Extreme arterial blood pressure differentials in a patient with Takayasu's arteritis

To describe the extreme arterial blood pressure differentials in a patient with Takayasu's arteritis and its implications for the preservation of cerebral perfusion during anaesthesia.

A 26-yr-old woman with Type III Takayasu's arteritis presented with a tentative diagnosis of mesenteric ischaemia. Determination of systolic arterial blood pressure assisted by oximetry revealed pressures of 114 mmHg in the left and 90 mmHg in the right arm while direct arterial line pressure monitoring of the left posterior tibial artery showed a pressure of 322/113 mmHg. Following induction of anaesthesia with thiopentone and succinylcholine and maintenance with N2O, isoflurane and fentanyl, posterior tibial arterial pressures were maintained (low of 213/96 mmHg) to maintain cerebral blood flow despite surgical requests to lower blood pressure. Epidural local anaesthesia was not considered for intra- or postoperative management due to the regional differences in blood pressure and the effect that sympatholysis may have had on cerebral perfusion.

In patients with Takayasu's arteritis, extreme arterial blood pressure differentials may exist which may affect regional blood flow, and monitoring of both upper and lower extremity arterial blood pressure should be considered.