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An autopsy study of Takayasu arteritis in India
B K Sharma1, S Jain, B D Radotra
1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Autopsy of 10 Takayasu arteritis (TA) patients revealed persistent arterial inflammation and significant hypertension-related organ damage. Major mortality causes included heart failure and kidney failure, highlighting TA
Area of Science:
- Cardiovascular Pathology
- Rheumatology
- Internal Medicine
Background:
- Takayasu arteritis (TA) is a chronic inflammatory condition affecting large arteries.
- Understanding autopsy findings is crucial for comprehending TA's full pathological spectrum and long-term consequences.
Purpose of the Study:
- To present autopsy findings in 10 Takayasu arteritis patients.
- To correlate pathological findings with clinical presentation and causes of mortality.
Main Methods:
- Autopsy examination of 10 patients diagnosed with Takayasu arteritis.
- Histological analysis of vascular lesions and affected organs.
- Review of clinical data and causes of death.
Main Results:
- Aorta involvement included stenosis, dilatation, aneurysm, and dissection, with the abdominal aorta most commonly affected.
- Renal artery involvement occurred in six patients.
- Histology showed active, fibrotic, or mixed inflammatory lesions, indicating persistent disease activity.
- Cardiac complications like left ventricular hypertrophy were prevalent.
- Major causes of mortality were congestive heart failure and chronic renal failure, linked to severe hypertension.
Conclusions:
- Takayasu arteritis in Indian patients is strongly associated with severe, uncontrolled hypertension, leading to significant cardiac, renal, and cerebral morbidity and mortality.
- The disease exhibits persistent inflammatory activity, even during clinically silent phases.
- Autopsy data underscores the critical impact of TA on major organ systems and highlights hypertension as a key driver of poor outcomes.
Abstract:
Autopsy findings of 10 patients with Takayasu arteritis (TA) are presented. These patients include six females and four males with a mean age of 22.6+/-10.2 years. Hypertension was the commonest mode of presentation. On autopsy, the vascular lesions in the aorta comprised of stenosis (eight), dilatation (six), aneurysm (two) and dissection of aorta involving its arch, thoracic and abdominal aorta (one). Abdominal aorta was the commonest site of involvement (nine patients) and renal artery was involved in six patients. Histologically, the three types of lesions were identified--active, fibrotic and combination of active and fibrotic lesions. Active inflammatory lesions in the arterial circuit were present despite a clinically chronic (silent) phase of the disease. Cardiac involvement included left ventricular hypertrophy (nine), right ventricular hypertrophy (four), biventricular hypertrophy (three), myocarditis (two) (rheumatic and Takayasu's myocarditis--one patient each) and involvement of coronary artery (one). The pulmonary artery was involved in two patients. Kidneys showed changes of malignant hypertension and benign nephrosclerosis in one patient each. Associated tuberculosis was present in four patients. The causes of mortality were congestive heart failure (four), chronic renal failure (two), intracranial bleed, aneurysmal rupture and pulmonary thromboembolism in one patient each. Thus, the major causes of morbidity and mortality in Indian patients with TA is due to severe uncontrolled hypertension and its effect on heart, kidney and brain. The disease appears to have a persistent activity for a prolonged period even when it appears to be clinically silent.