Takayasu's arteritis

Takayasu’s arteritis, a rare form of vasculitis, is a chronic condition characterized by inflammation of the largest blood vessel in the body, the aorta, and its branches. The inflammation can result in weakening that leads to aneurysms, ballooning of portions of the vessels that can lead to fatal rupture. The inflammation can also result in narrowing and blockage of the arteries that can lead to poor circulation, muscle pain with exertion, organ damage or stroke.

Takayasu’s arteritis is most common in young Asian women. It is also called aortic arch syndrome, Takayasu’s aortitis and pulseless disease, due to the inability to find a pulse in the extremities due to blood vessel narrowing. The cause is not known.

Early symptoms of Takayasu’s arteritis include fatigue, night sweats, fever, poor appetite, weight loss, joint pain and chest pain. However, the condition usually goes undiagnosed until more severe symptoms are present. These later symptoms depend on which portion of the arteries are affected and may include:

• High blood pressure and kidney failure, due to reduced blood flow to the kidneys
• Weak or absent pulses in the arms, neck or legs
• Differences in blood pressure between the right and left limbs
• Angina (chest pain), especially with exertion
• Shortness of breath and fatigue, resulting from congestive heart failure
• Fainting or dizziness, changes in vision, mini-stroke or stroke resulting from poor blood flow to the brain
• Abdominal pain, nausea and vomiting, resulting from poor blood flow to the abdomen
• Muscle weakness and pain in the arms or legs when moved

Takayasu’s arteritis is most commonly found in young, Asian women. Diagnosis usually occurs around the age of 30.

The earliest clue that a young person (less than 40 years of age) has Takayasu’s arteritis is unexplained high blood pressure. Physician’s use the following criteria to distinguish Takayasu’s arteritis from other forms of vasculitis:

• Symptoms beginning at age 40 or younger
• Muscle weakness and pain when you move your arms or legs
• A weak pulse in the brachial artery, the major artery in the upper arm
• A bruits, a “whooshing” sound heard in the subclavian artery or the aorta through a stethoscope
• A difference of at least 10 mmHg in the systolic blood pressure in the right versus left arm

The treatment of Takayasu’s arteritis focuses on decreasing inflammation and controlling blood pressure, both through medication. If the disease has caused significant damage or narrowing in a particular artery, it may require endovascular or surgical repair to restore proper function o the affected limb or organ.

Endovascular treatment

Arteries narrowed or occluded due to Takayasu’s arteritis may be treated using angioplasty and stenting. This involves the placement of a catheter in an artery of the groin through a small nick in the skin. A balloon is pushed through to the affected portion of the artery where it is opened, pushing apart the artery wall. A tube-like stent is then put in place to keep the artery open and the blood flowing freely. Patients usually stay in the hospital overnight and quickly resume normal activities.

Surgical repair

Open surgical repair of a severely damaged artery involves usually involves a graft taken from a healthy vessel.

Treatment with medication alone relieves symptoms in nearly 80 percent of Takayasu’s arteritis patients.