Discussion Author(s): Primary author: Jason Messinger
Contributing author: Eric Jones
Takayasu arteritis (TA) is a large vessel vasculitis that results in chronic inflammation of the aorta and its major branches. The disease can result in stenosis, obstruction, and aneurysm. Secondary effects of stenosis can manifest in patients as well including abdominal complications, cerebral vascular accidents, congestive heart failure, or ischemia. It has been reported that TA tends to affect Asian women more than any other race or sex; 80-90% of TA patients are women. A patientâ€™s race also seems to specify the type of manifestation of TA. In the US it has been reported that most manifestations involve the left subclavian, superior mesenteric, and abdominal aorta while in Japan the aortic arch is mostly afflicted. Detecting Takayasu arteritis can be done through radiographic imaging techniques including computer tomography (CT), magnetic resonance imaging (MRI), and angiography.
There are two stages of Takayasu arteritis: early and late. The late stage is subdivided into four categories; each of which has uniquely different radiographic characteristics. Usually angiography is done to demonstrate the luminal changes that arise from stenoses of major arteries in late-phase TA. It has been reported that stenosis occurs in approximately 90% of patients with TA.
Clinical symptoms that manifest during early-stage TA include fever, anthralgia, cough, anemia, pain in the chest and abdomen, and myalgia as well as laboratory findings of increased erythrocyte sedimentation rate and C-reactive protein test. Diagnosis of TA during early stage can be difficult for the reason that the symptoms mentioned are nonspecific. Findings on radiological imaging can also make diagnosis of early-stage TA difficult since the arterial wall is what is mainly affected. In late stage TA, most of the symptoms are attributed to the secondary effects of the disease. They can include a degenerated media, elastic fibers in the arterial wall, adventitial and intimal layer thickening of the artery involved. Radiological diagnosis of late-stage TA is more easily done because of the evident stenosis, obstruction, or dilatation that may be observed in the aorta and its branches or the increasingly common finding in the pulmonary artery.
The etiology for TA is unknown and is usually diagnosed in patients when symptoms of secondary effects begin to surface â€“ usually during the late stage. Although no clear etiology has been found, there is evidence to suggest a hereditary component to the disease. Various antigens have been associated with Takayasu arteritis.
Methods of treatment for the disease include steroidal treatment to reduce chronic inflammation. A study also reported the successful treatment of TA derived aortic and renal stenosis by percutaneous transluminal angioplasty; this may suggest its efficacy in treating stenosis in other major arterial branches. Aortic valve replacement, antiplatelet therapy, and/or coronary bypass surgery are treatments for TA manifestations. Mortality of TA is low and has a reported 15 year survival rate of 85-95%.
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