Abstract 176: Persistent Peripheral Arteritis Long After Kawasaki Disease - Another Documentation Of Ongoing Vascular Inflammation -

Abstract

A 22-year-old male patient, who was suffered from Kawasaki disease (KD) at 1 year and 1 month of age and left with bilateral axillary arterial aneurysms (AAA) and regressed coronary aneurysm, visited us because of left hand edema and itchiness. He has been taking aspirin for thromboprophylaxis of AAA and well without any vascular event for these 20 years and does not have any sign of inflammatory disease. Digital subtraction angiography of bilateral arms revealed complete occlusion of left AAA with multiple collateral arteries supplying blood flow to the distal arm and persistent giant right AAA with 12 mm in diameter with only mild stenosis proximal to this AAA. To determine if the active inflammatory process is going on the axillary artery wall, the patient underwent positron emission tomography (PET) using fluorodeoxyglucose (FDG) with co-registration of multi-detector x-ray computed tomography, PET indeed showed significant FDG uptake inside and part of the outer wall of the left AAA and only minimum FDG uptake at the right AAA. For left arm ischemia, he underwent resection of the left AAA and successful axilla-brachial artery bypass surgery using a reversed autologous saphenous vein graft that relieved his symptoms. Histological examination of the resected wall of AAA showed significant intimal thickening and the immunohistochemistry study labeling CD68, as the marker of macrophages, showed relatively dense staining of the intimal thickening of left AAA wall compatible with FDG uptake. This is the first documentation of persistent inflammation of peripheral arterial wall long after KD using FDG-PET that must have resulted in peripheral arterial remodeling.