Surgical Treatment of Takayasuʼs Disease

Abstract

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

Takayasu arteritis: a review

“…The use of angiotensin converting enzyme inhibitors requires careful monitoring in view of the frequency of renal artery stenosis. 31 …”

“…6 10 Surgery may be unnecessary for aortic arch and splanchnic disease as a result of extensive collateral development. 31 However, recent surgical experience of critical thoracic aortic arch stenoses and stroke risk from the National Institutes of Health, USA 32 33 concluded that critical stenoses should be corrected to prevent stroke, with grafts originating from the ascending aorta. Renal artery involvement is best treated by percutaneous transluminal angioplasty.…”

Is 18F‐fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in takayasu arteritis?

“…Evaluation of disease activity in patients with TA is challenging because clinical features do not correlate with acute-phase reactants in ϳ50% of cases (1)(2)(3), and imaging modalities do not always correlate with clinical and laboratory parameters (4). The complexity of evaluating disease activity in TA is further underlined by the fact that up to 45% of patients in clinical remission have histologic evidence of active disease (1,5).…”

The role of 18F‐fluorodeoxyglucose–positron emission tomography in the assessment of disease activity in patients with Takayasu arteritis

“…It may reflect vascular remodeling or atheroma. Alternatively, it could reflect residual inflammation of the arterial wall identified in surgical specimens from patients with clinically inactive disease (1,2). Some of them showed a response to immunosuppressive treatment on the followup scan.…”

“…A sensitive and useful method is necessary for the diagnosis of early inflammation and for following disease activity in TA. However, assessment of disease activity in TA is difficult in clinical situations because the clinical symptoms and laboratory parameters do not always adequately reflect the actual inflammation of the arterial wall (1,2), and, as of now, no adequate surrogate is available for assessing disease activity in TA. Imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) reveal anatomic inflammatory changes of the affected arterial wall and have been suggested for mon-itoring disease activity of TA (3), but have not shown consistent correlation with disease activity (4)(5)(6)(7).…”