Pulseless Disease Research Articles

Anaesthetic management of a case of Takayasu arteritis: A case report

Takayasu's arteritis (TA) is a rare disease characterized by chronic progressive pan-endarteritis involving large blood vessels with resultant feeble pulsations in involved arteries. Therefore, it is also referred as pulseless disease. The challenges for anaesthesia management includes uncontrolled hypertension, invasive arterial monitoring, central nervous system monitoring and end-organ dysfunction. We present successful management of a middle-aged female diagnosed with TA posted for aorto-carotid graft. The anaesthesia management and complications encountered are highlighted.

Unveiling the Silent Constrictor: A Case Report of Takayasu Arteritis Manifesting as a Vascular Enigma

Introduction
 Takayasu arteritis (TKA) is a rare large vessel vasculitis, most prevalent in Asia and affecting females ages 10-40 years. Through unclear etiology, it triggers chronic granulomatous inflammation leading to vessel wall thickening, stenosis, and occlusion. Manifestations vary from mild malaise to severe ischemic complications. Diagnosis hinges on clinical criteria, including angiography, and exclusion of mimicking conditions like giant cell arteritis, fibromuscular dysplasia, or atherosclerosis. Treatment necessitates immunosuppression and anti-inflammatories to curb disease progression and limit complications.
 Case Presentation
 A 61-year-old Caucasian female presented with claudication of the upper extremities upon using the shower. She reported episodes of headache, myalgia, fever and chills of several months. She reported fatigue with overhead reaching and difficulty finding her pulse on her upper extremities. Labs were notable for elevated ESR and CRP. MRA chest showed smoky thickened appearance of the descending aorta wall, some missing wall thickening in origins of the left common carotid and left subclavian arteries. PET scan revealed diffuse hypermetabolic activity involving the bilateral common carotid arteries, peripheral aortic arch and descending thoracic aorta (Figure 1). With these ongoing symptoms and characteristic features on imaging, we established the diagnosis of TKA. She was started on 5mg oral prednisone daily and methotrexate 10mg weekly with daily folic acid.
 Conclusion
 This case highlights the diagnosis and treatment of a rare condition, Takayasu arteritis, the pulseless disease. TKA is a challenging condition to study and understand fully, but advancements in medical knowledge, imaging, and management are gradually improving our understanding and ability to diagnose and treat this condition. With increased awareness of this condition, earlier detection and monitoring will serve to benefit future patient populations.

A Rare Presentation of Dilated Cardiomyopathy Along with Takayasu Arteritis in a Preschool Child

Dilated cardiomyopathy is the most common form of cardiomyopathy in children, is the cause of significant morbidity and mortality. Although the most common etiology of DCM remains idiopathic, it is estimated that upto 50% of cases are genetic. The pathogenesis of ventricular dilation and altered contractility seen in DCM varies depending on the underlying etiology; systolic dysfunction and myocyte injury are common. Takayasu arteritis also known as “pulseless disease”, is a chronic large vessel vasculitis of unknown etiology and predominantly involves the aorta and its major branches. This disease is most common in Asians and mostly diagnosed in adolescent age group, on average at the age of 13 years. TA is characterized by inflammation of the vessel wall starting from vasa vasorum. Persistent inflammation leads to progressive scarring and intimal proliferation and can result in stenotic or occluded vessels leading to systemic manifestations. We have reported a rare case of dilated cardiomyopathy along with Takayasu arteritis in a preschool child. The causality and association between both the conditions has not been fully understood yet. However DCM has been reported in only 5-6% cases of TA.

Ocular Manifestations of Takayasu's Arteritis-A Case-Based Systematic Review and Meta-Analysis.

