOI: 10.1016/s1051-0443(05)70216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE OF REVIEW Takayasu arteritis remains a therapeutic challenge. In spite of current treatments, progression of vascular lesions is observed frequently. The purpose of this article is to describe advances in therapeutic strategies for Takayasu arteritis. RECENT FINDINGS Immunosuppressive agents including methotrexate, mycophenolate mofetil, and azathioprine added to corticosteroids can bring Takayasu arteritis into remission in many patients. Unfortunately, relapse is common when prednisone is tapered to dosages of 15 mg/day or less. A better understanding of pathogenesis has lead to trials with anti-tumor necrosis factor-alpha agents in patients with refractory disease. Preliminary results are encouraging. For patients who require revascularization intervention, both surgical and endovascular procedures can be performed that are safe, with low morbidity and mortality. The best long-term outcomes are achieved with conventional bypass grafts. Percutaneous transluminal angioplasty provides good results for short lesions. In contrast to the results in treating atherosclerosis, the use of conventional stents may not yield long-term vessel patency in Takayasu arteritis. Persistent inflammation and endothelial dysfunction may put patients with Takayasu arteritis at risk for premature atherosclerosis. SUMMARY In the future, greater therapeutic success may be achieved by addressing both the inflammatory and the myointimal proliferative components of Takayasu arteritis. New drugs that target intimal hyperplasia, as well as drug-eluting stents, deserve to be studied for possible utility as adjuncts to present treatments.
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Affiliation(s)
- Patrick Liang
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Kumar A, Dubey D, Bansal P, Sanjeevan KV, Gulati S, Jain S, Sharma RK. Surgical and radiological management of renovascular hypertension in a developing country. J Urol 2003; 170:727-30. [PMID: 12913683 DOI: 10.1097/01.ju.0000081997.69890.f3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We determined the long-term outcome of radiological and surgical intervention in young patients with renovascular hypertension. MATERIALS AND METHODS Between 1989 and 2001, 85 patients with a mean age +/- SD of 21 +/- 10.3 years, including 59 with Takayasu's arteritis (TA) and 26 with fibromuscular dysplasia (FMD), underwent radiological (percutaneous transluminal angioplasty) or surgical treatment for renovascular hypertension due to renal artery stenosis. The technical success, complications and clinical response of each treatment were compared. RESULTS Of the patients 29 with TA and 20 with FMD underwent a total of 56 balloon angioplasties. Technical success was achieved in 94.58 renal units with a clinical response in 41 patients (83.9%). However, the re-stenosis rate was 24.13% in TA and 10% in FMD cases. A total of 41 surgical procedures were performed in the 28 and 7 patients with TA and FMD, respectively, including aortorenal bypass with vein in 12, and with a polytetrafluoroethylene graft in 4, lienorenal bypass in 4, iliorenal bypass in 2, gastroduodenal bypass in 1, autotransplantation in 1, nephrectomy in 14 and partial nephrectomy in 2. The clinical response rate to renal revascularization procedures was 94.4%, whereas it was only 50.0% for nephrectomy/partial nephrectomy during a median followup of 42 months (range 9 to 96). CONCLUSIONS Percutaneous transluminal angioplasty and renal revascularization provide comparable long-term results in the management of renal artery stenosis due to TA and FMD. Although it is technically complex, surgery for TA is safe and effective. However, the rate of re-stenosis following angioplasty for TA is higher compared with FMD.
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Affiliation(s)
- Anant Kumar
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, India.
