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Adams TN, Zhang D, Batra K, Fitzgerald JE. Pulmonary manifestations of large, medium, and variable vessel vasculitis. Respir Med 2018; 145:182-191. [PMID: 30509707 DOI: 10.1016/j.rmed.2018.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/14/2018] [Accepted: 11/06/2018] [Indexed: 02/01/2023]
Abstract
The hallmark of vasculitis is autoimmune inflammation of blood vessels and surrounding tissues, resulting in an array of constitutional symptoms and organ damage. The lung is commonly targeted in the more familiar ANCA-associated small vessel vasculitidies, but large and medium vessel vasculitides, including Takayasu arteritis, giant cell arteritis, polyarteritis nodosa, Behcet's disease, and necrotizing sarcoid granulomatosis, may also feature prominent pulmonary involvement. Pulmonary manifestations of these conditions include pulmonary arterial aneurysms, pulmonary hypertension, diffuse alveolar hemorrhage, pulmonary nodules, and parenchymal infiltrates. An understanding of the diverse manifestations of vasculitis and a high index of clinical suspicion are essential to avoid delays in disease recognition that may result in permanent or life threatening morbidity. In this review, we outline the general clinical manifestations, pulmonary manifestations, diagnostic workup, imaging findings, and treatment of medium, large, and variable vessel vasculitides.
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Affiliation(s)
- Traci N Adams
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States.
| | - Da Zhang
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States
| | - Kiran Batra
- University of Texas Southwestern Medical Center, Department of Radiology, United States
| | - John E Fitzgerald
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States
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2
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Batra K, Chamarthy M, Chate RC, Jordan K, Kay FU. Pulmonary vasculitis: diagnosis and endovascular therapy. Cardiovasc Diagn Ther 2018; 8:297-315. [PMID: 30057877 DOI: 10.21037/cdt.2017.12.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Pulmonary vasculitides are caused by a heterogeneous group of diseases with different clinical features and etiologies. Radiologic manifestations depend on the predominant type of vessel involved, which are grouped into large, medium, or small-sized vessels. Diagnosing pulmonary vasculitides is a challenging task, and radiologists play an important role in their management by providing supportive evidence for diagnosis and opportunities for minimally invasive therapy. This paper aims to present a practical approach for understanding the vasculitides that can affect the pulmonary vessels and lungs. We will describe and illustrate the main radiologic findings, discussing opportunities for minimally invasive treatment.
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Affiliation(s)
- Kiran Batra
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Rodrigo Caruso Chate
- Hospital Israelita Albert Einstein and Instituto to Coração HCFMUSP, Sao Paulo, Brazil
| | - Kirk Jordan
- UT Southwestern Medical Center, Dallas, TX, USA
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3
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Gülcü A, Gezer NS, Akar S, Akkoç N, Önen F, Göktay AY. Long-Term Follow-Up of Endovascular Repair in the Management of Arterial Stenosis Caused by Takayasu's Arteritis. Ann Vasc Surg 2017; 42:93-100. [DOI: 10.1016/j.avsg.2016.10.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/10/2016] [Accepted: 10/22/2016] [Indexed: 11/24/2022]
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4
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Bannas P, François CJ, Reeder SB. Magnetic Resonance Angiography of the Upper Extremity. Magn Reson Imaging Clin N Am 2016. [PMID: 26216777 DOI: 10.1016/j.mric.2015.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The magnetic resonance angiography (MRA) toolbox includes a wide array of versatile methods for diagnosis and therapy planning in patients with a variety of upper extremity vascular pathologies. MRA can provide excellent image quality with high spatial and high temporal resolution without the disadvantages of ionizing radiation, iodinated contrast, and operator dependency. Contrast-enhanced techniques are preferred for their robustness, image quality, and shorter scan times. This article provides an overview of the available MRA techniques and a description of the clinical entities that are well suited for evaluation with contrast-enhanced MRA.
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Affiliation(s)
- Peter Bannas
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Radiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
| | - Christopher J François
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA; Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705-2275, USA; Department of Medicine, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705-2281, USA; Department of Emergency Medicine, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
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5
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Nagpal P, Maller V, Garg G, Hedgire S, Khandelwal A, Kalva S, Steigner ML, Saboo SS. Upper Extremity Runoff: Pearls and Pitfalls in Computed Tomography Angiography and Magnetic Resonance Angiography. Curr Probl Diagn Radiol 2016; 46:115-129. [PMID: 26949062 DOI: 10.1067/j.cpradiol.2016.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Abstract
Upper extremity vasculature can be affected by various traumatic and nontraumatic pathologies; however, the evaluation of these arteries can be challenging for the radiologists as well as for the clinicians. After an accurate history and clinical examination, imaging plays a vital role in the diagnosis and treatment planning of these patients. Depending on the urgency and the indication, upper extremity arteries may be evaluated by ultrasonography with color Doppler, computed tomography (CT), magnetic resonance imaging (MRI), or digital subtraction angiography. This review article discusses relevant imaging anatomy of the upper extremity arteries, presents CT and MRI protocols, briefly describes the state-of-the-art CT and MRI of various pathologies affecting the upper extremity arteries, and summarizes the important pearls needed for busy practicing radiologist.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
| | - Vinod Maller
- Division of Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Gunjan Garg
- Department of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ashish Khandelwal
- Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Sanjeeva Kalva
- Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Michael L Steigner
- Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Sachin S Saboo
- Division of Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, Dallas, TX
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6
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Mandal SK, Gupta N, Goel R, Nair A, Arya S, Ganapati A, Mathew AJ, Joseph G, Nindugala Keshava S, Danda D. Imaging in Takayasu arteritis. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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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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8
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Seyahi E, Ucgul A, Cebi Olgun D, Ugurlu S, Akman C, Tutar O, Yurdakul S, Yazici H. Aortic and coronary calcifications in Takayasu arteritis. Semin Arthritis Rheum 2013; 43:96-104. [DOI: 10.1016/j.semarthrit.2012.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
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9
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Mohite PN, Kotkar KD, Popov AF, Thingnam SK. Tunneling technique for anatomical positioning of aortoaxillary bypass graft. Asian Cardiovasc Thorac Ann 2012; 20:93-4. [PMID: 22371958 DOI: 10.1177/0218492311430357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A technique for anatomical positioning of a synthetic aortoaxillary bypass tube graft is described. A tunnel is created with the help of a Roberts clamp and intercostal tube drain. There is no need to open the pleura because the graft is tunneled parallel to the subclavian vessels outside the chest cavity.
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Affiliation(s)
- Prashant N Mohite
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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10
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Saadoun D, Lambert M, Mirault T, Resche-Rigon M, Koskas F, Cluzel P, Mignot C, Schoindre Y, Chiche L, Hatron PY, Emmerich J, Cacoub P. Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis. Circulation 2012; 125:813-9. [PMID: 22230484 DOI: 10.1161/circulationaha.111.058032] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascular complications after surgery or endovascular treatment is still to be determined.
