Takayasu arteritis: surgical interventions

Open and endovascular surgery remains important in the management of Takayasu arteritis. This review summarizes the indications and approaches available, the evidence for them and recent advances.

The outlook in Takayasu arteritis has improved over the last decade, reflecting earlier diagnosis, increased use of noninvasive imaging and combination immunotherapy. This is likely to be reflected in a reduced requirement for vascular intervention in the next decade. An important role remains for open surgery, which is effective, well tolerated and improves long-term survival in those with severe disease. Primary angioplasty offers a less invasive option for specific arterial sites, although restenosis rates are higher. Interventional outcomes are significantly improved by adequate pre and postoperative immunosuppression to render arteritis inactive. Stent placement should be reserved predominantly for primary and secondary angioplasty failures. The role of drug-eluting stents is not yet established. Preliminary evidence suggests that stent grafts represent an important noninvasive option.

Vascular intervention remains important for the treatment of stenosed and occluded arteries leading to organ ischaemia or hypertension, and for aneurysmal disease. Endovascular stent grafts are likely to be increasingly deployed, and targeted biologic therapies may reduce the need for vascular intervention.