Ur12 4-2


Published on

Published in: Education
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Ur12 4-2

  1. 1. Takayasu’s arteritis <ul><li>a large vessel vasculitis of unknown etiology that typically affects the aorta and its branches . </li></ul><ul><li>Clinical manifestations relate to vascular insufficiency from narrowing, thrombus, or aneurysm of affected arteries . </li></ul><ul><li>Gross pathology typically reveals thickened arterial walls with vessel narrowing and compensatory collateralization . More severe damage consists of aneurysm formation, particularly of the proximal aorta . </li></ul>Koopman’s Arthritis and allied condition, 5 th edition
  2. 2. Takayasu’s arteritis <ul><li>The prepulseless phase of nonspecific constitutional symptoms is followed by a pulseless phase where vascular involvement is clinically and radiographically apparent. </li></ul><ul><li>Upper extremities are more frequently affected. </li></ul><ul><li>Lab: elevated ESR, elevated CRP, thrombocytosis, and normocytic, normochromic anemia </li></ul><ul><li>Long, stenotic lesions are the most characteristic finding on angiography, with poststenotic dilations and aneurysm formation occurring in approximately one third of patients. </li></ul>Koopman’s Arthritis and allied condition, 5 th edition
  3. 3. Primer on Rheumatic disease, 13 th edition
  4. 4. Takayasu’s arteritis: MRI <ul><li>Its advantages over angiography are that it is noninvasive, directly visualize the arterial wall for signs of inflammation, and does not use ionizing radiation. </li></ul><ul><li>In early disease, MRI may detect subtle mural wall abnormalities that precede detectable stenotic lesions seen on angiography. </li></ul><ul><li>Findings include increased wall thickness of vessels in a concentric pattern, aneurysm formation, and stenotic lesions. </li></ul>Koopman’s Arthritis and allied condition, 5 th edition
  5. 5. Takayasu’s arteritis: MRI <ul><li>Prospective investigations reveal that MRI abnormalities have a sensitivity of 88% to 94% in patients with clinically active disease. </li></ul><ul><li>I t is unclear if MRI overestimates disease activity or if current laboratory and clinical assessments fall short of accurately determining ongoing inflammation. </li></ul>Koopman’s Arthritis and allied condition, 5 th edition
  6. 6. Takayasu’s arteritis Koopman’s Arthritis and allied condition, 5 th edition Patients with at least three criteria have probable TA with a sensitivity of 90.5% and a specificity of 97.8% .    
  7. 7. Takayasu’s arteritis: DDX <ul><li>TB </li></ul><ul><li>Syphilis </li></ul><ul><li>Giant cell arteritis </li></ul><ul><li>SLE </li></ul><ul><li>RA </li></ul><ul><li>Behcet’s </li></ul><ul><li>Buerger’s disease </li></ul><ul><li>Kawasaki disease </li></ul>Koopman’s Arthritis and allied condition, 5 th edition
  8. 8. Takayasu’s arteritis: Rx <ul><li>Glucocorticoids : initial regimen of prednisone is 1 mg / kg po OD = cornerstone of therapy . </li></ul><ul><li>60% of pt achieve initial remission with glucocorticoids alone but additional cytotoxic agents are frequently required to maintain remission or as a steroid - sparing agent such as cyclosporine, cyclophosphamide, MTX, MMF and leflunomide . </li></ul>Koopman’s Arthritis and allied condition, 5 th edition
  9. 9. Takayasu’s arteritis: Rx <ul><li>Severe ischemia, stroke, HT from renal artery stenosis, or AR can require surgery or percutaneous intervention in order to control or alleviate symptoms. </li></ul><ul><li>Surgical or percutaneous intervention is typically recommended during disease inactivity because this may improve long - term outcomes . </li></ul>Koopman’s Arthritis and allied condition, 5 th edition
  10. 10. Review film <ul><li>CTA จากจันทบุรี Aorta ดูปกติ wall บางและ regular ดีไม่เหมือน Aortitis ดูเหมือนกับ Malformation มากกว่า , มี aberrant Rt subclavian อ้อมไปด้านหลัง trachea </li></ul><ul><li>MRA จากจันทบุรี 10/3/53 มี dilatation สลับกับ stricture ที่ aortic arch แต่ Aorta ดูเรียบๆ แต่ที่ femoral & anterior tibial artery ดูไม่เหมือน process ของ vasculitis หรือ thrombosis เนื่องจากบริเวณเส้นอื่นๆใกล้เคียงดูปกติไม่มีขรุขระเลย </li></ul>
  11. 11. Histological Diagnosis of Atypical Takayasu Arteritis Using Percutaneous Transluminal Atherectomy : case report <ul><li>24-year-old woman with severe peripheral artery disease, imaging showed bilateral occlusion of SFA , but no lesions of the proximal or supra-aortic vessels. The right SFA was treated first; after guidewire passage through the occlusion, followed by balloon angioplasty. Catheter biopsy showed inflammatory infiltrates consistent with Takayasu arteritis. </li></ul>Beschorner et al. Diagnosis of Atypical Takayasu Arteritis Using Percutaneous Transluminal Atherectomy. Journal of Endovascular Therapy. 2008. 1545-1550.15 : 241-243