PS 17-07 TAKAYASU'S ARTERITIS WITH RARE ABDOMINAL AORTIC THROMBOSIS CAUSED REPEATED ATTACKS OF HEART FAILURE AND UNCONTROLLED HYPERTENSION

Abstract

Objective: Takayasu's arteritis (TA) is a chronic, idiopathic, inflammatory disease affecting the aorta and its branches. Abdominal aortic thrombosis due to TA was rare. To date, only one case has been reported in literatures. Design and method: After bilateral artificial subclavian-iliac bypass, a case of abdominal aortic thrombosis due to TA was delayed diagnosis in a 44-year-old male with history of recurrent episodes of heart failure and uncontrolled hypertension with claudication of two extremities and elevated blood sugar for nearly 4 years. Results: He had smoked 30 cigarettes a day for 30 years. His upper-limb blood pressure (BP) was much higher than lower-limb BP. He had a bruit over the abdominal aorta with high serum creatinine and brain natriuretic peptide. Abdominal color Doppler sonography and CT aortography (CTA) showed occlusion of the abdominal aorta and narrowing of the bilateral renal arteries. His cardiac function was improved after vascular bypass and during 2-year follow-up, his blood pressure was controlled with reduced serum creatinine under antihypertensives, antidiabetic, antiplatelet therapy etc. Compared with prebypass, CTA showed abdominal aortic thrombosis resulted in arterial occlusion extending from the left renal artery initial segment level to bilateral common iliac artery and the bifurcation of renal artery except for vascular bypass. He was rehospitalized for heart failure and hydrothorax two years after the bypass and MR imaging revealed thickened wall of aortic branch. He was discharged after glucocorticoid treatment etc. His cardiac function and blood pressure were well-controlled for the next year. Conclusions: Abdominal aortic thrombosis due to TA is rare and potentially life threatening, probably become one atherosclerosis risk factor. Doppler sonography and CTA are important in diagnosis of TA, while MRI can identify the disease phase. Artificial vascular bypass can be used for severe TA patients with complicated aortic disease and glucocorticoid treatment is essential for those in acute phase.