Methods and Results—
This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25–50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2–11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication–free survival rates were 78% (IQR, 69%–88%), 67% (IQR, 57%–78%), 56% (IQR, 46%–70%), and 45% (IQR, 34%–60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42–39.39;
P
=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (
P
<0.001) and C-reactive protein (
P
<0.001) and fibrinogen (
P
<0.005) serum levels compared with those without complications.
Conclusions—
The overall 5-year arterial complication rate was 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with Takayasu arteritis.
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Affiliation(s)
- David Saadoun
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Marc Lambert
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Tristan Mirault
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Mathieu Resche-Rigon
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Fabien Koskas
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Philippe Cluzel
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Cécile Mignot
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Yoland Schoindre
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Laurent Chiche
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Pierre-Yves Hatron
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Joseph Emmerich
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Patrice Cacoub
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
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11
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Villa-Forte A, Mandell BF. [Cardiovascular disorders and rheumatic disease]. Rev Esp Cardiol 2011; 64:809-17. [PMID: 21763053 DOI: 10.1016/j.recesp.2011.05.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 05/25/2011] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease is a common and under-recognized problem in patients with systemic rheumatic conditions. Patients may present with disease associated heart involvement at the time of diagnosis or later in the course of the illness. The manifestations vary by disease, and all structures in the heart can be affected and may result in significant morbidity and mortality. Manifestations of cardiac disease in these patients range from subclinical to severe and may require aggressive immunosuppressive therapy. Early recognition is important for prompt institution of appropriate therapy. Treatment of disease associated cardiac involvement is based on severity of disease with more severe manifestations often requiring a combination of corticosteroid and cytotoxic agent. Premature atherosclerosis has been increasingly recognized in patients with systemic lupus erythematosus and rheumatoid arthritis and may result in premature coronary death when compared to the general population. Aggressive control of systemic inflammation in these diseases may result in a reduction in the risk of ischemic heart disease. Although aggressive treatment of the primary rheumatic disease has been associated with an improvement in mortality rates, specific guidelines for prevention of ischemic heart disease in this group of patients have not been formulated and recommendations at this time include aggressive control and monitoring of traditional risk factors.
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Affiliation(s)
- Alexandra Villa-Forte
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
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Kim HJ, Lee CS, Kim JS, Know SU, Kim JL, Park JW, Hyun DH, Suh DC. Outcomes after endovascular treatment of symptomatic patients with Takayasu's arteritis. Interv Neuroradiol 2011; 17:252-60. [PMID: 21696668 DOI: 10.1177/159101991101700219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 10/29/2010] [Indexed: 11/16/2022] Open
Abstract
We report our experience with endovascular treatment of supra-aortic arteries and follow-up results in patients with Takayasu's arteritis (TA) presenting with neurological symptoms. Of the 20 patients with TA who underwent cerebral angiography for neurological manifestations between May 2002 and May 2009, 12 (11 females, one male; mean age, 39 years; range 31-56 years) underwent endovascular treatment and evaluated outcome for 21 lesions, including nine common carotid arteries, four vertebral arteries, four subclavian arteries, two internal carotid arteries, and one brachiocephalic artery. Eight patients underwent multiple endovascular procedures for different lesions in single or multiple stages. Mean angiographic and clinical follow-up durations were 34 months (range, 11-79 months) and 39 months (range 11-91 months), respectively. Technical success was achieved for 20 procedures in 11 patients. One procedure failed, with 50% residual stenosis after stenting due to dense calcification of vessel walls. There were no procedure-related complications. Restenosis occurred at two lesions in two patients were treated by re-stenting. Asymptomatic occlusion occurred at two lesions in one patient. Ten patients remained in 0-1 on the modified Rankin scale (mRs) during mean 39 months. One patient, however, had a score of 3 on mRs due to a traumatic contusion during follow-up. One patient died from cardiac failure 36 months after successful angioplasty.Our data suggest that endovascular treatment of symptomatic supra-aortic lesions of TA is effective and durable in selected patients with neurologic symptoms.
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Affiliation(s)
- H J Kim
- Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul
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13
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Lee HK, Namgung J, Choi WH, Choe H, Kwon SU, Doh JH, Lee SY, Lee WR. Stenting of the Left Main Coronary Artery in a Patient With Takayasu's Arteritis. Korean Circ J 2011; 41:34-7. [PMID: 21359067 PMCID: PMC3040401 DOI: 10.4070/kcj.2011.41.1.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 03/15/2010] [Accepted: 05/24/2010] [Indexed: 11/11/2022] Open
Abstract
Management of Takayasu's arteritis of the left main coronary artery (LMCA) is difficult because of the possibility of restenosis. Clinically significant stenotic lesions must be considered anatomical correlation. Many studies have reported that the management of stenotic lesions of the LMCA with endoluminal stenting and balloon angioplasty and de-novo stenting is safe and effective for patients with Takayasu's arteritis. We report the case of a patient with Takayasu's arteritis of the LMCA. The patient had undergone two consecutive percutaneous coronary interventions because of recurrent restenosis of in-stent lesions, and eventually underwent coronary artery bypass graft (CABG) surgery for myocardial infarction in the same lesion. We suggested treatment with CABG because the pathophysiology of Takayasu's arteritis is different from that of atherosclerotic stenosis.
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Affiliation(s)
- Hyo Keun Lee
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University, Ilsan Paik Hospital, Goyang, Korea
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14
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Khandelwal N, Kalra N, Garg MK, Kang M, Lal A, Jain S, Suri S. Multidetector CT angiography in Takayasu arteritis. Eur J Radiol 2009; 77:369-74. [PMID: 19720487 DOI: 10.1016/j.ejrad.2009.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 08/02/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyse the spectrum of Takayasu's arteritis (TA) on multidetector CT angiography (MDCTA). MATERIALS AND METHODS A retrospective analysis of the MDCTA findings was performed on 15 patients clinically diagnosed as Takayasu's arteritis. The spectrum and incidence of imaging findings on CTA were compared to studies in literature on catheter angiography in Takayasu's arteritis. Laboratory parameters were available in nine patients. The disease was considered active if erythrocyte sedimentation rate (ESR) levels were elevated and 'C' reactive protein (CRP) was positive. An attempt was made to correlate disease activity with the imaging findings. RESULTS Ascending aorta, arch of aorta and descending thoracic aorta were involved in 14 out of 15 (93%) patients. The wall thickness varied between 1 and 10mm with maximal involvement in arch and descending thoracic aorta. Major neck vessels were involved in 11 (73%) patients with most pronounced changes seen in the brachiocephalic trunk, left common carotid artery (CCA) and left subclavian artery (SCA). Abdominal aorta and its branches were involved in all the 11 (100%) patients in whom abdominal CTA was performed. Celiac axis and SMA were involved in 10 (91%) and seven (64%) patients, respectively while renal artery stenosis was present in five (45%) patients. In six patients, ESR was elevated and CRP was positive indicating active disease. All patients in whom the laboratory parameters were available showed mural thickening in the aorta and at least one of the neck vessels except for one patient with inactive disease who had aortic mural thickening only. CONCLUSION MDCTA provides information about both the vessel wall and lumen in patients with Takayasu's disease.
