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Refractory rapidly progressive Takayasu's arteritis successfully treated with surgery
Ljiljana Petrovic-Rackov1, Nada Pejnovic, Miodrag Jevtic
1Clinic of Rheumatology and Clinical Immunology, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia. ljrackov@eunet.yu
Clinical Rheumatology
|January 17, 2007
Summary
This case study shows that bypass surgery can successfully treat severe Takayasu arteritis (TA) when immunosuppressants fail. Arterial grafting resolved ischemic symptoms and achieved long-term remission in a refractory TA patient.
Area of Science:
- Vascular Surgery
- Immunology
- Rheumatology
Background:
- Takayasu arteritis (TA) is a chronic inflammatory disease affecting large arteries.
- Refractory cases pose significant management challenges, often leading to severe ischemic complications.
Observation:
- A 38-year-old female patient presented with rapidly progressive TA refractory to immunosuppressive therapy.
- Symptoms included compromised cerebral circulation, limb claudication, and stenocardial pain due to arterial occlusions and stenosis.
- Arteriography confirmed occlusions in the subclavian and iliac arteries, abdominal aorta stenosis, and a completely occluded left subclavian artery causing subclavian steal syndrome.
Findings:
- Conventional immunosuppressive therapy was ineffective in managing the patient's severe ischemic symptoms.
- Surgical intervention with aorto-bifemoral and left carotid-axillary bypass grafting was performed.
- Post-surgery, all ischemic symptoms resolved, and the patient remained asymptomatic with no restenosis at 3-year follow-up.
Implications:
- Multiple arterial bypass grafting can be a viable and effective treatment option for progressive Takayasu arteritis unresponsive to immunosuppression.
- Surgical revascularization offers a satisfactory outcome and excellent long-term clinical remission in select TA patients.
- This case highlights the importance of considering surgical intervention for advanced TA with critical arterial involvement.
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