Supra-Aortic Branch Occlusion from Takayasu Arteritis with Systemic Collateral Vessels

The usefulness and limitation of digital subtraction angiography (DSA) in Takayasu arteritis were investigated in 32 patients. Intravenous DSA was particularly useful in the follow-up of patients with an established diagnosis of Takayasu arteritis. Pulmonary arterial involvement could also be demonstrated with intravenous DSA as obstructive arterial changes and lack of accumulation of contrast medium in the pulmonary parenchyma. Detailed information concerning the site and extent of vascular involvement and development of collateral vessels were obtained with intraarterial DSA. Thickening of the thoracic aortic wall, however, could not be recognized with either intravenous or intraarterial DSA. Conventional angiography of the descending thoracic aorta is still required as an initial examination, particularly when there is no aortic arch involvement. However, there is no doubt that DSA has the potential to become the diagnostic procedure of choice in Takayasu arteritis.

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Untreated Takayasu arteritis: an unusual case of widespread disease

BMJ Case Reports ◽

10.1136/bcr-2020-234825 ◽

2020 ◽

Vol 13 (8) ◽

pp. e234825

Author(s):

Thomas J Breen ◽

Thomas G Osborn ◽

Jennifer Kleinman Sween

Keyword(s):

Takayasu Arteritis ◽

Unusual Case ◽

Latent Tuberculosis ◽

Immunosuppressive Medications ◽

Perivascular Inflammation ◽

Active Inflammation ◽

Inflammatory Changes ◽

Work Up ◽

Aortic Branch ◽

Epigastric Abdominal Pain

A 38-year-old man with no medical history presented with bilateral flank and epigastric abdominal pain. CT abdomen and pelvis demonstrated diffuse nodules and lymphadenopathy, which were biopsied and showed chronic inflammatory changes. He later presented with pleuritic chest pain and was sent for a CT chest angiogram, which revealed perivascular inflammation involving the thoracic aortic arch, supra-aortic branch vessels and descending thoracic aorta. Further work-up showed vasculitic involvement of the coeliac, superior mesenteric and femoral arteries with heavy collateralisation. These findings were most consistent with widespread Takayasu arteritis that had been untreated for nearly 20 years. It was necessary to define the degree of active inflammation and need for immediate therapy, as the patient had a concomitant latent tuberculosis infection that precluded the use of immunosuppressive medications. This report illustrates an unusual case of Takayasu arteritis and highlights the presentation, diagnosis and work-up of suspected cases.

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Incidentally diagnosed Takayasu arteritis on thyroid ultrasonography showing prominent collateral vessels of thyroidal arteries and common carotid artery occlusion

ULTRASONOGRAPHY ◽

10.14366/usg.14007 ◽

2014 ◽

Vol 33 (3) ◽

pp. 222-225 ◽

Cited By ~ 1

Author(s):

Se Jin Nam ◽

Eun-Kyung Kim

Keyword(s):

Carotid Artery ◽

Takayasu Arteritis ◽

Common Carotid Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Thyroid Ultrasonography ◽

Collateral Vessels ◽

Common Carotid Artery Occlusion

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M.585 Minocycline has a steroid-sparing effect in treatment of Takayasu arteritis

Atherosclerosis ◽

10.1016/s0021-9150(04)90583-7 ◽

2004 ◽

Vol 5 (1) ◽

pp. 136

Author(s):

A MATSUYAMA

Keyword(s):

Takayasu Arteritis ◽

Sparing Effect ◽

Steroid Sparing

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Coarctation of the abdominal aorta: Demonstration of a rare anomaly using contrast-enhanced MR-angiography

VASA ◽

10.1024/0301-1526.38.1.66 ◽

2009 ◽

Vol 38 (1) ◽

pp. 66-71 ◽

Cited By ~ 2

Author(s):

Schubert

Keyword(s):

Abdominal Aorta ◽

Mr Angiography ◽

Parallel Imaging ◽

Left Renal Vein ◽

Systemic Hypertension ◽

Contrast Enhanced ◽

Younger Age ◽

Maximum Intensity Projections ◽

Collateral Vessels ◽

First Time

We describe a case of aortic coarctation at the level of the infrarenal abdominal aorta which is encountered in less than six individuals in one million. In contrast to aortic narrowing above or including the renal arteries, this seems to be a relatively benign anomaly without systemic hypertension or impaired renal function. For the first time in this type of anomaly, contrast-enhanced MR angiography (ce-MRA) on a multi-receiver channel MR system, with an 8-channel phased array coil and parallel imaging was used. Ce-MRA displayed a tortuous, narrowed aortic segment that was found to be associated with mesenteric artery stenosis and compression of the orthotopic left renal vein, also known as the nutcracker phenomenon. All major aortic branches could be depicted using 3D surface-shaded displays and subvolume maximum intensity projections (MIPs). Collateral vessels of the abdominal wall were identified using whole-volume MIPs. Since the majority of aortic malformations are diagnosed at a younger age, and many suffer from renal insufficiency, we conclude that ce-MRA will eventually place conventional DSA as the modality of choice in malformations of the abdominal aorta.