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Affiliation(s)
- Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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15
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Ogino H, Matsuda H, Minatoya K, Sasaki H, Tanaka H, Matsumura Y, Ishibashi-Ueda H, Kobayashi J, Yagihara T, Kitamura S. Overview of Late Outcome of Medical and Surgical Treatment for Takayasu Arteritis. Circulation 2008; 118:2738-47. [PMID: 19106398 DOI: 10.1161/circulationaha.107.759589] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hitoshi Ogino
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Kenji Minatoya
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hiroaki Sasaki
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hiroshi Tanaka
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Yu Matsumura
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hatsue Ishibashi-Ueda
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Toshikatsu Yagihara
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Soichiro Kitamura
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
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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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17
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Kim SY, Park JH, Chung JW, Kim HC, Lee W, So YH, Jae HJ. Follow-up CT evaluation of the mural changes in active Takayasu arteritis. Korean J Radiol 2007; 8:286-94. [PMID: 17673839 PMCID: PMC2627167 DOI: 10.3348/kjr.2007.8.4.286] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to evaluate the mural changes by CT on the follow-up examination of patients with active Takayasu arteritis. Materials and Methods The study included 18 patients, (4 males and 14 females), with active Takayasu arteritis. A total of 44 CT examinations were done during the follow-up period (mean: 55.6 months). At the time of the last follow-up CT, the disease, on the basis of the erythrocyte sedimentation rate (ESR), was found to be inactive in five patients and the disease was active and persistent in 13 patients. The thickness and CT attenuation of the aortic wall on the precontrast, arterial and venous phases were measured on the initial and the follow-up CT examinations. The ratio of the mural attenuation over that of the back muscle on the initial CT was compared with the ratio found on the follow-up CT. Results The initial CT findings included high density and calcifications of the aortic wall in the precontrast images and a thickened wall with enhancements in the arterial and the venous phases. A low-attenuation ring was demonstrated in the venous phase in 15 patients (83%). On the follow-up evaluation, the mean mural thickness decreased significantly from 4.1 mm to 2.4 mm. The mean mural attenuation ratio in the venous phase decreased significantly from 1.9 to 1.3 (p = 0.001). The low attenuation ring was identified in seven patients (39%) who had only with active, persistent Takayasu arteritis. Conclusion The mural changes demonstrated by the follow-up CT evaluations for the patients with active Takayasu arteritis included a decrease of the mural thickness and enhancement, disappearance of the low-attenuation ring on the venous phase, and an increase of the mural attenuation and calcification on the precontrast phase.
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Affiliation(s)
- Sang Young Kim
- Department of Radiology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
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18
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Stepansky F, Hecht EM, Rivera R, Hirsh LE, Taouli B, Kaur M, Lee VS. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics 2007; 28:e28. [PMID: 17967936 DOI: 10.1148/radiol.e28] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Unlike peripheral lower extremity vascular disease, upper extremity vascular disease is relatively uncommon. While atherosclerosis and embolic disease are the most common causes of upper extremity ischemia, a wide variety of systemic diseases and anatomic abnormalities can affect the upper extremity. Upper extremity ischemia poses a significant diagnostic and therapeutic challenge for both clinicians and radiologists. Although history and physical examination remain the mainstays of diagnosis, imaging can be vital in confirming suspected disease and guiding treatment planning. Digital subtraction angiography is often the preferred method for detection of upper extremity vascular disease, particularly for characterization of complex arteriovenous anatomy such as in vascular malformations and for evaluation of dialysis fistulas and grafts. However, this modality is invasive, requires iodinated contrast agents and radiation, and may fail to demonstrate significant extraluminal disease. More recently, magnetic resonance (MR) angiography techniques have made important advances, permitting higher temporal and spatial resolution that is preferable for diagnosing upper extremity vascular disorders. In this review, the authors present an overview of upper extremity MR angiography techniques and protocols, revisit the often variable vascular anatomy of the arm and hand, and offer examples of various pathologic entities diagnosed with MR angiography. Finally, several imaging pitfalls that one must be aware of for accurate diagnosis are illustrated and reviewed.
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Affiliation(s)
- Flora Stepansky
- Department of Radiology, 560 First Avenue, TCH-HW-202, New York University Medical Center, New York, NY 10016, USA
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19
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Chung JW, Kim HC, Choi YH, Kim SJ, Lee W, Park JH. Patterns of aortic involvement in Takayasu arteritis and its clinical implications: Evaluation with spiral computed tomography angiography. J Vasc Surg 2007; 45:906-14. [PMID: 17466787 DOI: 10.1016/j.jvs.2007.01.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 01/05/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Although the luminal changes of Takayasu arteritis are well depicted with conventional angiography, its mural changes can be best evaluated with spiral computed tomography (CT) angiography. Here, the authors investigated the patterns of aortic involvement in Takayasu arteritis by using CT angiography. METHODS CT angiography was performed from the carotid bifurcation to the iliac bifurcation in a consecutive 85 patients (M:F = 10:75, mean age: 37 years) with Takayasu arteritis. Two radiologists interpreted axial images and three-dimensional reconstructed images by consensus with respect to disease extent, lesion continuity, and disease activity based on mural and luminal changes on CT angiography. RESULTS Eighty-one (95%) patients had aortic involvement with or without aortic branch involvement, and the other four (5%) patients had only aortic branch involvement. In terms of aortic branches, the left common carotid artery (77%) and the left subclavian artery (76%) were most commonly involved. Extent of disease involvement assessed by mural change was wider than that assessed by luminal change in 52 (61%) patients. Although arterial involvement was contiguous in 69 (81%) patients, skipped lesions were identified in 16 (19%) patients. An analysis of mural findings revealed the coexistence of active and inactive lesions in nine (11%) patients. CONCLUSIONS Aortic involvement in Takayasu arteritis can occur from the aortic root to below the iliac bifurcation, and isolated branch vessel involvement is also possible. In most patients, aortic involvement occurs in a contiguous, synchronous fashion. However, skipped involvement and the coexistence of active and inactive lesions also occur.
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Affiliation(s)
- Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Seoul, South Korea.
