J Lipid Atheroscler.  2013 Dec;2(2):97-102. 10.12997/jla.2013.2.2.97.

Successful Endovascular Aortic Repair in a Young Female with Takayasu's Arteritis Presenting with Uncontrolled Hypertension

• Park SH
• Jeong HC
• Park KH
• Sim DS
• Hong YJ
• Kim JH
• Ahn Y
• Jeong MH

• KMID: 1845575
• DOI: http://doi.org/10.12997/jla.2013.2.2.97

Abstract

A 21-year-old female presented with uncontrolled hypertension. Neck, abdomen, chest computed tomography angiogram showed moderate stenosis in the left common carotid artery and the left subclavian artery, and multiple severe stenosis in the transitional area between the descending thoracic aorta and the abdominal aorta. Transthoracic echocardiography and aortography revealed that the pressure gradient between the descending thoracic aorta and the abdominal aorta was 80 mmHg. She underwent angioplasty with stent implantation. After stent implantation, claudication improved significantly, and the pressure gradient decreased to 18 mmHg. The blood pressure was normalized with single anti-hypertensive medication, and no adverse clinical event occurred during five-year follow-up.

Keyword

Arteritis; Hypertension; Angioplasty

MeSH Terms

Abdomen
Angioplasty
Aorta, Abdominal
Aorta, Thoracic
Aortography
Arteritis
Blood Pressure
Carotid Artery, Common
Constriction, Pathologic
Echocardiography
Female*
Follow-Up Studies
Humans
Hypertension*
Neck
Stents
Subclavian Artery
Takayasu Arteritis*
Thorax
Young Adult

Figure

• 

  Fig. 1 The doppler ultrasonography showed stenosis and increased peak velocity of the left common carotid artery (peak velocity=2.5 m/s) (left) and left subclavian artery (peak velocity=2.2 m/s) (right).

• 

  Fig. 2 The ultrasonography of the left common carotid artery showed intima-media thickness of 1.94 mm.

• 

  Fig. 3 The ultrasonography of the thoracoabdominal aorta showed continuous flow. The peak systolic velocity was 4.49 m/sec and the mean pressure gradient was 80 mmHg.

• 

  Fig. 4 Neck CTA showed moderate stenosis in the left common carotid artery and in the left subclavian artery.

• 

  Fig. 5 Chest and abdomen CTA showed multiple stenotic lesions, especially in the transitional area between the descending thoracic aorta and the abdominal aorta.

• 

  Fig. 6 After angioplasty with stent insertion, the pressure gradient (PG) decreased to 18 mmHg.

• 

  Fig. 7 (A) CT angiogram before stent implantation, (B) Follow-up CT angiogram 2 days after stent graft showed a patent lumen with good distal flow.

Reference

1. Koh KK, Hwang HK, Kim PG, Lee SH, Cho SK, Kim SS, et al. Isolated left main coronary ostial stenosis in Oriental people: operative, histopathologic and clinical findings in six patients. J Am Coll Cardiol. 1993; 21:369–373.

2. Pyun WB, Yoon YS, Park KJ, Kim SY, Cho SY, Shim WH. Carotid artery stenting in patients with Takayasu's arteritis: early and long-term follow-up results. Korean Circ J. 2000; 30:592–598.

3. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med. 1994; 120:919–929.

4. Tyagi S, Kaul UA, Nair M, Sethi KK, Arora R, Khalilullah M. Balloon angioplasty of the aorta in Takayasu's arteritis: initial and long-term results. Am Heart J. 1992; 124:876–882.

5. Giordano JM. Surgical treatment of Takayasu's arteritis. Int J Cardiol. 2000; 75:Suppl 1. S123–S128.

6. Bali HK, Jain S, Jain A, Sharma BK. Stent supported angioplasty in Takayasu arteritis. Int J Cardiol. 1998; 66:Suppl 1. S213–S217.

7. Gimenez-Roqueplo AP, Tomkiewicz E, La Batide-Alanore A, Moreau I, Paul JF, Raynaud A, et al. Stent treatment for pseudocoarctation and refractory hypertension in an elderly patient with Takayasu's arteritis. Nephrol Dial Transplant. 2000; 15:536–538.

8. Stanley JC, Criado E, Eliason JL, Upchurch GR Jr, Berguer R, Rectenwald JE. Abdominal aortic coarctation: surgical treatment of 53 patients with a thoracoabdominal bypass, patch aortoplasty, or interposition aortoaortic graft. J Vasc Surg. 2008; 48:1073–1082.

9. Ghazi P, Haji-Zeinali AM, Shafiee N, Qureshi SA. Endovascular abdominal aortic stenosis treatment with the OptiMed self-expandable nitinol stent. Catheter Cardiovasc Interv. 2009; 74:634–641.

10. Feugier P, Toursarkissian B, Chevalier JM, Favre JP. AURC. Endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta: long-term outcome. Ann Vasc Surg. 2003; 17:375–385.

11. Sharma S, Gupta A. Visceral Artery Interventions in Takayasu's Arteritis. Semin Intervent Radiol. 2009; 26:233–244.

12. Tyagi S, Singh B, Kaul UA, Sethi KK, Arora R, Khalilullah M. Balloon angioplasty for renovascular hypertension in Takayasu's arteritis. Am Heart J. 1993; 125:1386–1393.

13. Saadoun D, Lambert M, Mirault T, Resche-Rigon M, Koskas F, Cluzel P, et al. Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience. Circulation. 2012; 125:813–819.