Surgical intervention and its role in Takayasu arteritis

Abstract

Vascular surgery remains an important option in the management of Takayasu arteritis. Its use is predominantly confined the treatment of symptomatic organ ischaemia or life-threatening aneurysm formation. In most cases this follows the failure of medical therapy to prevent arterial injury. Open surgery and endovascular approaches are used. The choice between them, at least in part, is determined by the site and nature of the lesion. Although more invasive, open surgery offers enhanced duration of arterial patency. For endovascular intervention, primary angioplasty without stenting is preferred, with stenting reserved for primary or secondary angioplasty failures. Although there is increasing interest in the role of stent grafts and tailor-made endovascular stents, long-term outcomes remain to be reported. Interventional outcomes are improved and complications reduced by therapeutic control of disease activity pre-and post-surgery. The wider use of combined immunosuppression and the introduction of biologic therapy for refractory Takayasu arteritis may reduce future requirements for surgical intervention.

Takayasu arteritis in a patient presenting with stroke and improvement of hemiparesis following vascular bypass surgery: A case report

“…Treatment options. Even though the majority of patients with TA are treated with medication only, in the case of stenosed or occluded arteries, vascular intervention offers the most effective long-term treatment option, particularly for organ ischemia, hypertension and aneurysmal disease (11,17,19,20).…”

“…In the advanced stages of TA, with significant stenosis or the occlusion of blood vessels, invasive treatment is performed as needed; angioplasty and stent placement are employed on specific arterial sites with stenosis of <5 cm, while more severe cases are more effectively treated with open surgery, which has lower re-stenosis rates and improves long-term survival; pre-and post-operative immunosuppression is crucial (17).…”

Intervention in Takayasu Aortitis: When, Where and How?

“…This can compromise cerebral blood supply, resulting in symptoms of cerebral ischaemia including visual impairment, dysphasia, transient hemiparesis, loss of consciousness and stroke [25]. In contrast, ascending aortitis may be associated with ostial coronary artery stenoses and with dilatation or aneurysm formation in the ascending aorta and aortic arch, which is often accompanied by aortic valve regurgitation [26]. Disease of the thoracic aorta may also result in aneurysmal dilation and increase the risk of aortic dissection.…”

“…Visceral arterial involvement can affect the renal, mesenteric and coeliac arteries. Stenotic lesions affecting these arteries are typically ostial in nature, whereas those in the subclavian/axillary arteries are often long and irregular ( Figure 3B) [26]. The involvement of coronary or pulmonary artery should be indicated as C (+) or P (+), respectively.…”

“…Across a number of series, the main indications for surgery are: refractory hypertension related to renal artery stenosis, aortic disease including coarctation and ascending aortic dilatation ± aortic valve regurgitation, ischaemic heart disease, supra-aortic disease with cerebral ischaemia, mesenteric ischaemia, severe limb-threatening claudication and aneurysm repair [26,36,37] (Figures 2 and 3).…”