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20
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Dubel GJ, Soares GM. Interventional management of renal vascular origin hematuria. Semin Intervent Radiol 2007; 24:124-9. [PMID: 21326751 DOI: 10.1055/s-2007-971201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several renal vascular pathological processes have been associated with hematuria. These include renal artery aneurysm (RAA), fibromuscular dysplasia (FMD), renal nutcracker syndrome (RNS), renal arteriovenous malformation, renal vasculitis, and renal artery or vein thrombosis. We present an unusual case of hematuria in a patient eventually diagnosed with RAA, FMD, and RNS. Percutaneous therapy, including endovascular coiling, percutaneous transluminal angioplasty, and stent placement were used to address the underlying pathology. The differential diagnosis, pathophysiology, and surgical and interventional management of these renal vascular disorders are reviewed.
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Affiliation(s)
- Gregory J Dubel
- Department of Diagnostic Imaging, Brown University Medical School, Providence, Rhode Island
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21
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Seyahi E, Ugurlu S, Cumali R, Balci H, Seyahi N, Yurdakul S, Yazici H. Atherosclerosis in Takayasu arteritis. Ann Rheum Dis 2006; 65:1202-7. [PMID: 16439439 PMCID: PMC1798281 DOI: 10.1136/ard.2005.047498] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis are associated with accelerated atherosclerosis. We hypothesised that atherosclerosis may also be increased in Takayasu arteritis. METHODS The frequency of atherosclerotic plaques and the intima-media thickness (IMT) were investigated in 30 female patients with Takayasu arteritis (mean age (standard deviation), 35.4 (8.0) years), along with 45 sex-matched and age-matched patients with SLE (37.4 (6.8)) and 50 healthy controls (38.2 (5.7)). Plaques were scanned and IMT was measured at both sides of the common carotids, carotid bulb, and internal and external carotid arteries by B-mode ultrasonography. Traditional risk factors for atherosclerosis were also assessed. RESULTS Most of the atherosclerotic risk factors were comparable between patients with Takayasu arteritis and SLE. More atherosclerotic plaques were observed among patients with Takayasu arteritis (8/30; 27%) and those with SLE (8/45; 18%) than among the healthy controls (1/50; 2%; p = 0.005). Logistic regression analyses showed that the presence of a plaque was associated only with age in both Takayasu arteritis and SLE (p = 0.04 and 0.02, respectively). The mean overall IMT was significantly higher among patients with Takayasu arteritis (0.95+/-0.31 mm) than among the patients with SLE (0.58+/-0.10 mm) and the healthy controls (0.59+/-0.08 mm; p<0.001). CONCLUSION Patients with Takayasu arteritis have a high rate of atherosclerotic plaques, at least as frequent as that observed among patients with SLE.
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Affiliation(s)
- E Seyahi
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, Istanbul University, Aksaray Istanbul, Turkey
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22
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Kalangos A, Christenson JT, Cikirikcioglu M, Vala D, Buerge A, Simonet F, Didier D, Beghetti M, Jaeggi E. Long-term outcome after surgical intervention and interventional procedures for the management of Takayasu’s arteritis in children. J Thorac Cardiovasc Surg 2006; 132:656-64. [PMID: 16935123 DOI: 10.1016/j.jtcvs.2006.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 03/27/2006] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE There is little information available on the results of reconstructive arterial surgery for Takayasu's arteritis in children. This study evaluates midterm to long-term outcome after surgical, as well as interventional, procedures. METHODS From 1984 through 2004, 10 children (5 boys and 5 girls; age, 12.7 +/- 2.6 years) with Takayasu's arteritis were referred to our center. Baseline cardiovascular assessment included contrast angiography (n = 4), magnetic resonance imaging-angiography (n = 3), and combined contrast angiography plus magnetic resonance imaging-angiography (n = 3). Two patients had disease confined to the thoracic aorta, 4 had disease confined to the abdominal aorta, and 4 had combined thoracoabdominal aortic disease. Steno-occlusive lesions were predominant in 92% of cases. Seven patients were maintained on steroid therapy throughout the follow-up period. Eight children underwent complex surgical procedures, 1 patient had balloon dilatation of the renal and mesenteric arteries, and 1 patient had combined vascular surgery with percutaneous transluminal angioplasty. Overall, 24 grafts (polytetrafluoroethylene, Dacron grafts, and cryopreserved homografts) were implanted in various locations. RESULTS There were no perioperative deaths. Arterial hypertension regressed in all patients, and cardiac function normalized in all 4 patients with dilative cardiomyopathy. Over a 20-year period, 1 patient presented with sudden death and 2 showed nonfatal disease progression, one of whom required surgical reintervention. The occlusion rate was higher in Dacron grafts. CONCLUSIONS Our study shows that despite the extent and severity of vascular lesions, children with Takayasu's arteritis could benefit from reconstructive surgery, with low mortality, morbidity, and satisfactory long-term results.
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Affiliation(s)
- Afksendiyos Kalangos
- Clinic for Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland.
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23
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Abstract
Takayasu's arteritis is a rare, idiopathic, chronic inflammatory disease with cell-mediated inflammation, involving mainly the aorta and its major branches. It leads to stenosis, occlusion or aneurysmal degeneration of large arteries. The clinical presentation is characterised by an acute phase with constitutional symptoms, followed, months or years later, by a chronic phase in which symptoms relate to fibrosis or occlusion of vessels. Angiography is the gold standard for diagnosis and for topographical classification and it correlates with symptoms and prognosis. Here we focus on the pathophysiology, clinical and angiographical classification, diagnostic assessment and therapeutic approach of Takayasu's arteritis.
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Affiliation(s)
- Silvia Maffei
- Division of Medicine III, Department of Clinical Medicine and Immunological Medicine, University of Siena, Siena, Italy
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24
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What Is YOUR Diagnosis? Ultrasound Q 2005. [DOI: 10.1097/01.ruq.0000198680.08008.a2] [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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25
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Gotway MB, Araoz PA, Macedo TA, Stanson AW, Higgins CB, Ring EJ, Dawn SK, Webb WR, Leung JWT, Reddy GP. Imaging findings in Takayasu's arteritis. AJR Am J Roentgenol 2005; 184:1945-50. [PMID: 15908559 DOI: 10.2214/ajr.184.6.01841945] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the clinical usefulness of cross-sectional imaging for establishing the diagnosis of Takayasu's arteritis (TA), an inflammatory vascular disorder that produces arterial stenoses and aneurysms primarily involving the thoracoabdominal aorta and its branches and the pulmonary arteries. CONCLUSION CT and MRI findings of TA include vascular wall thickening and enhancement early in the disease, and arterial stenoses, occlusions, and aneurysms later in the disease. Cross-sectional imaging is useful for establishing the diagnosis of TA and for showing response to nonsurgical therapy or for planning a surgical intervention.
