Late diagnosis of Takayasu's arteritis with repeated attacks of heart failure and uncontrolled hypertension due to abdominal aortic thrombosis: Case report and review of the literature

Abstract

Takayasu's arteritis (TA) is a chronic, idiopathic, inflammatory disease affecting the aorta and its branches. To date, only one case involving abdominal aortic thrombosis due to TA has been reported. After bilateral artificial subclavian-iliac bypass, a case of abdominal aortic thrombosis due to TA received a delayed diagnosis in a 44-year-old Chinese male who experienced recurrent episodes of heart failure and uncontrolled hypertension with claudication of two extremities. Abdominal color Doppler sonography and computed tomography aortography (CTA) showed occlusion of the abdominal aorta and bilateral renal artery stenosis. After vascular bypass and during 1 year follow-up, his cardiac function improved and blood pressure was well controlled, with reduced serum creatinine. Postoperative CTA still showed abdominal aortic thrombosis resulting in arterial occlusion extending from the left renal artery initial segment level to the bilateral common iliac artery and the bifurcation of the renal artery, except for the vascular bypass. Abdominal aortic thrombosis due to TA is very rare and potentially life threatening, probably becoming an atherosclerosis risk factor. Doppler sonography and CTA results are important for diagnosis. Artificial vascular bypass can be used for TA in debilitated patients with diffuse aortic disease.

Total Occlusion of Abdominal Aorta in Takayasu Arteritis

“…The patient underwent vascular bypass surgery. At one-year follow-up, the patient showed significant improvement in heart failure symptoms and better control of hypertension [12]. Our case illustrates that conservative medical therapy alone can be used to manage such patients due to the formation of collateral vessels.…”

Takayasu arteritis with acute pulmonary embolism as the primary clinical symptom: A case study

“…Therefore, the acute pulmonary embolism was considered to have resulted from Takayasu arteritis. Previous cases of Takayasu arteritis presenting with aortic and iliac artery thrombosis have been reported 5–7 . On the one hand, aorto‐arteritis promotes a hypercoagulable state, leading to thrombus formation by significantly increasing platelets and coagulation activity 8 .…”

“…Previous cases of Takayasu arteritis presenting with aortic and iliac artery thrombosis have been reported. [5][6][7] On the one hand, aorto-arteritis promotes a hypercoagulable state, leading to thrombus formation by significantly increasing platelets and coagulation activity. 8 On the other hand, inflammation increases procoagulant factors and also suppresses the natural anticoagulant pathway and fibrinolytic activity, while chronic inflammation may cause endothelial damage, leading to the loss of physiological anticoagulation, antiaggregation and vasodilatation.…”

The effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis patients

“…Ранее на выборке из китайской когорты пациентов с АТ было показано, что увеличение времени от появления симптомов заболевания до подтверждения диагноза ассоциировалось с возрастанием риска кардиоваскулярных осложнений, что подтверждает важность ранней диагностики АТ для своевременного назначения адекватной терапии [23]. По данным М. Zimba и соавт., в 55% случаев диагноз АТ удавалось верифицировать только при аутопсии пациентов с АТ.…”