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Affiliation(s)
- M C Cid Xutglà
- Grupo de Investigación sobre Vasculitis Sistémicas. Servicio de Medicina Interna General. Hospital Clínico. Facultad de Medicina. Universidad de Barcelona. IDIBAPS (Instituto de Investigaciones Biomédicas August Pi i Sunyer). Barcelona. Spain
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Abstract
AIM OF THE STUDY The aim of this work was to study the localizations of Takayasu's disease to the aorta and the renal arteries, the long-term results of their surgical treatment and the evolution of the disease with time. PATIENTS AND METHODS From 1972 to 2000, 23 patients (16 females, 7 males) with aortic and/or renal lesions were operated on. Mean age was 19.5 +/- 12.4 years. Despite heavy medical treatment, all had severe and uncontrollable hypertension. Eighteen patients had associated lesions of the aorta and renal arteries, 5 had isolated lesions of the renal artery, 10 had lesions of mesenteric arteries, 6 had lesions of supra-aortic trunks. Percutaneous transluminal angioplasty of the renal artery (ies) was attempted in 4 cases and was unsuccessful in all. Due to bilateral lesions in 12 patients, the surgical treatment consisted of 3 nephrectomies and 32 artery repairs of which 23 were performed by conventional in situ surgery and 9 by extracorporeal repair. An aortic bypass was performed in 7 patients and revascularization of other visceral arteries in 3. The follow-up extends from 1 to 18 years (mean: 5). RESULTS There was no mortality. Three postoperative thromboses of repairs occurred: 2 of renal artery and 1 of mesenteric artery. Immediate results on blood pressure control were as follows: complete cure in 18 patients (78%), improvement in 3 (13%) and failure in 2 (9%). During the follow-up, evolution of the disease was observed in 10 patients (43%): 4 repeat stenoses of renal arteries due to aggravation of aortic lesions requiring reoperation in 2 patients, 3 aggravation of aortic lesions requiring an aortic bypass in 1 patient, 1 coronary insufficiency requiring a coronary bypass at 8.5 years. During the long-term follow up, due to secondary anatomical deteriorations, the results of surgery on blood pressure control were as follow: complete cure in 14 patients (61%), improvement in 4 (17%), failure in 5 (22%). CONCLUSION Surgical treatment of reno-aortic lesions in Takayasu's disease must be reserved to patients whose arterial hypertension is uncontrollable despite heavy medical treatment. Results are altered by the evolution of the disease either locally or in other territories and that may require several operations. Due to frequently occurring late degeneration of repairs, surgical therapy must be carefully decided and patients' follow-up must be prolonged.
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Affiliation(s)
- M Lacombe
- Hôpital Beaujon, 100, boulevard du Général-Leclerc, 92118 Clichy, France
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Keith DS, Markey B, Schiedler M. Successful long-term stenting of an atypical descending aortic coarctation. J Vasc Surg 2002; 35:166-7. [PMID: 11802149 DOI: 10.1067/mva.2002.118807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stenotic lesions of the descending aorta are rare causes of coarctation of the aorta. The majority of cases of atypical coarctation are thought to be caused by Takayasu's arteritis. This report describes an atypical coarctation of the descending aorta treated with angioplasty and stent placement. Patency of the stent and control of the hypertension at 2 and a half years suggest that endovascular treatment of atypical coarctation may be successful with the use of mechanical stents and may be an alternative to surgical correction.
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Affiliation(s)
- Douglas Scott Keith
- Northwest Kaiser Permanente, PC, 6902 SE Lake Road, Suite 100, Milwaukie, OR 97267, USA.
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Besson-Léaud L, Grenier N, Besson-Léaud M, Boniface C, Guillard JM. [Takayasu's disease: interest in methotrexate treatment]. Arch Pediatr 2001; 8:724-7. [PMID: 11484455 DOI: 10.1016/s0929-693x(00)90305-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
UNLABELLED Takayasu's disease is a nonspecific aortic arteritis that affects mostly young women and sometimes children. Usual treatment consists of early and prolonged steroids. Some patients do not respond to this treatment, become steroid-dependent or suffer from side effects. We report a case in which methotrexate proved to be effective. CASE REPORT A 6-year-old girl presented with Takayasu's disease with elevated blood pressure of renovascular origin. Corticosteroids controlled the inflammatory syndrome but not the renal involvement and stopped the growth. Methotrexate (10 mg/m2/week) resulted in the control of the disease, the reduction of steroids and normal growth. CONCLUSION In Takayasu's disease, steroids should be given as first-line therapy. In case of failure, side effects or steroid dependency, small doses of methotrexate may facilitate the disease's control and weaning from the steroids.