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Affiliation(s)
- Michael B Gotway
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA
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26
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Desai MY, Stone JH, Foo TKF, Hellmann DB, Lima JAC, Bluemke DA. Delayed Contrast-Enhanced MRI of the Aortic Wall in Takayasu's Arteritis: Initial Experience. AJR Am J Roentgenol 2005; 184:1427-31. [PMID: 15855090 DOI: 10.2214/ajr.184.5.01841427] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Delayed contrast-enhanced MRI is increasingly being used for cardiac viability imaging. Takayasu's arteritis is a rare inflammatory disorder of unknown cause that affects the aorta, its major branches, and the pulmonary artery; it is characterized by inflammation and fibrosis in the arterial wall. We report our initial experience with seven patients (six women, one man; age range, 25-62 years) with delayed (20 min) gadolinium-enhanced MRI (inversion recovery prepared gated fast gradient-echo pulse sequence) in patients with known Takayasu's arteritis. CONCLUSION Patients with Takayasu's arteritis (particularly those with abnormal laboratory values) have evidence of delayed hyper-enhancement on delayed contrast-enhanced MRI. Thus, delayed contrast-enhanced MRI might be a useful technique to identify inflammation in arterial wall.
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Affiliation(s)
- Milind Y Desai
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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27
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Abstract
The primary systemic vasculitides are a rare group of inflammatory disorders, where damage is directed against the blood vessels. They range in severity from acute self-limiting illness to chronic life and organ threatening diseases requiring long-term treatment with toxic immunosuppressive regimes. None of them have specific tests and few have hard diagnostic criteria. This review summarises the gastrointestinal features of these diseases, along with their general clinical and epidemiological features and the evidence available to guide in their management.
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Affiliation(s)
- Matthew D Morgan
- Department of Renal Immunobiology, The Medical School, Vincent Drive, Edgbaston, Birmingham B15 2TT, UK.
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28
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Abstract
Takayasu's arteritis (TA) is a chronic inflammatory disease of unknown etiology that can produce stenosis, occlusion, or aneurysmal degeneration of large arteries. TA occurs worldwide but disproportionately affects young females of Asian descent. A variable acute phase of largely constitutional symptoms is followed by a chronic phase in which symptoms related to arterial compromise predominate. Diagnosis is made using a combination of clinical and angiographic criteria. Initial therapy involves the use of corticosteroids to induce remission of acute phase activity, with the addition of cytotoxic medications for nonresponders. Angioplasty and stenting can be used in the treatment of shorter stenoses such as those encountered in the renal arteries. Surgical bypass is the preferred treatment of longer segment stenoses and occlusions. Bypass grafts should originate from unaffected arteries to ensure durable inflow. Endovascular therapy is effective initially but long-term durability data are lacking.
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Affiliation(s)
- Jose R Parra
- Division of Vascular Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
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29
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Abstract
Takayasu arteritis is a chronic vasculitis involving the aorta and its main branches, the pulmonary arteries, and the coronary tree, and needs to be considered in a young patient with angina, in particular when pulses are absent. This case illustrates the limitations of exercise testing in diagnosing the extent of coronary artery disease and the risks associated with coronary angiography in patients with inflammatory disease in the left main stem coronary artery. It also highlights the novel use of non-invasive scanning with positron emission tomography using 18-fluorodeoxyglucose in assessing remission from this disease. Revascularisation was performed with percutaneous transluminal coronary angioplasty and stenting as an emergency procedure, but treatment of the restenosis with directional atherectomy was based on a review of the available literature. The lymphocytic alveolitis seen in this patient has not been previously described in Takayasu's disease.
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Affiliation(s)
- I S Malik
- Waller Department of Cardiology, St Mary's Hospital, London, UK.
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30
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Rothman A, Levy DJ, Sklansky MS, Grossfeld PD, Auger WR, Ajami GH, Behling CA. Balloon angioplasty and stenting of multiple intralobar pulmonary arterial stenoses in adult patients. Catheter Cardiovasc Interv 2003; 58:252-60. [PMID: 12552552 DOI: 10.1002/ccd.10407] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Balloon angioplasty and stent placement for pulmonary arterial stenoses in children are well-established therapies. In contrast, management of isolated peripheral pulmonary arterial stenoses in adults remains relatively unexplored. Four women (ages 18-63 years) with multiple discrete intralobar pulmonary arterial stenoses were treated with balloon angioplasty. Initially, 4-5 stenoses were dilated in each patient. The mean minimum diameter of the stenoses increased from 1.3 to 3.1 mm (P < 0.001), and the mean ratio of right ventricular to aortic systolic pressure decreased from 0.92 to 0.62 (P < 0.05). Each patient had marked symptomatic improvement. However, three patients developed recurrence of symptoms 4-24 months after angioplasty, and two had angiographic evidence of restenosis at previously dilated sites. These restenoses were treated with repeat angioplasty or stent implantation (three stents in each patient). One of these two patients developed near-occlusive restenosis of the stents and had successful bilateral lung transplantation. The other patient had a third catheterization with successful implantation of three additional stents. The third patient with recurrent symptoms died 2 years later, without further intervention. Transcutaneous catheter therapy for multiple intralobar pulmonary arterial stenoses in adults is highly successful acutely, but restenosis is common within several months. For some patients, balloon angioplasty and stent implantation may provide definitive management, while for others these procedures may serve as a bridge to lung transplantation.
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Affiliation(s)
- Abraham Rothman
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Diego, California, USA.
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Rigby WFC, Fan CM, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 39-2002--a 35-year-old man with headache, deviation of the tongue, and unusual radiographic abnormalities. N Engl J Med 2002; 347:2057-65. [PMID: 12490688 DOI: 10.1056/nejmcpc020021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Yoshida S, Akiba H, Tamakawa M, Yama N, Takeda M, Hareyama M, Nakata T, Shimamoto K. The spectrum of findings in supra-aortic Takayasu's arteritis as seen on spiral CT angiography and digital subtraction angiography. Cardiovasc Intervent Radiol 2001; 24:117-21. [PMID: 11443398 DOI: 10.1007/s002700000368] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Yoshida
- Department of Radiology, Sapporo Medical University, School of Medicine, South-1, West-16, Chuo-ku, Sapporo 060-8543, Japan.
