DOI QR코드

DOI QR Code

Endovascular treatment of Takayasu arteritis in a middle-aged woman with syncope and limb claudication: a case report

  • Ha-Young Choi (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Sunggun Lee (Division of Rheumatology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Jino Park (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Yeo-Jeong Song (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Dong-Kie Kim (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Ki-Hun Kim (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Sang-Hoon Seol (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Doo-Il Kim (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Seunghwan Kim (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine)
  • Received : 2023.01.31
  • Accepted : 2023.03.14
  • Published : 2023.10.31

Abstract

Takayasu arteritis (TA) is a disease that causes inflammation and stenosis of medium to large blood vessels. We report a case of a 50-year-old female patient with newly developed hypertension, syncope, and claudication of the extremities. Total occlusion of the left subclavian artery at the origin was found and significant stenosis of the right common iliac artery was revealed by hemodynamic analysis. She was successfully treated with percutaneous angioplasty for multiple peripheral arterial diseases and was finally diagnosed with TA. In consultation with a rheumatologist, medical treatment for TA was initiated, the patient's hypertension disappeared, and her claudication symptoms improved.

Keywords

Acknowledgement

Conceptualization: all authors; Investigation, Data curation: HYC; Formal analysis, Supervision: SL, JP, YJS, DKK, KHK, SHS, DIK, SK; Writing-original draft: HYC; Writing-review & editing: all authors.

References

  1. Ishikawa K. Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu's arteriopathy. J Am Coll Cardiol 1988;12:964-72.
  2. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 1996;54(Suppl):S155-63.
  3. Osiro S, Zurada A, Gielecki J, Shoja MM, Tubbs RS, Loukas M. A review of subclavian steal syndrome with clinical correlation. Med Sci Monit 2012;18:RA57-63.
  4. Gu YQ, Wang ZG. Surgical treatment of cerebral ischaemia caused by cervical arterial lesions due to Takayasu's arteritis: preliminary results of 49 cases. ANZ J Surg 2001;71:89-92.
  5. de Boer SW, Heinen S, van den Heuvel D, van de Vosse FN, de Vries J; study contributors. How to define the hemodynamic significance of an equivocal iliofemoral artery stenosis: review of literature and outcomes of an international questionnaire. Vascular 2017;25:598-608.
  6. Zhu FP, Luo S, Wang ZJ, Jin ZY, Zhang LJ, Lu GM. Takayasu arteritis: imaging spectrum at multidetector CT angiography. Br J Radiol 2012;85:e1282-92.
  7. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33:1129-34.
  8. Hellmich B, Agueda A, Monti S, Buttgereit F, de Boysson H, Brouwer E, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2020;79:19-30.
  9. Sharma BK, Jain S, Suri S, Numano F. Diagnostic criteria for Takayasu arteritis. Int J Cardiol 1996;54(Suppl):S141-7.
  10. Yoneda S, Nukada T, Tada K, Imaizumi M, Takano T. Subclavian steal in Takayasu's arteritis: a hemodynamic study by means of ultrasonic Doppler flowmetry. Stroke 1977;8:264-8.
  11. Agueda AF, Monti S, Luqmani RA, Buttgereit F, Cid M, Dasgupta B, et al. Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis. RMD Open 2019;5:e001020.
  12. Patel SN, White CJ, Collins TJ, Daniel GA, Jenkins JS, Reilly JP, et al. Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv 2008;71:963-8.
  13. Ogino H, Matsuda H, Minatoya K, Sasaki H, Tanaka H, Matsumura Y, et al. Overview of late outcome of medical and surgical treatment for Takayasu arteritis. Circulation 2008;118:2738-47.
  14. Choi YK, Jung YO, Kim HM, Kang MK. A case of a patient with Takayasu arteritis treated with left subclavian artery stent implantation. J Cardiol Cases 2015;12:123-5.
  15. Satti SR, Golwala SN, Vance AZ, Tuerff SN. Subclavian steal: Endovascular treatment of total occlusions of the subclavian artery using a retrograde transradial subintimal approach. Interv Neuroradiol 2016;22:340-8.
  16. Hadjipetrou P, Cox S, Piemonte T, Eisenhauer A. Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels. J Am Coll Cardiol 1999;33:1238-45.
  17. Kandarpa K, Becker GJ, Hunink MG, McNamara TO, Rundback JH, Trost DW, et al. Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: part I. J Vasc Interv Radiol 2001;12:683-95.
  18. Brountzos EN, Malagari K, Kelekis DA. Endovascular treatment of occlusive lesions of the subclavian and innominate arteries. Cardiovasc Intervent Radiol 2006;29:503-10.