Refractory rapidly progressive Takayasu's arteritis successfully treated with surgery.
We describe a case of a patient with rapidly progressive Takayasu's arteritis (TA) refractory to conventional immunosuppressive therapy in whom bypass surgery was successfully performed. A 38-year-old woman had 2 years history of symptoms of compromised cerebral circulation, severe claudication of upper and lower limbs and stenocardial symptoms. Serial arteriography revealed occlusions of the right subclavian and right common iliac arteries and later on stenosis of the abdominal aorta and complete obliteration of the left subclavian artery. Coronarography did not show coronary stenosis. Completely occluded left subclavian artery resulted in a characteristic subclavian steal syndrome. Therapy with combined immunosuppressants was ineffective, severe ischaemic symptoms related to arterial occlusions progressed and surgical intervention was inevitable. She underwent aorto-bifemoral and 10 months later left carotid-axillary bypass grafting. The ischaemic symptoms were resolved after surgery. At 3 years follow-up, the patient remained asymptomatic with no evidence of restenosis. This case indicates that patients with progressive TA with no improvement while on conventional immunosuppressive therapy could have satisfactory outcome and excellent long-term clinical remission after multiple arterial bypass grafting.
Petrovic-Rackov
Ljiljana
L
Clinic of Rheumatology and Clinical Immunology, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia. ljrackov@eunet.yu
Pejnovic
Nada
N
Jevtic
Miodrag
M
D000328:Adult; D000792:Angiography / Q000379:methods; D001013:Aorta, Thoracic / Q000473:pathology; D001167:Arteritis / Q000473:pathology; D003251:Constriction, Pathologic; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D013348:Subclavian Artery / Q000473:pathology; D013625:Takayasu Arteritis / Q000601:surgery*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents