Visceral Artery Interventions in Takayasu's Arteritis

Sanjiv Sharma; Ashish Gupta

doi:10.1055/s-0029-1225668

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2009; 26(3): 233-244
DOI: 10.1055/s-0029-1225668

Visceral Artery Interventions in Takayasu's Arteritis

Sanjiv Sharma¹ , Ashish Gupta¹

¹Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India

Abstract

ABSTRACT

Takayasu's arteritis is an idiopathic chronic inflammatory disease affecting the aorta, its major branches and the pulmonary arteries. It leads to stenosis, occlusion, dilatation, and aneurysm formation in the involved vessels. Visceral arterial involvement occurs in 11 to 68% cases. Steno-obstructive lesions are most commonly seen and are usually symptomatic. Dilative and aneurismal lesions are uncommon and, when present, are usually clinically silent. Renal arteries are most commonly involved (24 to 68%), resulting in renovascular hypertension, whereas mesenteric arterial involvement is seen in 11 to 28% cases and is usually clinically silent. The assessment of disease activity is of utmost importance in its management as revascularization is best performed in the inactive phase. The disease activity can be assessed by clinical, biochemical, or radiological markers. The primary objectives of treatment include the control of disease activity by drug therapy, pharmacologic control of blood pressure (BP), supportive management and revascularization (surgical or endovascular) of the symptomatic ischemic territory. Surgical treatment is challenging due to the diffuse nature of the disease and involvement of adjacent aortic walls. It has a high incidence of anastomotic aneurysm formation (12 to 14%) and graft failure (20 to 40%) over time. Endovascular therapy (usually in the form of balloon angioplasty) has specific technical and procedural issues, but is safe and effective in the control of hypertension with success rates ranging between 80 to 96%. The overall complication rates are low. The cumulative 5-year patency rate for the management of renal artery stenosis is 67%. The use of stents is usually restricted as a bailout to treat obstructive dissection after angioplasty, due to a variety of reasons as their use may adversely affect the long-term outcome of treatment. Angioplasty is less effective in relieving obstruction in the mesenteric arteries and the outcomes are also infrequently reported.

KEYWORDS

Takayasu's arteritis - arteritis - renal artery - mesenteric artery - stenosis - angioplasty

Full Text

References

REFERENCES

1 Takayasu M. Case with unusual changes of the vessels in the retina. Acta Soc Opthalmol Jpn. 1908; 12 554-555
2 Numano F, Okawara M, Inomata H, Kobayashi Y. Takayasu's arteritis. Lancet. 2000; 356(9234) 1023-1025
3 Maffei S, Di Renzo M, Bova G, Auteri A, Pasqui A L. Takayasu's arteritis: a review of the literature. Intern Emerg Med. 2006; 1(2) 105-112
4 Lande A, Bard R, Rossi P, Passariello R, Castrucci A. Takayasu's arteritis. A worldwide entity. N Y State J Med. 1976; 76(9) 1477-1482
5 Sekiguchi M, Suzuki J. An overview on Takayasu arteritis. Heart Vessels Suppl. 1992; 7(7) 6-10
6 Kerr G S, Hallahan C W, Giordano J et al.. Takayasu arteritis. Ann Intern Med. 1994; 120(11) 919-929
7 Liu Y Q. Radiology of aortoarteritis. Radiol Clin North Am. 1985; 23(4) 671-688
8 Sharma S, Rajani M, Talwar K K. Angiographic morphology in nonspecific aortoarteritis (Takayasu's arteritis): a study of 126 patients from north India. Cardiovasc Intervent Radiol. 1992; 15(3) 160-165
9 Yamato M, Lecky J W, Hiramatsu K, Kohda E. Takayasu arteritis: radiographic and angiographic findings in 59 patients. Radiology. 1986; 161(2) 329-334
10 Sharma S, Kamalakar T, Rajani M, Talwar K K, Shrivastava S. The incidence and patterns of pulmonary artery involvement in Takayasu's arteritis. Clin Radiol. 1990; 42(3) 177-181
11 Domingo R T, Maramba T P, Torres L F, Wesolowski S A. Acquired aorto-arteritis. A worldwide vascular entity. Arch Surg. 1967; 95(5) 780-790
12 Piyachon C. Takayasu's arteritis in Thailand. Australas Radiol. 1977; 21(4) 350-361
13 Moriwaki R, Noda M, Yajima M, Sharma B K, Numano F. Clinical manifestations of Takayasu arteritis in India and Japan—new classification of angiographic findings. Angiology. 1997; 48(5) 369-379
14 Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol. 1996; (54, Suppl) S155-S163
15 Mwipatayi B P, Jeffery P C, Beningfield S J et al.. Takayasu arteritis: clinical features and management: report of 272 cases. ANZ J Surg. 2005; 75(3) 110-117
16 Johnston S L, Lock R J, Gompels M M. Takayasu arteritis: a review. J Clin Pathol. 2002; 55(7) 481-486
17 Sharma S, Rajani M, Shrivastava S et al.. Non-specific aorto-arteritis (Takayasu's disease) in children. Br J Radiol. 1991; 64(764) 690-698
18 de Franciscis S, Serra R, Luongo A, Sabino G, Puzziello A. The management of Takayasu's arteritis: personal experience. Ann Vasc Surg. 2007; 21(6) 754-760
19 Soto M E, Espinola N, Flores-Suarez L F, Reyes P A. Takayasu arteritis: clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival and prognosis. Clin Exp Rheumatol. 2008; 26(3, Suppl 49) S9-S15
20 Chung J W, Kim H C, Choi Y H, Kim S J, Lee W, Park J H. Patterns of aortic involvement in Takayasu arteritis and its clinical implications: evaluation with spiral computed tomography angiography. J Vasc Surg. 2007; 45(5) 906-914
21 Hotchi M. Pathological studies on Takayasu arteritis. Heart Vessels Suppl. 1992; 7 11-17
22 Nasu T. ‘Pathology of pulseless disease’, a systemic study and review of 21 autopsy cases reported in Japan. Angiology. 1963; 14 225-242
23 Chugh K S, Jain S, Sakhuja V et al.. Renovascular hypertension due to Takayasu's arteritis among Indian patients. Q J Med. 1992; 85(307-308) 833-843
24 Johnston S L, Lock R J, Gompels M M. Takayasu arteritis: a review. J Clin Pathol. 2002; 55(7) 481-486
25 Robles M, Reyes P A. Takayasu's arteritis in Mexico: a clinical review of 44 consecutive cases. Clin Exp Rheumatol. 1994; 12(4) 381-388
26 Duzova A, Türkmen O, Cinar A, Cekirge S, Saatci U, Ozen S. Takayasu's arteritis and tuberculosis: a case report. Clin Rheumatol. 2000; 19(6) 486-489
27 Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela J E. Takayasu's arteritis. Clinical study of 107 cases. Am Heart J. 1977; 93(1) 94-103
28 Aggarwal A, Chag M, Sinha N, Naik S. Takayasu's arteritis: role of Mycobacterium tuberculosis and its 65 kDa heat shock protein. Int J Cardiol. 1996; 55(1) 49-55
29 Sagar S, Ganguly N K, Koicha M, Sharma B K. Immunopathogenesis of Takayasu arteritis. Heart Vessels Suppl. 1992; 7 85-90
30 Salazar M, Varela A, Ramirez L A et al.. Association of HLA-DRB1*1602 and DRB1*1001 with Takayasu arteritis in Colombian mestizos as markers of Amerindian ancestry. Int J Cardiol. 2000; 75(Suppl 1) S113-S116
31 Vargas-Alarcón G, Zúñiga J, Gamboa R et al.. DNA sequencing of HLA-B alleles in Mexican patients with Takayasu arteritis. Int J Cardiol. 2000; 75(Suppl 1) S117-S122
32 Khraishi M M, Gladman D D, Dagenais P, Fam A G, Keystone E C. HLA antigens in North American patients with Takayasu arteritis. Arthritis Rheum. 1992; 35(5) 573-575
33 Kodama K, Kida O, Morotomi Y, Tanaka K. Male siblings with Takayasu's arteritis suggest genetic etiology. Heart Vessels. 1986; 2(1) 51-54
34 Mehra N K, Jaini R, Balamurugan A et al.. Immunogenetic analysis of Takayasu arteritis in Indian patients. Int J Cardiol. 1998; 66(Suppl 1) S127-S132 discussion S133