Takayasu's arteritis (TA) is a type of vasculitis in which inflammation develops in large vessels, especially in the aorta and its branches. Our study aims to determine the prevalence and type of ocular manifestations in TA. A systematic literature search was conducted in December 2022 using three electronic databases (PubMed, Scopus, and Web of Science). The following data were extracted from each article: the name of the first author; the patient's age, sex, and origin (continent); circumstances connected with the diagnosis of TA; symptoms given by the patients; reported ocular manifestations; and administered treatment. The final analysis was based on data collected from 122 cases. Retinal ischemia, followed by optic neuropathy, cataract, and retinal artery occlusion, were the most prevalent eye conditions associated with the disease. Systemic steroid therapy, vascular procedures, and methotrexate were mainly used to treat pulseless disease. Patients mostly complained of gradual vision acuity loss, sudden vision acuity loss, ocular pain, and amaurosis fugax. The diagnosis of Takayasu's arteritis should be considered in patients presenting symptoms of visual decline/loss, ocular pain, or signs of retinal ischemia, optic neuropathy, or early cataract formation. A proper diagnosis is crucial to ensure the patient receives treatment without significant delay.

Takayasu's arteritis - a summary of current, clinically relevant knowledge of the disease

Takayasu's disease, also known as pulseless disease or aortic arch syndrome, is a rare inflammation of the aorta and its branches, and sometimes the pulmonary arteries, which, according to studies, occurs most frequently in people from the Far East and Asian countries. In addition, its incidence is significantly higher in women, and the mean age of affected patients is 45.4 years [1]. The first official clinical case report of the disease by Shimizu and Sano appeared in 1951, while the name of the disease was proposed by Cassamise and Okuda in 1954 to honour the first clinician, Mikito Takayasu, who as early as 1908 presented a case of a young female patient with characteristic fundus lesions associated with pulse disturbances [2].

АА-амилоидоз – редкая причина поражения почек у пациентки с артериитом Такаясу

Takayasu’s arteritis (TAK) is a systemic large vessel vasculitis that usually develops at young age in females and affects aorta and its branches (pulseless disease). Patients with TAK frequently present with renal artery stenosis associated with renovascular hypertension and ischemic nephropathy, whereas glomerular and interstitial kidney disease is very rare. As any other chronic inflammatory diseases, TAK can be complicated with AA-amyloidosis manifesting by progressive proteinuria, nephrotic syndrome and chronic renal failure. AA-amyloidosis in patients with TAK and other immune-mediated inflammatory disease justifies intensification of immunosuppressive and antiinflammatory therapy (e.g. using interleukin-6 inhibitors) that is essential to prevent progression of kidney amiloidosis.

Takayasu arteritis associated with tuberculosis: a case report

Takayasu arteritis, also called pulseless disease, is the chronic inflammation of the vessels, mainly the aorta and large vessels. It mainly affects females more than males with the ratio of 2.15:1 and in the second and third decade of life. Mechanism may be transmural fibrous thickening of the arterial walls. Takayasu’s is characterized by granulomatous inflammation of the vessel wall, leading to occlusion of the vessel wall. It is represented with claudication, fever, arthralgia. Clinical features are chest pain, vascular bruits, Hypertension. Investigation is based on angiography and CT scan. Medical treatment prednisolone is the first line agent 1mg/kg/day maximum dose is 60mg/day with gradual tapering as per European league against rheumatism guidelines, methotrexate and azathioprine are for inducing remission of arterial lesions, tumour necrosis factor-a antagonists, anti-IL-6 receptor monoclonal antibody like tocilizumab. Surgical treatment is angioplasty and stenting renal artery stenosis but less invasive and safest method is percutaneous transluminal angioplasty (PTA). Takayasu arteritis might be associated with Tuberculosis, yet, the relationship and mechanism are not clearly understood. Here we report a case of Takayasu arteritis associated with tuberculosis.

