Middle Aortic Syndrome in Takayasu’s Arteritis: Report of Two Surgical Cases

Background Middle aortic syndrome is a rare disease. Several surgical treatments are available; however, the optimal treatment strategy and long-term outcomes remain unelucidated. We herein report the 5-year outcomes of six patients treated with extra-anatomical bypass surgery for middle aortic syndrome. Case presentations Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu’s arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle–brachial pressure index was .61. The three patients with Takayasu’s arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle–brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up. Conclusion Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.

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Histological verification of non-specific aorta-arteritis (Takayasu's arteritis) using percutaneous transluminal atherectomy

VASA ◽

10.1024/0301-1526.33.4.247 ◽

2004 ◽

Vol 33 (4) ◽

pp. 247-251 ◽

Cited By ~ 6

Author(s):

Zeller ◽

Koch ◽

Frank ◽

Bürgelin ◽

Schwarzwälder ◽

...

Keyword(s):

Clinical Diagnosis ◽

Axillary Artery ◽

Takayasu’S Arteritis ◽

Giant Cells ◽

Interventional Therapy ◽

Takayasu's Arteritis ◽

New Device ◽

First Case ◽

Anti Inflammatory ◽

Percutaneous Transluminal

Diagnosis of non-specific aorto-arteritis (NSAA, Takaysu's arteritis) is typically based on clinical and investigational parameters. We report here about two patients with clinically suspected diagnosis of a Takayasu's arteritis already under anti-inflammatory therapy in whom percutaneous transluminal atherectomy of subclavian and axillary artery stenoses was performed to relief the patients from symptoms – intermittent dyspraxia of the arms – and to verify the clinical diagnosis by histology. In the first case aorto-arteritis could be histologically confirmed through the analysis of plaque material including media structures excised from the subclavian and axillary arteries using a new device for atherectomy. The biopsy showed diffuse inflammation and granulomatous lesions with giant cells typically for Takayasu's disease. In the second patient, biopsy showed no acute or chronic inflammatory signs but only atherosclerotic lesions. Percutaneous transluminal atherectomy is therefore not only an interventional but also a diagnostic tool and should be used in every case of interventional therapy of suspected aorto-arteritis to make the clinical diagnosis and as a major consequence the initiation of an aggressive anti-inflammatory medical therapy more reliable.

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Transluminal Catheter angioplasty of abdominal aorta in Takayasu's arteritis

Acta Radiologica ◽

10.3109/02841858809171926 ◽

1988 ◽

Vol 29 (5) ◽

pp. 509-513 ◽

Cited By ~ 10

Author(s):

Z. M. Gu ◽

G. Lin ◽

J. R. Yi ◽

J. M. Li ◽

J. Zhou ◽

...

Keyword(s):

Abdominal Aorta ◽

Takayasu’S Arteritis ◽

Takayasu's Arteritis

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THE DIAGNOSE AND CLINICAL POLYMORPISM FEATURES OF TAKAYASU’S ARTERITIS

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2020-21-2-106-111 ◽

2020 ◽

Vol 21 (2) ◽

pp. 106-111

Author(s):

N.S. SAMSONOV ◽

◽

S.A. USHAKOVA ◽

O.Y. KHALIDULLINA ◽

E.A. BASHTAKOVA ◽

...

Keyword(s):

Takayasu’S Arteritis ◽

Takayasu's Arteritis

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Extended-release tofacitinib improves refractory Takayasu’s arteritis

Scandinavian Journal of Rheumatology ◽

10.1080/03009742.2021.1911054 ◽

2021 ◽

pp. 1-4

Author(s):

C-R Wang ◽

Y-S Tsai ◽

Y-W Liu ◽

Y-H Li

Keyword(s):

Extended Release ◽

Takayasu’S Arteritis ◽

Takayasu's Arteritis

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HADS-depression score is a mediator for illness perception and daily life impairment in Takayasu’s arteritis

Clinical Rheumatology ◽

10.1007/s10067-021-05719-2 ◽

2021 ◽

Author(s):

Simay Erdal ◽

Banu Nalbantoğlu ◽

Mert Berke Gür ◽

Murathan Yıldırım ◽

Alperen Kılıçarslan ◽

...

Keyword(s):

Daily Life ◽

Takayasu’S Arteritis ◽

Illness Perception ◽

Depression Score ◽

Takayasu's Arteritis

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Pyoderma gangrenosum associated with Takayasu's arteritis in a young Caucasian woman and response to biologic therapy with tocilizumab

JAAD Case Reports ◽

10.1016/j.jdcr.2020.12.034 ◽

2021 ◽

Vol 9 ◽

pp. 4-6

Author(s):

Dean J. Choong ◽

Jeremy L. Ng ◽

Carl Vinciullo

Keyword(s):

Pyoderma Gangrenosum ◽

Biologic Therapy ◽

Takayasu’S Arteritis ◽

Caucasian Woman ◽

Takayasu's Arteritis

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Tocilizumab in refractory Caucasian Takayasu’s arteritis: a multicenter study of 54 patients and literature review

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211020917 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110209

Author(s):

Diana Prieto-Peña ◽

Pilar Bernabeu ◽

Paloma Vela ◽

Javier Narváez ◽

Jesús C. Fernández-López ◽

...

Keyword(s):

Adverse Events ◽

Multicenter Study ◽

Takayasu’S Arteritis ◽

Imaging Techniques ◽

Takayasu's Arteritis ◽

Prednisone Dose ◽

Reactive Protein ◽

Caucasian Origin ◽

Caucasian Patients ◽

Sparing Effect

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu’s arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5–50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0–31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5–50.0) to 5.0 (0.0–5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0–14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX ( n = 28), cyclosporine A ( n = 2), azathioprine ( n = 1). Patients on TCZCOMBO were younger [38.0 (27.0–46.0) versus 45.0 (38.0–57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0–38.0) versus 6.0 (1.0–23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7–5.6) versus 1.3 (0.3–3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.

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