Abstract No. 374 Juxtarenal aortic angioplasty in the patients of Takayasu arteritis presenting in emergency with uncontrolled hypertension: experience from a tertiary care center

Abstract

Takayasu’s arteritis (TA) can involve aorta and its major branches. With recent technical advances, endovascular treatment gaining attention in the management of TA. The involvement of juxta-renal abdominal aorta is quite challenging to treat because of close vicinity of visceral branches and renal arteries, which has got potential for obstructing these important branches and further worsening the clinical symptoms. Stenting in this territory is also fought with fear because of the same reasons. We retrospectively analyzed safety and outcome of juxta-renal abdominal aortic angioplasty in TA patients presenting in emergency with uncontrollable hypertension. We retrospectively analyzed the departmental data of aortic interventions in TA between 2015 to 2019. We found total of 38 patients of TA, in whom supra to infrarenal aortic interventions were performed. Among these patients, 8 patients met our study criteria and all of them underwent only juxtarenal abdominal aortic angioplasty. The patients aged from 7 to 40 years. 6 patients were females and 2 were males. All of them had uncontrollable hypertension with significant juxta-renal aortic stenosis (pressure gradient > 20 mm Hg). Juxta-renal aortic angioplasty was performed in all the patients, leaving residual stenosis of 30-40% stenosis and residual pressure gradient of 20 to 30 mm Hg. All the patients except one patient developed non obstructive focal dissection flap. However, none of them were causing visceral branch obstruction and managed conservatively. In one patient, the flap was extending to right renal artery which was managed with renal angioplasty. None of the patients underwent aortic stenting. Despite intermediate angiographic results, there was short-term clinical improvement with adequate control of BP. The juxta-renal aortic lesions are quite challenging, whether it is surgical or endovascular treatment. Surgical management is associated with high morbidity and mortality. Endovascular technique provide alternative treatment option in these kind of challenging anatomy. It is feasible and provide good early outcome results. Despite intermediate angiographic results, the clinical outcomes are adequate.