Takayasu arteritis –anatomy, classification physical examination

1. Takayasu Arteritis –Anatomy, Classification
Physical examination
Student: Guilherme Lima Paschoalini
Group 29, 5th year
KURSK - 2017
Dr
STATE BUDGETARY EDUCATIONAL ESTABLISHMENT
OF HIGHER PROFESSIONAL EDUCATIONAL
MINISTRY OF PUBLIC HEALTH OF RUSSIAN FEDERATION
KURSK STATE MEDICAL UNIVERSITY
DEPARTMENT OF SURGERY
Head of Department: MD Phd Prof Ivanov. S. V
Teacher: MD Dr Tsukanov. A. V

2. Definition
Takayasu arteritis is a rare, systemic,
inflammatory large-vessel vasculitis of
unknown etiology that most commonly affects
women of childbearing age. It is defined as
"granulomatous inflammation of the aorta and
its major branches"

3. ANATOMY
The aorta can be divided into four
sections: the ascending aorta,
the aortic arch, the thoracic
(descending) aorta and
the abdominal aorta.

4. BRANCHES
 Ascending Aorta: left and right coronary arteries
 Thoracic Aorta: Bronchial arteries; Mediastinal arteries; Oesophageal arteries;
Pericardial arteries; Superior phrenic arteries; Intercostal and subcostal arteries
 Abdominal Aorta: Inferior phrenic arteries; Coeliac artery; Superior mesenteric
artery; Middle suprarenal arteries; Renal arteries; Gonadal arteries; Inferior
mesenteric artery; Median sacral artery; Lumbar arteries.

6. Aortic Arch:
 Brachiocephalic trunk: The first and largest branch that ascends laterally
to split into the right common carotid and right subclavian arteries. These
arteries supply the right side of the head and neck, and the right upper
limb.
 Left common carotid artery: Supplies the left side of the head and neck.
 Left subclavian artery: Supplies the left upper limb.

8. CLASSIFICATION
Angiography-based categories:
 Type I - Branches of the aortic arch
 Type IIa - Ascending aorta, aortic arch, and its branches
 Type IIb - Type IIa region plus thoracic descending aorta
 Type III - Thoracic descending aorta, abdominal aorta, renal arteries, or a
combination
 Type IV - Abdominal aorta, renal arteries, or both
 Type V - Entire aorta and its branches

10. HISTORY
 Constitutional symptoms include the following: Headache (50-70%);
Malaise (35-65%); Arthralgias (28-75%); Fever (9-35%); Weight loss (10-
18%)
 Cardiac and vascular features include the following: Bruit, with the most
common location being the carotid artery (80%); Blood pressure difference
of extremities (45%-69%); Claudication (38-81%); Carotodynia or vessel
tenderness (13-32%); Hypertension (28-53%; 58% with renal artery
stenosis in one series); Aortic regurgitation (20-24%)
 Neurologic features include the following: Headache (50-70%); Visual
disturbance (16-35%) - Strong association with common carotid and
vertebral artery disease; Stroke (5-9%)

11. Classification criteria
The American College of Rheumatology has established classification
criteria for Takayasu arteritis (3 of 6 criteria are necessary).
 Age of 40 years or younger at disease onset
 Claudication of the extremities
 Decreased pulsation of one or both brachial arteries
 Difference of at least 10 mm Hg in systolic blood pressure between arms
 Bruit over one or both subclavian arteries or the abdominal aorta
 Arteriographic narrowing or occlusion of the entire aorta, its primary branches, or
large arteries in the upper or lower extremities that is not due to arteriosclerosis,
fibromuscular dysplasia, or other causes

12. STAGES
 The first stage is an early systemic stage during which the patient may complain of
constitutional symptoms (eg, fatigue, malaise, giddiness, fever). This stage is
considered to be prevasculitic.
 The second stage is the vascular inflammatory stage when stenosis, aneurysms, and
vascular pain (carotidynia) tend to occur.
 The third stage is the burned-out stage, when fibrosis sets in, and generally is
associated with remission.

14. PHYSICAL EXAMINATION
 A thorough physical examination is essential, with particular attention paid to peripheral
pulses, blood pressure in all 4 extremities, and ophthalmologic examination. The most
discriminatory finding is a systolic blood pressure difference (>10 mm Hg) between
arms.
 Hypertension due to renal artery involvement (and sometimes leading to hypertensive
encephalopathy) is found in approximately 50% of patients. Carotidynia may be present.
Aortic regurgitation is a common finding.
 Absent or diminished pulses are the clinical hallmark of Takayasu arteritis, but pulses are
normal in many patients and upper limbs are affected more often than lower limbs.
 Ophthalmologic examination may show retinal ischemia, retinal hemorrhages, cotton-
wool exudates, venous dilatation and beading.

15.  Complete occlusion of the left common carotid artery in a 48-
year-old woman with Takayasu disease.

16.  Characteristic long, tapered narrowing of the distal aorta
and iliac vessels.

17.  Narrowing of the proximal descending aorta and right
brachiocephalic artery.

18. REFERENCES
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