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Preinfarction Angina and Improved Reperfusion of the Infarct-related Artery

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615557 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 68-72 ◽

Cited By ~ 2

Author(s):

Alessandro Sciahbasi ◽

Eugenia De Marco ◽

Attilio Maseri ◽

Felicita Andreotti

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Infarct Size ◽

Ischemic Preconditioning ◽

Early Reperfusion ◽

Vast Number ◽

Beneficial Effects ◽

Infarct Related Artery ◽

Cardioprotective Effects ◽

Collateral Vessels

SummaryPreinfarction angina and early reperfusion of the infarct-related artery are major determinants of reduced infarct-size in patients with acute myocardial infarction. The beneficial effects of preinfarction angina on infarct size have been attributed to the development of collateral vessels and/or to post-ischemic myocardial protection. However, recently, a relation has been found between prodromal angina, faster coronary recanalization, and smaller infarcts in patients treated with rt-PA: those with preinfarction angina showed earlier reperfusion (p = 0.006) and a 50% reduction of CKMB-estimated infarct-size (p = 0.009) compared to patients without preinfarction angina. This intriguing observation is consistent with a subsequent observation of higher coronary recanalization rates following thrombolysis in patients with prodromal preinfarction angina compared to patients without antecedent angina. Recent findings in dogs show an enhanced spontaneous lysis of plateletrich coronary thrombi with ischemic preconditioning, which is prevented by adenosine blockade, suggesting an antithrom-botic effect of ischemic metabolites. Understanding the mechanisms responsible for earlier and enhanced coronary recanalization in patients with preinfarction angina may open the way to new reperfusion strategies.A vast number of studies, globally involving ≈17,000 patients with acute myocardial infarction, have unequivocally shown that an infarction preceded by angina evolves into a smaller area of necrosis compared to an infarct not preceded by angina (Table 1) (1). So far, preinfarction angina has been thought to have cardioprotective effects mainly through two mechanisms: collateral perfusion of the infarctzone (2-4), and ischemic preconditioning of the myocardium (5-7). Here we discuss a further mechanism of protection represented by improved reperfusion of the infarct-related artery.

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Depression of Collateral Blood Flow Following Arterial Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651903 ◽

1977 ◽

Vol 38 (04) ◽

pp. 0850-0862 ◽

Cited By ~ 1

Author(s):

Robert G. Schaub ◽

Ronald Sande ◽

Kenneth M. Meyers

Keyword(s):

Blood Flow ◽

Arterial Thrombosis ◽

Hind Limb ◽

Therapeutic Interventions ◽

Collateral Blood Flow ◽

Serotonin Antagonist ◽

Limb Perfusion ◽

Clinical Consequences ◽

Collateral Vessels ◽

Iliac Bifurcation

SummaryPermanent ligation of the feline aorta at the iliac bifurcation is followed by rapid opening of pre-existing collateral blood vessels. However, if ligation is combined with formation of a clot, these protective collateral vessels do not function. This study was undertaken to determine if drugs which alter serotonin function can improve collateral blood flow after arterial thrombosis. Permanent ligations were placed at the iliac bifurcation, circumflex iliac and sixth lumbar arteries in all cats. A clot was produced in the aorta of 27 cats by injection of 0.1 ml of thromboplastin. Ligated clot-occluded cats were untreated (10); had blood serotonin depleted using a single dose of reserpine (0.1 mg/kg i. m.) followed by para-chlorophenylanine (p-CPA) (100 mg/kg orally) every 3 days (9) ; or were treated prior to surgery with a serotonin antagonist cinanserin HC1 (4 mg/kg i. v.) (8). Control cats (18) were acutely ligated. 9 of these cats were untreated, 5 were cinanserin HC1-treated, and 4 were reserpine/p-CPA-treated. Extent of collateral development was assessed by aortograms 3 days after occlusion and by neurologic rating. Aortograms of acutely ligated cats indicated a significant collateral blood flow around the segment of ligated aorta, while ligated clot-occluded cats had a severely depressed hind-limb perfusion. Reserpine/p-CPA-treated ligation clot-occluded cats had aortograms similar to acutely ligated cats. The cinanserin HC1-treated ligation clot-occluded cats had aortograms which indicated hind-limb perfusion was not as adequate as the acutely ligated cats. However, the perfusion of these animals was improved over untreated ligation clot-occluded cats. Neurologic rating correlated with aortograms. These results suggest: 1) the clinical consequences of arterial thrombosis cannot be entirely attributed to mechanical occlusion of an artery, but may be due to depression of protective collateral blood flow induced by thrombosis, 2) serotonin is an important factor in this depression of collateral blood flow, and 3) isolation of the factors responsible for collateral inhibition could permit the development of therapeutic interventions.

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