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Stegeman CA, Kallenberg CG. Clinical aspects of primary vasculitis. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 2001; 23:231-51. [PMID: 11591100 DOI: 10.1007/s002810100079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C A Stegeman
- Department of Internal Medicine/Division of Nephrology, University Hospital Groningen, Faculty of Medical Sciences, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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Yamada I, Nakagawa T, Himeno Y, Kobayashi Y, Numano F, Shibuya H. Takayasu arteritis: diagnosis with breath-hold contrast-enhanced three-dimensional MR angiography. J Magn Reson Imaging 2000; 11:481-7. [PMID: 10813857 DOI: 10.1002/(sici)1522-2586(200005)11:5<481::aid-jmri3>3.0.co;2-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of the study was to determine the diagnostic accuracy of breath-hold contrast-enhanced three-dimensional (3D) magnetic resonance (MR) angiography in Takayasu arteritis. Thirty patients suspected of having Takayasu arteritis were examined with MR angiography and conventional angiography. Takayasu arteritis was diagnosed in 20 of these patients. MR angiography was performed using a 1.5-T system after bolus injection of 0.1 mmol/kg of gadodiamide. MR angiography clearly depicted various vascular lesions in the aorta and its major branches in all 20 patients with Takayasu arteritis. It also depicted pulmonary artery lesions in 10 (50%) of the 20 patients. MR angiography accurately depicted 323 (98%) of 330 arteries, but 7 (2%) stenotic arteries were overestimated as occluded. The sensitivity and specificity of MR angiography for the diagnosis of Takayasu arteritis were both 100%. Breath-hold contrast-enhanced 3D MR angiography clearly depicts various vascular lesions in both the systemic and pulmonary arteries in Takayasu arteritis, thus allowing a definitive diagnosis of Takayasu arteritis.
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Affiliation(s)
- I Yamada
- Department of Radiology, Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
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Tyagi S, Kaul UA, Arora R. Endovascular stenting for unsuccessful angioplasty of the aorta in aortoarteritis. Cardiovasc Intervent Radiol 1999; 22:452-6. [PMID: 10556402 DOI: 10.1007/s002709900431] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The efficacy and safety of endovascular stent implantation to correct dissection or a suboptimal result after percutaneous transluminal angioplasty (PTA) was evaluated in patients suffering from aortic stenosis due to aortoarteritis. METHODS Twelve children and young adults [aged (mean +/- SD) 18.2 +/- 8.7 years] underwent stent implantation after PTA of the aorta, seven for obstructive dissection, four for ineffective balloon dilatation, and one for recurrent restenosis. Nine patients underwent implantation of self-expandable stents and three received balloon-expandable Palmaz stents. RESULTS Stent implantation could be successfully performed in all 12 patients. After stent implantation, the peak systolic pressure gradient decreased from 91 +/- 33.5 mmHg to 12.4 +/- 12.5 mmHg (p < 0.001). The diameter of the stenosed segment increased from 4.6 +/- 0.8 mm to 11.1 +/- 1.9 mm (p < 0.001). The dissection was completely covered in all seven patients with dissection. Except for epigastric pain with vomiting in one patient, there was no complication. On follow-up, over 12-57 months (mean 26.8 +/- 10.8 months), 11 patients (91.6%) had marked improvement in their blood pressure. Patients with congestive heart failure and claudication also showed improvement. Repeat catheterization in five patients, between 6-30 months (mean 16.8 +/- 9.1 months) after stent implantation, showed sustained improvement in four and a fusiform, long segment, intrastent restenosis after 30 months in one child. The stenosis was safely redilated. CONCLUSION Endovascular aortic stent implantation is safe and provides good immediate relief in patients with unsatisfactory results after balloon angioplasty. Improvement is sustained in most patients on intermediate-term follow-up.
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Affiliation(s)
- S Tyagi
- Department of Cardiology, G. B. Pant Hospital and Maulana Azad Medical College, New Delhi 110002, India
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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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Abstract
Conventional angiography has been used for diagnosis of Takayasu arteritis (TA). In early stage of TA, subtle inflammatory wall thickening of the aorta and its branches without significant stenosis may be the only morphologic change of TA. Magnetic resonance (MR) imaging appears to be useful in the diagnosis of early stage TA by visualizing concentric wall thickening of the vessels. T2-weighted images may show bright signal of edema in and around the inflamed vessel. Contrast media-enhanced MR shows enhanced wall of vessels even in chronic stage, which may indicate the activity of TA at the tissue level. MR angiography allows us noninvasive assessment of the vascular tree and it may replace conventional angiography.
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Affiliation(s)
- Y H Choe
- Cardiovascular Institute, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea
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Park JH, Chung JW, Lee KW, Park YB, Han MC. CT angiography of Takayasu arteritis: comparison with conventional angiography. J Vasc Interv Radiol 1997; 8:393-400. [PMID: 9152912 DOI: 10.1016/s1051-0443(97)70579-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare computed tomography (CT) angiography with conventional angiography in the evaluation of the extent of disease in the aorta and its major branches in patients with Takayasu arteritis. MATERIALS AND METHODS Both conventional (digital subtraction) and CT angiography were performed in 10 patients with Takayasu arteritis. The luminal abnormalities were assessed with both conventional angiography and maximum intensity projection (MIP) CT angiography. Transverse images from CT angiography also were used to assess mural changes, which were not assessed with conventional angiography. RESULTS Conventional angiography revealed 51 sites of luminal abnormalities. In five patients (50%), both conventional and MIP CT angiography depicted the same number of involved sites. At 36 of the 51 sites (71%), the estimation of luminal changes was the same for both modalities. In all patients, the transverse images provided additional mural findings in the aorta and its major branches. The integrated information provided by CT angiography, including MIP and transverse images, depicted more extensive disease than conventional angiography. CONCLUSION CT angiography including MIP and transverse images has advantages over conventional angiography in the evaluation of disease extent by providing additional mural information in Takayasu arteritis.
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Affiliation(s)
- J H Park
- Department of Radiology, Seoul National University College of Medicine, Korea
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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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Taniguchi N, Itoh K, Honda M, Obayashi T, Nakamura M, Kawai F, Irie T. Comparative ultrasonographic and angiographic study of carotid arterial lesions in Takayasu's arteritis. Angiology 1997; 48:9-20. [PMID: 8995338 DOI: 10.1177/000331979704800102] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the usefulness of ultrasonography to that of angiography for studying arterial lesions in Takayasu's arteritis. Ultrasonographic and angiographic findings from 44 carotid arteries of 22 patients with Takayasu's arteritis (2 men and 20 women; mean age, 41.2 years) were compared. Angiography was used to classify the patency of the carotid arteries into three groups: nonstenotic, stenotic, and occlusive. Ultrasonography was also used to classify the same arteries into four groups: nonstenotic, mildly stenotic, moderately stenotic, and occlusive. Thickness of the wall (intima-media complex) of the carotid artery was measured with high-frequency transducers. Angiography showed 23 carotid arteries to be nonstenotic; 12, stenotic; and 9, occlusive; whereas ultrasonography showed 16 to be nonstenotic; 18, mildly stenotic; 7, moderately stenotic; and 3, occlusive. Results of the two diagnostic modalities correlated closely (P < 0.0001). Ultrasonography, aided by color flow imaging, detected six instances of a marginal but definite blood flow that angiography had failed to reveal. Arterial wall thickness correlated closely with the severity of ultrasonographic stenosis (P < 0.005). This thickness was 1.3 +/- 0.4 mm in the nonstenotic group, 1.6 +/- 0.5 mm in the mildly stenotic group, 2.2 +/- 0.8 mm in the moderately stenotic group, and 1.9 +/- 0.2 mm in the occlusive group. Even the walls of the nonstenotic arteries were significantly thicker than those of the normal carotid arteries (0.7 +/- 0.1 mm, P < 0.01). Ultrasonography appeared to be more useful than angiography in estimating stenotic severity of the carotid artery in Takayasu's arteritis. Characteristic ultrasonic findings included luminal stenosis or occlusion on two-dimensional ultrasonograms, decrease in or lack of flow shown by color Doppler flow imaging, and concentric thickening of the carotid arterial walls. Ultrasonographic mural thickness was the most sensitive indicator of early, latent inflammation.