Артериит Такаясу после перенесенной коронавирусной инфекции у молодой женщины: клиническое наблюдение

The article describes the clinical onset of Takayasu's arteritis (non-specific aortoarteritis) which occurred after coronavirus disease in a young woman with Still's disease in her medical history. Takayasu's arteritis primarily affects young women, most commonly of Asian race. Clinical manifestations of the disease can be conditionally divided into two groups: non-specific symptoms, indicating a systemic inflammatory response, and specific symptoms associated with the damage of the aorta and its branches. Physical examination plays an important role in diagnosing Takayasu's arteritis. Characteristic signs of the disease include vascular bruits over the large arteries, arterial blood pressure differentials in the right and left extremities, and failure to palpate pulse on the radial arteries (therefore it is also called pulseless disease). Imaging diagnostic techniques include contrast-enhanced angiography and Duplex sonography of the vessels. Etiology of the disease is not fully understood. Research papers present data showing that novel coronavirus infection could be a triggering factor in the emergence of vasculitis of the large vessels, including Takayasu's arteritis. This should be taken into consideration in the management of patients belonging to the risk group. KEYWORDS: Takayasu's arteritis, non-specific aortoarteritis, COVID-19, post-COVID-19 syndrome, vasculitis, Stills' disease. FOR CITATION: Gordeev I.G., Vechorko V.I., Otarova S.M. et al. Takayasu's arteritis after coronavirus disease in young woman: case report. Russian Medical Inquiry. 2023;7(3):181–186 (in Russ.). DOI: 10.32364/2587-6821-2023-7-3-181-186.

TAKAYASU ARTERITIS IN PREGNANCY - CASE REPORTS

Takayasu arteritis known as pulseless disease is a chronic vasculitis that involves mainly large vessels like aorta and its branches, coronary and pulmonary arteries . It was rst described by Japanese ophthalmologist Mikito Takayasu in 1908 . The classical denition of TA is chronic, progressive inammatory, occlusive disease of the large vessels. The arterial lesion can lead to secondary hypertension, retinopathy, cardiac involvement, cerebrovascular events and premature death . Frequently observed in Asian countries is the most common cause of renovascular hypertension in India, China, Korea, Japan and 4 other countries of south east Asia. It is also known as young female disease as it is more commonly seen in young women than men. Antenatal women with TA suffer from extremely high risk of poor maternal and fetal outcomes. Wing's scoring can be useful to predict neonatal outcome. Management of pregnant women with TA is challenging because of the chance of increase in cardiovascular complications. The course of the disease per se is not affected by pregnancy

Anaesthetic management of a parturient with Takayasu’s arteritis coming for emergency caesarean section

Takayasu’s arteritis (TA) also known as pulseless disease is a rare disease that involves aorta and its main branches. It can cause inflammatory reaction of tunica media and adventitia of the arteries involved causing stenosis, occlusion or aneurysm., Anaesthesia for caesarean section in a parturient with Takayasu’s arteritis is complicated by associated hypertension, end organ dysfunction, stenosis of major blood vessels and overall vasculopathy.The optimal anaesthetic management in a parturient with Takayasu’s arteritis is controversial, but avoidance of regional anaesthesia has been recommended by some authors because of the risk of hypotension and the subsequent need for vasopressors., We herein report the use of general anaesthesia in a term parturient with Takayasu’s arteritis coming for emergency Lower segment caesarean section (LSCS).

Takayasu Arteritis: A Case Report

<p style="text-align: justify;">Takayasu arteritis is also known as pulseless disease and is an autoimmune disease with unknown etiology which is a rare type of chronic granulomatous vasculitis involving inflammation in the wall of the aorta and its main branches such as carotid, coronary, pulmonary and renal arteries. The left subclavian artery is the most frequently involved vessel. The disease can lead to narrowed artery walls that may tear, bulge and leads to pain in the chest, or arm, high blood pressure and eventually heart failure or stroke. It has a worldwide distribution, with the greatest prevalence in Asia. Women are affected in 80 to 90 per cent of cases, with an age of onset that is usually between 10 to 40 years. Stenosis of the renal artery has been reported in 23 to 31 per cent of cases and may result in malignant hypertension, ischemic renal disease, and decompensated heart failure. Involvement of both renal arteries is uncommon. A case study of 27-yearold female with symptoms like a blurred vision of the left eye, weakness, syncopal attacks. Computerized tomography angiography shows Takayasu arteritis with the early onset of anuria and acute kidney injury which were found very rare in the literature survey. The main complication of this case was Reno-vascular hypertension which was treated with T. Nicardia XL 30mg T. Arkamine 0.1mg Inj Labetalol 20mg and corticosteroids and immune suppressants were given to treat other complications. <p style="text-align: justify;"><strong>Key words:</strong> Autoimmune disease, Granulomatous Vasculitis, Left renal artery stenosis, Renovascular hypertension, Takayasu arteritis.

