Incidence of Aneurysms in Takayasu's Arteritis

Abstract

The angiographic findings of Takayasu's arteritis in a series of 113 patients were reviewed. Predominant findings were stenotic or occlusive changes, but fusiform or saccular aneurysms were also found in 36 patients (31.9%) in the various sites of aorta and its major branches. Multiple aneurysms were found in 15 patients. The most common site of aneurysms was the ascending aorta (16 patients); in 7 of the patients these were complicated by aortic regurgitation. Aneurysms developed in the aortic arch in 3 patients, in the descending aorta in 11, in the abdominal aorta in 7, and in the major branches of the aortic arch in 9 patients. In 2 patients, follow-up angiograms showed enlargement of the aneurysms, and rupture of the aneurysm occurred in 1 patient. Aneurysms were found even in young patients. A fifteen-year-old female showed a huge aneurysm in the ascending aorta as the initial manifestation of this disease. Thickening of the walls of aneurysms was common and characteristic. This study revealed the moderately high incidence of aneurysms of various sites of arteries in patients with Takayasu's arteritis. The authors conclude that aneurysm, as well as occlusive changes, can be a primary lesion.

Isolated Aortic Aneurysm with Aortic Valve Regurgitation in Takayasu Disease

“…Sheikhzadeh et al [6] described isolated aneurysms in 2% of their patients with Takayasu disease. Matsumura et al [7] described higher frequency in patients older than 40 years, and mostly within the ascending aorta.…”

Aortic Aneurysms in Takayasu Arteritis

“…The aneurysmal symptoms include a pulsatile mass, embolism from mural thrombus and rupture leading to hemotorax or death. Rupture of aneurysms is uncommon perhaps because their wall tents to be rather thick (Matsumura et al, 1991). The natural history of Takayasu arteritis has not been well elucidated because of the paucity of reported series and numbers of patients.…”

“…Usually, aneurismal dilatation develops in patients over the age of 40, although cases of a descending thoracic aorta aneurysm have been reported in a 23-year-old woman (Chieh et al, 2003) and in a 25-year-old man (Regina et al, 2007). The annual risk of rupture is relatively low, ranging from 1% to 7% (Matsumura et al, 1991;Sunramanyan et al, 1989). In a series of 120 patients (111 women, 9 men), Ishikawa & Maetani (1994) reported 16 deaths related to Takayasu disease during a median follow-up of 13 years (range 1 month to 34 years), 5 of congestive heart failure, 4 of cerebrovasclar incidents, 3 after postoperative complications, 2 of acute myocardial infarction and 2 of other causes.…”

“…Occlusive disease is more prevalent in the United States and Europe, whereas aneurysmal disease is more common in Japan, India, Thailand, Mexico and Africa (Desiron et al, 2000;Matsumura et al, 1991;Kumar et al, 1990 (Matsumura et al, 1991) described aneurysms in 31.9% of patients with Takayasu arteritis, with a higher frequency in patients over the age of 40, and mostly within the ascending aorta. Aneurysms are a marker of extreme disease activity and are usually found in older patients with a longer history of the disease.…”

“…Aneurysm formation is considered one of the major complications related to the prognosis in Takayasu arteritis. The real incidence of rupture of either the abdominal or thoracic aortic aneurysms is not known, but seems to be low (Matsumura et al, 1991). However, it should be remembered that young patients may have 40 to 50 more years of life expectancy and therefore the risks of aneurysm rupture over that period of time might be quite significant.…”