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Affiliation(s)
- N Taniguchi
- Department of Clinical Pathology, Jichi Medical School, Tochigi, Japan
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Abstract
Angiographic assessment is essential to make a diagnosis of Takayasu arteritis, since it is a systemic disease in which aorta and pulmonary artery and their branches show occlusion or stenosis in the late occlusive phase. Recently spiral CT angiography with breath-hold technique enables us to obtain well-enhanced, thin-section transaxial images in arterial and delayed phases. CT angiography reveals mural changes in addition to luminal abnormalities. Those are high-attenuation wall in pre-contrast transverse CT images, circumferential wall thickening with or without enhancement, a concentric low-attenuation ring inside the aortic wall and mural enhancement in delayed phase. CT angiography may provide the information for the disease activity, which will be useful in the management of the disease.
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Affiliation(s)
- J H Park
- Department of Radiology, Seoul National University Hospital 28, Yongon-dong, Chongno-gu, Korea
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Ogawa Y, Hayashi K, Sakamoto I, Matsunaga N. Pulmonary arterial lesions in Takayasu arteritis: relationship of inflammatory activity to scintigraphic findings and sequential changes. Ann Nucl Med 1996; 10:219-23. [PMID: 8800451 DOI: 10.1007/bf03165395] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In order to investigate the relationship between inflammatory activity and pulmonary arterial changes in Takayasu arteritis and the progression of the disease, we retrospectively reviewed 110 perfusion lung scans obtained by using 99mTc-macroaggregated albumin in a total of 57 patients. The scintigraphic findings were compared with the inflammatory activity and clinical course. Inflammatory activity was determined on the basis of the physical findings and laboratory data, i.e., the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) value. Scintigraphic abnormality was seen in 32 (56%) of the patients. The incidence of scintigraphic abnormality in the patients with active inflammation (7 of 21 patients, 33%) was lower than that in the patients in the chronic stage (22 of 32, 69%) (p < 0.02). Six of 22 patients who had undergone more than one scintigraphic examination showed progression in the scintigraphic findings. Four of the 6 patients showed relapse clinically, and corticosteroid medication could not be withdrawn from them. The lower incidence of scintigraphic abnormality in the patients with active inflammation suggests that in the acute phase no stenotic or occlusive changes in the pulmonary artery have yet been produced. Pulmonary arterial lesions can progress. The incidence of progression may be slightly higher in the patients who have had a relapse after corticosteroid therapy than in those who remained in remission after therapy or who were in the chronic stage, although neither difference was significant.
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Affiliation(s)
- Y Ogawa
- Department of Radiology, Nagasaki University School of Medicine, Japan
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Sharma S, Shrivastava S, Kothari SS, Kaul U, Rajani M. Influence of angiographic morphology on the acute and longer-term outcome of percutaneous transluminal angioplasty in patients with aortic stenosis due to nonspecific aortitis. Cardiovasc Intervent Radiol 1994; 17:147-51. [PMID: 7916266 DOI: 10.1007/bf00195508] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We studied the relationship of initial angiographic morphology in patients with aortic stenosis due to nonspecific aortitis and its relationship to immediate and later outcome following percutaneous transluminal angioplasty (PTA). METHODS Correlation was performed in 10 successive patients by retrospective analysis. All had clinically inactive nonspecific aortitis and hemodynamically significant aortic stenosis resulting in hypertension or lower limb claudication. Five patients had discrete concentric stenosis; the other five had eccentric stenosis with diseased aortic segments adjacent to the stenosis. RESULTS The five patients with concentric stenosis (Group I) had primarily successful and uncomplicated PTA with sustained improvement. The five patients (Group II) with eccentric stenosis had initial success in three patients and two initial treatment failures with one patient showing late improvement. Four of these patients developed large intimal flaps. One of these had an aneurysm during follow-up. Follow-up angiograms in five patients showed remodelling with further angiographic and clinical improvement. CONCLUSION Eccentricity of the stenosis and diffuse aortic disease correlate unfavorably with immediate outcome of PTA but late improvement may still be seen.
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Affiliation(s)
- S Sharma
- Department of Cardiovascular Radiology, C.N. Centre, All India Institute of Medical Sciences, New Delhi
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Abstract
We studied the prevalence, severity and clinical significance of ventricular arrhythmias in 78 female patients with Takayasu arteritis by 24-h ambulatory electrocardiography monitoring. Fifty (64%) of 78 patients had no or less than 30 beats/h premature ventricular contractions (Group A). The remaining 28 (36%) patients exhibited frequent or complex premature ventricular contractions (Group B). The frequency of HLA Bw52 which is closely associated with this morbid condition, echocardiographic and thallium-201 stress myocardial scintigraphic findings were then compared between these two groups. The frequency of positive HLA Bw52 was not significantly different between these two groups. Echocardiographically determined left ventricular mass (309 +/- 94 vs. 166 +/- 64 g; P < 0.01), frequency of complicated aortic regurgitation (77% vs. 24%; P < 0.01) and abnormal thallium-201 scintigraphic findings (76% vs. 38%; P < 0.05) were found higher in Group B as compared with those in Group A. These data indicate that frequent or complex ventricular arrhythmias in patients with Takayasu arteritis were associated with the presence of left ventricular hypertrophy, aortic regurgitation and decreased coronary reserve.