A Case of Takayasu Arteritis in a Male Patient

Takayasu arteritis (TA), otherwise called “pulseless disease”, is a category of primary systemic vasculitis involving medium and large arteries, including the aorta, its branches and the pulmonary and the coronary arteries. The presence of TA is often observed in women and the main population of patients develops their first symptoms between 15 years to 30 years. If left untreated, this disease may lead to the development of many comorbid renal and pulmonary obstructions causing lethal consequences. Here we present a case report of the diagnosis of TA in a 25-year-old male, treatment and following procedures. A patient with no anamnesis was hospitalized with paralysis of the right half of body and altered consciousness. He had been experiencing symptoms like fatigue, general weakness and respiratory distress for the past year. After extensive medical analysis patient was treated with oral prednisone and later endarterectomy was performed. After the operation, the patient improved and was discharged. Till date, no new complaints were reported.

Tocilizumab and Renal Artery Stent–Therapeutic Strategy for Takayasu Arteritis

Takayasu vasculitis (TAK) is a form of large vessel vasculitis clinically manifesting as pulseless disease or hypertension. It is more common in South East Asia and Japan, India, and Mexico [1]. It is increasingly being recognized due to increased awareness among medical fraternity and better imaging modalities. Undetected hypertension, pulselessness, and syncope are more common symptoms and presentation during pregnancy is unusual and can lead to bad obstetric outcomes. Recent evidences support the use of tocilizumab for inducing remission in Takayasu arteritis. We report this rare case of vasculitis presenting in pregnancy as malignant hypertension. A 20-year-old pregnant woman (45 days) presented with headache and nausea but no fever. She had a history of intermittent claudication of legs for the past 3 years but not evaluated. During examination, pulses were felt normally and blood pressure (BP) 180/110, no murmurs in cardiac auscultation, but she had abdominal bruit (renal vessels). Other systems were normal. Echocardiogram (ECHO) showed dilated ascending aorta. Doppler of renal vessels showed narrowing of renal arteries. Unfortunately, she had to undergo termination of pregnancy (high BP in spite of antihypertensives). Her computed tomography (CT) angiogram showed features of TAK with type 5 pattern–she had methylprednisolone infusion 500 mg daily for 3 days, followed by injection tocilizumab 400 mg monthly 3 doses. Once remission was achieved, she had recanalization by percutaneous transluminal angioplasty of right renal artery. She is currently maintained on aspirin and telmisartan. Awareness of causes of high BP, inputs by radiologist, cardiologist, and rheumatologist and understanding by the patient and family helped to achieve good outcome albeit the miscarriage.

Revisiting the history of Takayasu's disease studies and surgical techniques used in its treatment

Nonspecific aortoarteritis is a systemic disease, which has been referred to the group of vasculitis affecting elastic and muscular arteries oflarge and medium calibre with the inflammatory processlocalized in the media and adventitia. The article presents the history of development of ideas about clinical manifestations, morphological changes and the course of the disease from 1761 to the present day, the timeline of medical advances in this disease studies. The genuine interest in nonspecific aortoarteritis arose at the beginning of thelast century, when the Japanese ophthalmologist Mikito Takayasu reported unusual changes in the retinal vessels of a 21-year-old Japanese girl suffering from recurrent bouts of syncope. The first publications dealt with clinical manifestations in the patients, who had only brachiocephalic arterial involvement. In the early 60s, it was found that nonspecific aortoarteritis (Takayasu's disease) can affect not only the branches of the aortic arch, but also the thoracic aorta, renal and visceral arteries. It was the mosaic clinical manifestations in patients with various forms of Takayasu's disease that caused the presentation of the disease in theliterature until the mid-1970s under various terms such as “pulseless disease”, “arteritis of young women”, “brachiocephalic arteritis”, “atypical coarctation of aorta”, “Martorell's syndrome”, “syndrome of obliteration of the supra-aortic trunks”, “panaortitis” or “panarteritis”, “aortitis syndrome”, “mid-aortic syndrome”, “occlusive thromboarteriopathy”. The review details the epidemiology and prevalence of this disease. Views not only on the etiology and pathogenesis, but also on the methods of treating this disease have changed since M. Takayasu's publication in 1908. Much attention is paid to the historical aspect of the first surgical procedures. Starting in 1951, the surgical method has firmly taken the lead in the treatment of stenosis of the carotid arteries, thoracic aorta, renal and visceral arteries. Surgical concepts changed, but the literature data indicate the sustainability of the basic principle of treatment: combination of surgical interventions and various antiinflammatory therapy regimens.

