Longterm Outcomes of Renal Artery Involvement in Takayasu Arteritis

Hong, Seokchan; Ghang, Byeongzu; Lee, Chang‐Keun; Yoo, Bin

doi:10.3899/jrheum.160974

Cited by 20 publications

(20 citation statements)

References 27 publications

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“…Evidence supporting the surgical management of arterial stenosis in TAK arises from several retrospective case series (LoE 4), with variable baseline characteristics of the patients included, different involved vascular sites and variable concomitant medical treatment 76–108. Indications for referral, when specified, mainly comprised symptomatic arterial stenosis (eg, renovascular uncontrolled hypertension, transient ischaemic attack, limb claudication, syncope, vertigo, angina).…”

Section: Resultsmentioning

confidence: 99%

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

et al. 2019

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ObjectiveTo collect available evidence on management of large vessel vasculitis to inform the 2018 update of the EULAR management recommendations.MethodsTwo independent systematic literature reviews were performed, one on diagnosis and monitoring and the other on drugs and surgical treatments. Using a predefined PICO (population, intervention, comparator and outcome) strategy, Medline, Embase and Cochrane databases were accessed. Eligible papers were reviewed and results condensed into a summary of findings table. This paper reports the main results for Takayasu arteritis (TAK).ResultsA total of 287 articles were selected. Relevant heterogeneity precluded meta-analysis. Males appear to have more complications than females. The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. Evidence for details on the best disease monitoring scheme was not found. High-quality evidence to guide the treatment of TAK was not found. Glucocorticoids are widely accepted as first-line treatment. Conventional immunosuppressive drugs and tumour necrosis factor inhibitors were beneficial in case series and uncontrolled studies. Tocilizumab failed the primary endpoint (time to relapse) in a randomised controlled clinical trial; however, results still favoured tocilizumab over placebo. Vascular procedures may be required, and outcome is better when performed during inactive disease.ConclusionsEvidence to guide monitoring and treatment of patients with TAK is predominantly derived from observational studies with low level of evidence. Therefore, higher-quality studies are needed in the future.

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Section: Resultsmentioning

confidence: 99%

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

et al. 2019

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“…Renal insufficiency in TA is usually attributed to renal ischemia caused by vascular obstruction and renal parenchymal damage induced by systemic hypertension; glomerular disease is considered exceptional [ 13 ]. Recent clinical studies [ 5 , 14 ] support this contention. Hong et al [ 5 ] found that 9.7% of TA patients with renal artery involvement developed chronic renal insufficiency over a 90-month follow-up period.…”

Section: Discussionmentioning

confidence: 98%

“…Recent clinical studies [ 5 , 14 ] support this contention. Hong et al [ 5 ] found that 9.7% of TA patients with renal artery involvement developed chronic renal insufficiency over a 90-month follow-up period. Similarly, Obiagwu et al [ 14 ] showed that renal artery revascularization procedures were effective in salvaging renal function in children with TA-induced renal artery stenosis.…”

Section: Discussionmentioning

confidence: 98%

“…Renal insufficiency is an important indication for the use of CO 2 angiography, given the absence of nephrotoxicity with this agent [ 2 ]. Takayasu arteritis (TA), a chronic idiopathic granulomatous large vessel vasculitis affecting the aorta and its main branches [ 3 ], can produce renal insufficiency [ 4 ], mainly by causing renal artery stenosis [ 5 ]. At our center, prevalence of renal dysfunction in 118 patients with TA presenting during the period 1963–1977 was 13.6% [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Carbon dioxide Angiography-Guided Renal-Related Interventions in Patients with Takayasu Arteritis and Renal Insufficiency