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Affiliation(s)
- L Besson-Léaud
- Département de pédiatrie médicale, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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Masković J, Janković S, Lusić I, Cambj-Sapunar L, Mimica Z, Bacić A. Subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent. Eur J Radiol 1999; 31:193-6. [PMID: 10566520 DOI: 10.1016/s0720-048x(98)00160-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.
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Affiliation(s)
- J Masković
- Department of Radiology, Clinical Hospital Split, Croatia
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Sharma S, Bahl VK, Saxena A, Kothari SS, Talwar KK, Rajani M. Stenosis in the aorta caused by non-specific aortitis: results of treatment by percutaneous stent placement. Clin Radiol 1999; 54:46-50. [PMID: 9915510 DOI: 10.1016/s0009-9260(99)91239-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To evaluate the short-term results of percutaneous stent placement in treating stenosis in the aorta caused by non-specific aortitis (Takayasu's disease). METHOD Five patients were treated by this method, all of whom had uncontrolled hypertension, haemodynamically significant stenosis in the aorta and a clinically inactive disease. Stents were placed to treat an obstructing dissection in four and recurrent stenosis in one patient. All procedures were carried out via the percutaneous transfemoral route, utilizing self-expanding stents. RESULTS The lesion was located in the thoracic aorta in three patients and in the abdominal aorta in two patients. The stenosis decreased from 81+/-2 to 7+/-3%, the pressure gradient fell from 97+/-5 to 9+/-2 mmHg, the blood pressure improved from 200+/-3/124+/-2 to 131+/-2/81+/-2 mmHg, and the drug requirement fell from 4+/-.2 to 1.3+/-.3 (P value for all <0.001). No complication was encountered. At follow-up at 13+/-4 months, all of the patients had improved clinically. Intimal hyperplasia within the stent was seen in two patients who underwent follow-up angiograms. CONCLUSION Percutaneous aortic stenting is useful in treating selected patients with non-specific aortitis. Further information about the long-term behaviour of intimal hyperplasia and the response of stented segments to the aging process needs to be understood before elective stenting in this young patient population can be advocated.
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Affiliation(s)
- S Sharma
- Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi
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Murakami R, Korogi Y, Matsuno Y, Matsukawa T, Hirai T, Takahashi M. Percutaneous transluminal angioplasty for carotid artery stenosis in Takayasu arteritis: persistent benefit over 10 years. Cardiovasc Intervent Radiol 1997; 20:219-21. [PMID: 9134848 DOI: 10.1007/s002709900141] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 66-year-old man was admitted to our hospital with right hemiplegia due to a cerebral infarction associated with Takayasu arteries. We successfully performed percutaneous transluminal angioplasty for stenoses of the innominate and right common carotid arteries. Improvement of the stenotic lesions persisted over 10 years.
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Affiliation(s)
- R Murakami
- Department of Radiology, Kumamoto University School of Medicine, Japan
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Joseph G, Krishnaswami S, Baruah DK, Kuruttukulam SV, Abraham OC. Transseptal approach to aortography and carotid artery stenting in pulseless disease. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 40:416-20; discussion 421. [PMID: 9096949 DOI: 10.1002/(sici)1097-0304(199704)40:4<416::aid-ccd23>3.0.co;2-j] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report on a patient with pulseless disease (Takayasu's arteritis) in whom access to the central circulation by extremity arterial cannulation was not possible due to absent pulses in all four limbs. The transseptal approach was used for aortography, bilateral selective carotid angiography, and successful elective stent deployment in the right common carotid artery.
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Affiliation(s)
- G Joseph
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
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Mitty HA, Shapiro RS, Parsons RB, Silberzweig JE. RENOVASCULAR HYPERTENSION. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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