Balloon angioplasty of the aorta in Takayasu's arteritis: Initial and long-term results

Abstract

Percutaneous transluminal balloon angioplasty for stenosis of the aorta was performed in 36 patients with Takayasu's arteritis (age range, 8 to 36 years; mean, 19.1 ± 7.7 years). Balloon dilatation was successful in 34 patients and resulted in a decrease in the mean peak systolic pressure gradient (PSG) from 75.2 ± 29.1 mm Hg to 24.8 ± 19 mm Hg ( p < 0.001) and a mean increase in the diameter of the stenosed segments from 4.5 ± 2.2 mm to 9.6 ± 3.8 mm ( p < 0.001). Hemodynamic and angiographic restudy, which was performed in 20 patients at a mean follow-up period of 7.7 ± 4.1 months (range, 3 to 24 months), showed a further decrease in PSG (≥ 15 mm Hg) in seven patients (from 40.0 ± 11.2 mm Hg to 15.7 ± 10.2 mm Hg; p < 0.01), no significant change in PSG in 12 patients (17.1 ± 13.6 mm Hg vs 16.6 ± 12.7 mm Hg; p = NS, and an increase in PSG from 15 mm Hg to 85 mm Hg in one patient. The patient who showed restenosis underwent successful redilatation. Six patients who underwent late recatheterization and angiography at 36 to 60 months (mean, 43 ± 9.4 months) show continued relief of stenosis (mean PSG, 8.8 ± 7.8 mm Hg). Patients with short-segment (< 4 cm) stenosis experience more relief than patients with long-segment (≥ 4 cm) stenosis (residual PSG, 18.6 ± 8.2 mm Hg vs 40 ± 16 mm Hg; p < 0.01). All successfully treated patients experienced improvement in their symptoms and hypertension. There were no significant complications. No patient showed evidence of an aneurysm immediately after percutaneous transluminal balloon angioplasty or during follow-up aortography. Percutaneous transluminal balloon angioplasty for stenosis of the aorta in patients with Takayasu's arteritis is safe and highly effective and produces sustained improvement.