Absent Bilateral Upper Limb Pulses in Middle Age Male? Takayasu Arteritis

Takayasu arteritis also termed as pulseless disease is a rare and chronic inflammatory arteritis of large vessels. It is manifested mainly in young age group between 10-40 years with a female predominance. Anesthetic management of these patients is challenging in view of fluctuation in blood pressure, intimal fibrosis and stenosis of major blood vessels and multiorgan involvement. Here we present a case of 55 year old male patient with bilateral absent upper limb pulses posted for emergency surgery in view of gall bladder perforation that was successfully managed under general anesthesia. Keywords: Takayasu; Chronic; Inflammatory.

Tanısı FDG PET-BT İle Konan Erken Evre Takayasu Arteriti Olgusu Ve Literatürün Gözden Geçirilmesi

Tanısı FDG PET-BT İle Konan Erken Evre Takayasu Arteriti Olgusu Ve Literatürün Gözden Geçirilmesi Nagehan Didem Sarı, Gülşen Yörük, Gülhan Eren Sağlık Bilimleri Üniversitesi İstanbul Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları ve klinik mikrobiyoloji Kliniği Takayasu arteriti (TA), etyopatogenezi tam olarak bilinmeyen ve damar duvarında granulomatöz inflamasyonla seyreden, kronik seyirli büyük damar vaskülitidir. Klinik belirtiler hastalığın erken evrelerinde nonspesifik olmakla birlikte ilerleyen dönemde etkilenen damarların beslediği bölgelerde vasküler yetmezlik bulgularıyla seyreder. Hastalık Sebebi Bilinmeyen Ateş (SBA) kliniğiyle nadiren bulgu verebilir. Bu çalışmada SBA tetkiki esnasında tanısı FDG PET-CT ile konan erken evre TA olgusu sunulmuştur. Anahtar Kelimeler: Sebebi bilinmeyen ateş, Takayasu arteriti, vaskülit Türkçe Kısa Başlık: PET-BT İle Tanı Konan Takayasu Arteriti An Early Stage Takayasu Arteritis Case Diagnosed with FDG PET-CT and Review of the Literature Nagehan Didem Sarı, Gülşen Yörük, Gülhan Eren Health Sciences University Istanbul Training and Research Hospital Infectious Diseases and Clinical Microbiology Clinic Takayasu’s arteritis also known as pulseless disease is a kind of granulomatous vasculitis that characterized large size vessels involvement. It is usually occurs in female gender in young ages. At early stage of disease, nonspesific and different clinical presentation can occur. At diagnosis, ischemic symptom are usually present in the affected vessels. However, fever of unknown origin (FUO) is rare as an initial presentation and explanation the condition too difficult to diagnose. In this case report, a patient who presented with a fever of unknown origin, described. A 59-year-old female was diagnosed with Takayasu arteritis after fluorodeoxyglucose (FDG) positron-emission tomography-computed tomography (PET-CT) was performed at the early stage. Keywords: Fever of unknown origin, PET-CT, Takayasu arteritis, Vasculitis İngilizce Kısa Başlık: Takayasu arteritis diagnosed by PET-CT

