The association between aneurysm formation and systemic hypertension in Takayasu's arteritis

We have studied the incidence and patterns of aneurysm formation in 88 consecutive patients with Takayasu's arteritis by utilizing digital subtraction pan-aortoarteriography by the intravenous and/or intra-arterial route. Seventy-two patients underwent initial intravenous angiography of which 64 (89%) were diagnostic. All the intra-arterial studies (n = 24) were diagnostically adequate. Arterial aneurysms were seen in eight patients (9.1%) and the saccular variety (75%) was the most common. Clinical and angiographic features of these eight patients were compared with those of the remaining patients. No major differences were observed except that longstanding uncontrolled hypertension was present in all patients with aneurysm formation. In comparison, hypertension was observed in 30 (49.2%) of the remaining 61 patients in whom clinical details were available. Angiographic localization of the aneurysm is important since there are no clinical features that distinguish these patients and rupture of a strategically located aneurysm can prove fatal. The association between hypertension and aneurysm formation suggests that hypertension in these patients should be aggressively managed at the onset of disease. In this regard percutaneous transluminal renal angioplasty may prove a possible management adjunct.