Takayasu arteritis with multiple cardiovascular complications

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Vascular Surgery

Background:

• Takayasu arteritis is a large vessel vasculitis often affecting the aorta and its branches.
• Coronary ostial stenosis is a known, though less common, manifestation of Takayasu arteritis.
• Surgical revascularization for coronary artery disease can be challenging in patients with extensive aortic disease.

Observation:

• A 60-year-old Japanese woman with effort angina presented with bilateral coronary ostial stenosis and Takayasu arteritis.
• Initial surgical attempts for coronary artery bypass graft (CABG) were unsuccessful due to poor donor artery flow and severe ascending aortic calcification.
• A unique arterial reconstruction using the proper hepatic artery to the left anterior descending artery was performed.

Findings:

• The patient experienced worsening angina, with new findings of bilateral subclavian artery occlusions, vein graft occlusion, aortic regurgitation, and descending aorta stenoses.
• Severe aortic wall calcification and thickening precluded further surgical interventions, including aortic valve replacement and revascularization.
• Medical management was initiated, leading to the patient's discharge without severe angina.

Implications:

• This case highlights the extreme complexity that Takayasu arteritis can impose on managing concurrent coronary artery disease.
• The extensive vascular calcification and multiple occlusive lesions presented a unique challenge, rendering standard surgical approaches impossible.
• Conservative medical management proved effective in symptom control for this rare and complex cardiovascular presentation.