TAKAYASU ARTERITIS – A CASE REPORT: WITH MAXILLOFACIAL SURGEON‟S PERSPECTIVE AND BRIEF REVIEW OF LITERATURE

Takayasu arteritis is a chronic inflammatory disease that affects major vessels, mainly the aorta and its branches. The diseased condition leads to occlusion, stenosis, aneurysm or dilatations along the path of the affected artery. The etiology remains unknown. The disease has been reported worldwide, with an increased incidence in young Asian women. Like other medical condition, Takayasu arteritis patients will seek dental treatment. Hence the purpose of this article is to highlight the disease features and what a dentist should know or take precautions before treating them. KEYWORDS: Takayasu Arteritis, Pulseless disease, Autoimmune.

Takayasu arteritis: a rare case scenario

Takayasu’s arteritis (TA), commonly known as “Pulseless disease”, is rare granulomatous arteritis, which affects large and medium-sized arteries, especially the aorta and its branches. Other arteries that can be affected are proximal portions of pulmonary, coronary, and renal arteries. Initially, mononuclear cell infiltrates in the adventitia leading to granuloma formation, followed by disruption of the elastic layer and subsequent massive medial and intimal fibrosis. These lesions result in segmental stenosis, occlusion, dilatation, and aneurysmal formation in the affected vessels. Diminished or absent pulses are present in 84-96% of patients, associated with limb claudication and blood pressure discrepancies between the two arms. The symptoms are secondary to the involved artery, and it may evolve into a life-threatening condition. The involvement of the carotid artery leads to ophthalmic artery hypoperfusion and causes the ocular ischemic syndrome. It usually affects young females during the second and the third decades of life but rare cases have been reported in children as young as 24 months of age. Although females are more likely to be affected in TA, males are also affected. In adults approximately 80% of patients with TA are women, although the female-to-male ratio varied from 9:1 in reports from Japan, 6.9:1 in Mexico to 1.2:1 in Israel. Aim of our report is to describe the case of a young female of 14 years of age. She presented with arterial hypertension and respiratory distress. CT Angiography showed Type IIb Takayasu Arteritis. ECHO revealed dilated cardiomyopathy with grade III diastolic dysfunction with decreased ejection fraction up to 20-25%. She was treated with steroids, anti-hypertensive drugs, and diuretics.

Atypical Presentation of Takayasu's Arteritis—A Case Report

AbstractTakayasu's arteritis, known as “pulseless disease,” is a chronic idiopathic inflammatory disease, which has a greater predilection for large vasculature in the body. Initially described in the1800s, this rare condition is more commonly seen in Asian women in 40 years age group. Herein, the authors report the case of a 36-year-old woman whose exertional claudication was the initial manifestation of active Takayasu's arteritis along with involvement of multiple peripheral arteries not involving ostial area of the vessels, instead affecting the proximal area and also presenting with thrombosis of right CIA (common iliac artery), which is an unusual presentation in case of Takayasu's arteritis without aneurysmal involvement.

Takayasu's arteritis: Anesthetic implications and management of a patient for cesarean section using combined spinal-epidural technique

Takayasu's arteritis (TA) or pulseless disease is a rare, idiopathic, chronic granulomatous vasculitis that affects mainly aorta and its major branches. We report herewith the anesthetic management of a parturient who suffered from TA scheduled for elective cesarean section by using combined spinal-epidural technique, which offers the combined advantage of both spinal and epidural anesthesia and postoperative analgesia. Anesthesia for patients with TA is complicated by severe uncontrolled hypertension, end-organ dysfunction, stenosis of major branches of aorta, and difficulties in monitoring hemodynamic parameters. Our patient was a full-term, 29-year-old female weighing 60 kg, of height 154 cm, gravida 1, and para 0 scheduled for elective lower segment cesarean section. The intraoperative period was uneventful with minimal rise in blood pressure (BP) which was managed accordingly with antihypertensive medications. The patient was stable in the postoperative period with minor rise in BP from baseline and was shifted to ward after being monitored in the intensive care unit for 24 h.