Chacko

Joseph

Thomson

et al. 2018

Cardiovasc Intervent Radiol

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BackgroundUse of iodinated contrast agents for angiography in patients with renal insufficiency risks further deterioration of renal function and its adverse sequelae.ObjectiveTo study the effectiveness and safety of carbon dioxide (CO2) angiography in guiding percutaneous renal-related interventions in patients with Takayasu arteritis and renal insufficiency.MethodsData on CO2 angiography-guided interventions were obtained from a 23-year database of 692 Takayasu arteritis patients who underwent percutaneous interventions and were analyzed retrospectively. Follow-up data were also obtained. The CO2 angiography system used was developed in-house and was pressure-driven.ResultsSeven patients (6 female, age 16–59 years, baseline serum creatinine 1.62–4.55 mg/dl, estimated glomerular filtration rate 12.2–36.9 ml/min/1.73 m2) underwent CO2 angiography-guided interventions: five underwent angioplasty or stenting to treat six stenotic/occluded renal arteries, one underwent extensive endovascular repair for spontaneous focal abdominal aortic dissection with false lumen aneurysm and aorto-iliac true lumen narrowing, and one underwent balloon dilatation of previously deployed aortic stents used to treat aortic occlusion at two levels. Follow-up (median 5 years, range 2 months–16 years) was obtained in all patients. All the procedures were successful and resulted in relief of symptoms, better blood pressure control, improvement in left ventricular systolic function and recovery or stabilization of renal function. There were no early or late complications related to CO2 angiography. Three renal lesions that had restenosis at follow-up were managed successfully by repeat intervention.ConclusionCO2 angiography-guided renal-related interventions are effective and safe in patients with Takayasu arteritis and renal insufficiency; they significantly improve the care of such patients.

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“…In another study of nine Korean patients with TA undergoing renal artery revascularization, long‐term outcomes (> 8 years median follow up) such as renal insufficiency, death and refractory hypertension did not differ in the three patients undergoing stenting as opposed to the six undergoing angioplasty alone. However, all three restenoses occurred in the stented renal arteries . A recently published meta‐analysis of 130 arterial segments undergoing stenting as compared to 186 undergoing angioplasty alone across seven studies did not identify differences in restenosis rates or overall complications, although the data on restenosis rates were heterogeneous.…”

Section: Vascular Interventionsmentioning

confidence: 97%

Recent advances in the management of Takayasu arteritis

et al. 2019

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Takayasu arteritis (TA) is a challenging large vessel vasculitis to treat. Distinguishing disease activity from vascular damage is difficult, often relying on clinician judgement aided by composite clinical disease activity indices with angiographic evidence of vessel wall thickening or vessel wall hypermetabolism demonstrable on positron emission tomography computerized tomography (PET CT). Glucocorticoids form the mainstay of remission induction. While other conventional disease modifying anti-rheumatic drugs (cDMARDs) or biologic DMARDs (bDMARDs) are commonly used, evidence supporting their usefulness is sparse and generally of low quality. The only two randomized controlled trials (RCT) of a DMARD in TA failed to show efficacy of abatacept in reducing relapses of TA, however, tocilizumab showed a trend towards reduction in time to relapses. Of the cDMARDs, methotrexate, azathioprine, mycophenolate mofetil (MMF), leflunomide and cyclophosphamide have shown clinical efficacy in case series, with some evidence that methotrexate, azathioprine and MMF might retard angiographic progression. Among bDMARDs, anti-tumor necrosis factor alpha agents and tocilizumab may be useful in patients refractory to cDMARDs with retardation of angiographic progression, based on evidence derived from mostly retrospective case series, whereas the role of rituximab and ustekinumab needs further elucidation. Revascularization, either surgical or endovascular, is the treatment of choice to relieve critical, symptomatic stenoses and are best undertaken during inactive disease. Emerging evidence suggests that patients with TA also have increased cardiovascular risk and this requires appropriate management. Large studies involving multiple centers are the need of the hour to appropriately evaluate utility of currently available immunosuppressive therapy in TA.

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Longterm Outcomes of Renal Artery Involvement in Takayasu Arteritis

Abstract: Bilateral lesions and renal functional impairment at presentation, but not implementation of revascularization procedures, were significant factors for outcomes in TA patients with renal artery involvement.

Cited by 20 publications

References 27 publications

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

Carbon dioxide Angiography-Guided Renal-Related Interventions in Patients with Takayasu Arteritis and Renal Insufficiency

Recent advances in the management of Takayasu arteritis

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