Anesthetic Management of a Patient With Takayasu Arteritis

Managing Anesthesia for a Patient with Takayasu Illness

This article intended to provide an overview of the anesthetic management for a patient with Takayasu arteritis, an uncommon and challenging disease. Despite the limited literature, it becomes more evident that there is no right answer for all patients. Considering that, it is important to take into account the severity and specific features of the underlying disease to decide the best anesthetic approach. In this context, an adequate preoperative assessment focusing on cardiovascular function becomes essential. Adequate cardiovascular monitoring is also essential in the intraoperative period. A multidisciplinary team should be involved in the perioperative period to provide the best care possible and improve patient outcomes. This case illustrates a successful hysterectomy in a patient with Takayasu arteritis, pointing out the pathophysiologic considerations and discussing the means to reduce the perioperative risk. The particularities described in this case report may help other physicians choose the best strategy when facing challenging patients similar to the one described.

Complications of Vascular Disease

Vascular diseases and their sequelae increase perioperative risk for noncardiac surgical patients. In this review, the authors discuss vascular diseases, their epidemiology and pathophysiology, risk stratification, and management strategies to reduce adverse perioperative outcomes.

Refractory convulsive syncope in pregnancy: a rare presentation of Takayasu's arteritis - a case report and literature review

BACKGROUND

Neurological manifestation of Takayasu's Arteritis (TA) in pregnancy presenting as convulsive syncope is extremely rare, and poses a serious diagnostic dilemma due to other vast causes of fits in pregnancy.

OBJECTIVE

We aimed to present and shed more light on a case of TA with convulsive syncope in pregnancy refractory to anticonvulsants for seven weeks, and review the literature on the management of TA in pregnancy.

CASE PRESENTATION

A gravida 4 para 3+0 at 28 weeks of amenorrhea presented with repeated episodes of the sudden loss of consciousness, followed by a fall and jerking of the limbs. These were refractory to anticonvulsants that she had used for seven weeks. Physical examination revealed undetectable pulse and blood pressure (BP) in the upper limbs but elevated BP in the lower limbs. Further investigations confirmed TA and she improved on steroids and antihypertensives.

CONCLUSION

This case typically describes the unexpected presentation of TA with convulsive syncope. It calls for meticulous clinical assessment of epileptic seizures in pregnancy to avoid a late diagnosis of TA and its potential poor outcomes.

Update on pregnancy in Takayasu arteritis-A narrative review

Takayasu arteritis (TA) is a chronic, idiopathic large-vessel vasculitis that affects women of reproductive age, and has significant maternal and fetal implications. Although there are contrasting data on the effect of TA on fertility, most studies have shown that fertility outcomes remain unaffected. The disease activity of TA usually either remains stable or decreases during pregnancy. The important fetomaternal complications are maternal hypertension, pre-eclampsia, prematurity, and intrauterine growth restriction. To reduce maternal and fetal morbidity, controlling the disease before conception is important. This review article discusses the various implications, challenges, and medical and endovascular management of TA during pregnancy.