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Affiliation(s)
- G Siburian
- Third Department of Internal Medicine, Tokyo Medical and Dental University, School of Medicine, Japan
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Mandalam KR, Joseph S, Rao VR, Gupta AK, Unni NM, Rao AS, Kumar S, Subramanyan R, Halbe S, Rao EV. Aortoarteritis of abdominal aorta: an angiographic profile in 110 patients. Clin Radiol 1993; 48:29-34. [PMID: 8370216 DOI: 10.1016/s0009-9260(05)80103-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The angiographic appearances in 110 patients (49 males, 61 females, age range 11-46 years, mean 27.8 years) with aortoarteritis involving the abdominal aorta and/or its branches were analysed. There were 41 aneurysms of the abdominal aorta in 37 patients and eight aneurysms of its branches in as many patients. In 50 patients, 53 obstructive lesions involved the abdominal aorta and were classified as stenoses of focal, segmental and diffuse types and total occlusions. Branch obstructions (182 lesions in 85 patients) affected in order of frequency, the renal, superior mesenteric, coeliac, iliac and the inferior mesenteric arteries. Mesenteric arterial lesions were significantly more common in males (P = 0.01). Collateral circulation through a prominent mesenteric arcade was a distinctive angiographic feature in 28 patients. Computed tomography done in four patients showed peri-adventitial thickening and layered thrombus within aneurysms in three patients, and luminal occlusion of the upper abdominal aorta in one patient. Angiographic appearances in aortoarteritis of the abdominal aorta are characteristic and sufficiently distinctive for definitive diagnosis and appropriate management.
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Affiliation(s)
- K R Mandalam
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Tyagi S, Singh B, Kaul UA, Sethi KK, Arora R, Khalilullah M. Balloon angioplasty for renovascular hypertension in Takayasu's arteritis. Am Heart J 1993; 125:1386-93. [PMID: 8097612 DOI: 10.1016/0002-8703(93)91012-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Percutaneous transluminal renal angioplasty was performed in 54 consecutive patients with hypertension and renal artery stenosis caused by Takayasu's arteritis. Angioplasty was technically successful in 67 (89.3%) of 75 lesions attempted. In these 67 lesions, the degree of stenosis decreased from 88.3 +/- 4.8% to 23.5% +/- 13.6% (p < 0.001) after angioplasty. Following successful angioplasty there was significant improvement in hypertension (p < 0.001) within 48 hours. Patients with bilateral renal artery stenosis had higher systolic blood pressure both before balloon dilatation (p < 0.05) and after balloon dilatation before discharge (p < 0.001), compared with patients with unilateral renal artery stenosis. Three to 70 months (mean 26.4 +/- 10.3 months) after successful angioplasty, blood pressure was reduced to normal or was improved in 93% of patients. Angiographic restudy an average of 14.2 +/- 7.8 months after angioplasty showed restenosis at the same site in 7 of 52 (13.5%) lesions and fresh stenosis in one artery. All these eight lesions were successfully dilated. Further improvement in the luminal diameter was observed in 11 (21.2%) lesions. Late angiographic restudy in seven patients an average of 56.1 +/- 6.3 months after angioplasty showed no restenosis. Our results suggest that balloon angioplasty is safe and highly effective in relieving renal artery stenosis caused by Takayasu's arteritis and should be the treatment of choice for renovascular hypertension in this disease.
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Affiliation(s)
- S Tyagi
- Department of Cardiology, G. B. Pant Hospital, New Delhi, India
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Sharma S, Talwar KK, Rajani M. Coronary artery to pulmonary artery collaterals in nonspecific aortoarteritis involving the pulmonary arteries. Cardiovasc Intervent Radiol 1993; 16:111-3. [PMID: 8097966 DOI: 10.1007/bf02602991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a patient with nonspecific aortoarteritis (Takayasu's disease) in whom occlusion of the right upper lobe pulmonary artery was associated with collateral flow from the left circumflex coronary artery. Coronary to pulmonary artery collaterals are rare in this disease but have important clinical implication because of their ability to produce coronary steal and myocardial ischemia. Awareness of these pathways is essential for their detection in patients with angina-like symptoms and for differentiation of myocardial ischemia due to direct coronary artery involvement by this disease.
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Affiliation(s)
- S Sharma
- Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi
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Schwarz-Eywill M, Breitbart A, Csernok E, Pezzutto A, Gross WL. Treatment modalities and ANCA in Takayasu's arteritis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1993; 336:497-501. [PMID: 7905234 DOI: 10.1007/978-1-4757-9182-2_90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
As other vasculitic-syndromes Takayasu's-Arteritis needs a long-term immunosuppressive therapy in order to control disease-activity. As steroids create many problems in the long run other immunosuppressives should be considered. We report 3 cases treated with low-dose methotrexate. In all patients the arteritis was controlled, steroids reduced or stopped. In the effort to find autoantibodies 16 patients were screened for c-/p-ANCA and neutrophil granular enzymes. In no patient a positive result could be obtained.
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Affiliation(s)
- M Schwarz-Eywill
- Department of Rheumatology, Medical University of Lübeck, Germany
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Tyagi S, Kaul UA, Nair M, Sethi KK, Arora R, Khalilullah M. Balloon angioplasty of the aorta in Takayasu's arteritis: Initial and long-term results. Am Heart J 1992; 124:876-82. [PMID: 1356310 DOI: 10.1016/0002-8703(92)90967-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Percutaneous transluminal balloon angioplasty for stenosis of the aorta was performed in 36 patients with Takayasu's arteritis (age range, 8 to 36 years; mean, 19.1 +/- 7.7 years). Balloon dilatation was successful in 34 patients and resulted in a decrease in the mean peak systolic pressure gradient (PSG) from 75.2 +/- 29.1 mm Hg to 24.8 +/- 19 mm Hg (p less than 0.001) and a mean increase in the diameter of the stenosed segments from 4.5 +/- 2.2 mm to 9.6 +/- 3.8 mm (p less than 0.001). Hemodynamic and angiographic restudy, which was performed in 20 patients at a mean follow-up period of 7.7 +/- 4.1 months (range, 3 to 24 months), showed a further decrease in PSG (greater than or equal to 15 mm Hg) in seven patients (from 40.0 +/- 11.2 mm Hg to 15.7 +/- 10.2 mm Hg; p less than 0.01), no significant change in PSG in 12 patients (17.1 +/- 13.6 mm Hg vs 16.6 +/- 12.7 mm Hg; p = NS), and an increase in PSG from 15 mm Hg to 85 mm Hg in one patient. The patient who showed restenosis underwent successful redilatation. Six patients who underwent late recatheterization and angiography at 36 to 60 months (mean, 43 +/- 9.4 months) show continued relief of stenosis (mean PSG, 8.8 +/- 7.8 mm Hg). Patients with short-segment (less than 4 cm) stenosis experience more relief than patients with long-segment (greater than or equal to 4 cm) stenosis (residual PSG, 18.6 +/- 8.2 mm Hg vs 40 +/- 16 mm Hg; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Tyagi
- Department of Cardiology, G. B. Pant Hospital, New Delhi, India
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