[Renal and aortic involvement in Takayasu's disease]

From 1972 to 2003, we surgically treated 25 patients (17 females) for aortic and renal complications of Takayasu's disease. Their mean age was 18.5 +/- 11.2 years. Despite heavy medical treatment, all had severe uncontrollable hypertension. Nineteen patients had associated lesions of the aorta and renal arteries, 6 had isolated lesions of a renal artery, and 10 had lesions of the mesenteric arteries. Percutaneous transluminal angioplasty of the renal artery or arteries was attempted in four cases and was always unsuccessful. Thirteen patients with bilateral lesions underwent nephrectomy (three cases) and renal artery repair (35 cases). Aortic bypass was performed in 7 patients and revascularization of other visceral arteries in 4 patients. Follow-up ranges from 1 to 20 years (mean 5 years). There were no deaths. Three thromboses occurred post-operatively, two in a renal artery and one in the superior mesenteric artery. Immediately after the operation blood pressure normalized in 18 patients (72%), was improved in 4 (16%) and remained unchanged in 3 (12%). The disease progressed in 11 patients (44%), with four recurrent stenoses of renal arteries, 3 aggravations of aortic lesions (requiring an aortic bypass in one patient at three years), 3 aggravations of supraaortic artery involvement, and one case of coronary insufficiency requiring bypass at 8.5 years. Long term blood pressure normalized in 14 patients (56%), was improved in 5 patients (20%) and remained unchanged in 6 patients (24%), owing mainly to secondary or late anatomical deterioration.