35 Judge R D, Currier R D, Gracie W A, Figley M M. Takayasu's arteritis and the aortic arch syndrome. Am J Med. 1962; 32 379-392
36 Kothari S S. Takayasu's arteritis in children: a review. Images Paediatr Cardiol. 2002; 9 4-23
37 Park M C, Park Y B, Jung S Y, Lee K H, Lee S K. Anti-endothelial cell antibodies and antiphospholipid antibodies in Takayasu's arteritis: correlations of their titers and isotype distributions with disease activity. Clin Exp Rheumatol. 2006; 24(2, Suppl 41) S10-S16
38 Numano F, Shimamoto T. Hypersecretion of estrogen in Takayasu's disease. Am Heart J. 1971; 81(5) 591-596
39 Inada K, Swashima Y, Okada A, Shimizu V. Aortitis syndrome: the diagnostic criteria. Gendai-lryo. 1976; 8 1183-1188
40 Kerr G S, Hallahan C W, Giordano J et al.. Takayasu arteritis. Ann Intern Med. 1994; 120(11) 919-929
41 Hoffman G S. Takayasu arteritis: lessons from the American National Institutes of Health experience. Int J Cardiol. 1996; 54(Suppl) S99-S102
42 Lagneau P, Michel J B, Vuong P N. Surgical treatment of Takayasu's disease. Ann Surg. 1987; 205(2) 157-166
43 Seth S, Goyal N K, Jagia P et al.. Carotid intima-medial thickness as a marker of disease activity in Takayasu's arteritis. Int J Cardiol. 2006; 108(3) 385-390
44 Park J H, Chung J W, Im J G, Kim S K, Park Y B, Han M C. Takayasu arteritis: evaluation of mural changes in the aorta and pulmonary artery with CT angiography. Radiology. 1995; 196(1) 89-93
45 Park J H. Conventional and CT angiographic diagnosis of Takayasu arteritis. Int J Cardiol. 1996; 54(Suppl) S165-S171
46 Kim S Y, Park J H, Chung J W et al.. Follow-up CT evaluation of the mural changes in active Takayasu arteritis. Korean J Radiol. 2007; 8(4) 286-294
47 Choe Y H, Han B K, Koh E M, Kim D K, Do Y S, Lee W R. Takayasu's arteritis: assessment of disease activity with contrast-enhanced MR imaging. AJR Am J Roentgenol. 2000; 175(2) 505-511
48 Matsunaga N, Hayashi K, Sakamoto I et al.. Takayasu arteritis: MR manifestations and diagnosis of acute and chronic phase. J Magn Reson Imaging. 1998; 8(2) 406-414
49 Sharma S, Sharma S, Taneja K, Bahl V K, Rajani M. Morphological mural changes in the aorta in non-specific aortoarteritis (Takayasu's arteritis): assessment by intravascular ultrasound imaging. Clin Radiol. 1998; 53(1) 37-43
50 Kobayashi Y, Ishii K, Oda K et al.. Aortic wall inflammation due to Takayasu arteritis imaged with 18F-FDG PET coregistered with enhanced CT. J Nucl Med. 2005; 46(6) 917-922
51 Talwar K K, Chopra P, Narula J et al.. Myocardial involvement and its response to immunosuppressive therapy in nonspecific aortoarteritis (Takayasu's disease)—a study by endomyocardial biopsy. Int J Cardiol. 1988; 21(3) 323-334
52 Scott D, Awang H, Sulieman B, Wang F, Arshad R B, Thomson N. Surgical repair of visceral artery occlusions in Takayasu's disease. J Vasc Surg. 1986; 3(6) 904-910
53 Miyata T, Sato O, Deguchi J et al.. Anastomotic aneurysms after surgical treatment of Takayasu's arteritis: a 40-year experience. J Vasc Surg. 1998; 27(3) 438-445
54 Miyata T, Sato O, Koyama H, Shigematsu H, Tada Y. Long-term survival after surgical treatment of patients with Takayasu's arteritis. Circulation. 2003; 108(12) 1474-1480
55 Fields C E, Bower T C, Cooper L T et al.. Takayasu's arteritis: operative results and influence of disease activity. J Vasc Surg. 2006; 43(1) 64-71
56 Taketani T, Miyata T, Morota T, Takamoto S. Surgical treatment of atypical aortic coarctation complicating Takayasu's arteritis—experience with 33 cases over 44 years. J Vasc Surg. 2005; 41(4) 597-601
57 Reddy E, Robbs J V. Surgical management of Takayasu's arteritis in children and adolescents. Cardiovasc J Afr. 2007; 18(6) 393-396
58 Yamato M, Lecky J W, Hiramatsu K, Kohda E. Takayasu arteritis: radiographic and angiographic findings in 59 patients. Radiology. 1986; 161(2) 329-334
59 Ishikawa K. Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu's arteriopathy. J Am Coll Cardiol. 1988; 12(4) 964-972
60 Dong Z-J, Li S H, Lu X C. Percutaneous transluminal angioplasty for renovascular hypertension in arteritis: experience in China. Radiology. 1987; 162(2) 477-479
61 Kumar S, Mandalam K R, Rao V R et al.. Percutaneous transluminal angioplasty in nonspecific aortoarteritis (Takayasu's disease): experience of 16 cases. Cardiovasc Intervent Radiol. 1990; 12 321-325
62 Tyagi S, Singh B, Kaul U A, Sethi K K, Arora R, Khalilullah M. Balloon angioplasty for renovascular hypertension in Takayasu's arteritis. Am Heart J. 1993; 125(5 Pt 1) 1386-1393
63 Sharma S, Sharma S, Taneja K, Gupta A K, Rajani M. Morphologic mural changes in the aorta revealed by CT in patients with nonspecific aortoarteritis (Takayasu's arteritis). AJR Am J Roentgenol. 1996; 167(5) 1321-1325
64 Liang P, Hoffman G S. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol. 2005; 17(1) 16-24

Sanjiv SharmaM.D.

Professor and Head, Department of Cardiac Radiology, All India Institute of Medical Sciences

New Delhi 10029, India

Email: meetisv@yahoo.com