he diseased aorta in Takayasu’s arteritis features areas of ectasia and stenosis; the aorta is left with very little elastic tissue due to diffuse fibrosis of the intima, media, and externa. Stent-supported endovascular aortoplasty and surgical revascularization are associated with higher complication and recurrence rates, even with regular immunomodulation follow-up. Unlike atheromatous disease, the inflexible artery is vulnerable to dissection, and is as “brittle as glass” during balloon angioplasty. Therefore, some authors suggest self-expanding stent or stent-graft supported angioplasty for this condition, with high-pressure dilation,to overcome fibrosis caused by panarteritis. However, the incidence of dissection in this situation appears to be under-reported.

1. Takayasu’s arteritis
The name comes after a Japanese
ophthalmologist, Dr Mikito Takayasu,
who in 1908 first reported characteristic
symptoms of this disease

2. Also known as
Pulseless disease
Occlusive
thromboaortopathy

3. Epidemiology
Affect women more often, with a
ratio of 1.2‐29:1
rare in North America but more
prevalent in the Far East

4. Pathology
• Inflammatory injury to the vessel wall
• Patchy disappearance of the elastic tissue and smooth muscle layer
• Intimal hyperplasia
• Vascular stenosis in virtually all patients
• Dilatation and aneurysm in about 25%

5. Course of disease
• Most patients develop nonspecific generalized symptoms such as
malaise, fever, night sweats, arthralgias, anorexia, and weight
loss, which may occur months before vessel involvement is
apparent. Later in the course of the disease, patients often
present with hypertension and contribute to renal, cardiac, and
cerebral injury. The course of the disease is variable; most
patients have a chronic relapsing and remitting course. Survival
rates have increased greatly recently so that 10‐year survival
rates of 80%‐90% have become common. Disease‐related
mortality most often occurs from heart failure, stroke, myocardial
infarction, aneurysm rupture, renal failure, or infectious
complications of immunosuppressive treatment

6. In 1990, the American
College of Rheumatology
criteria for the diagnosis of
Takayasu's arteritis
• Age of onset < 40 years
• Claudication of extremities.
• Decreased brachial artery pressure.
• Blood pressure difference > 10 mm Hg
• Bruit over subclavian arteries and aorta.
• Aortogram abnormalities.
• At least 3 of the above 6
criteria are to be met for the
diagnosis and demonstrate a
sensitivity of 90.5% and a
specificity of 97.8%

7. Standard treatment for Takayasu's arteritis
High‐dose steroids Immunomodulators:methotrexate,
cyclophosphamide, and azathioprine
Structural damage to affected vessels:
angioplasty to improve blood flow or arterial
bypass or reconstruction in severe cases

8. Wish you
Happy New
Year 2020