Therapeutic approach to progressive Takayasu's arteritis

Abstract

Background. Takayasu's arteritis (TA) is a nonspecific autoimmune inflammation manifested with systemic large vessel vasculitis which affects predominantly the aorta and its main branches. Case report. We presented a 40-year-old woman with a two-year history of the symptoms of compromised circulation in the head, the neck, the upper extremities and the right leg, followed by claudications in the left leg, numbness in the left hand and stenocardia. Aortic arch angyography revealed occlusion of the right subclavian artery stenosis of the right vertebral artery (20?30%) and the right iliac artery. Anti-inflammatory agents had no satisfactory effect and due to the discase progression first aorto-bifemoral bypass grafting, and 10 months later left carotid-axillary bypass grafting were performed which led to the restoration of circulation in the lower extremities and the left arm. Conclusion. This case suggested that a surgical therapy should be applied in the cases with progressive Takayasu's arteritis, particularly in the absence of a response to the conventional immunosupressive therapy to prevent eventual fatal complications.