Results of Renal Angioplasty in Nonspecific Aortoarteritis (Takayasu Disease)

doi:10.1016/S1051-0443(98)70294-5

Journal of Vascular and Interventional Radiology

Volume 9, Issue 3, May 1998, Pages 429-435

https://doi.org/10.1016/S1051-0443(98)70294-5 Get rights and content

Purpose

To evaluate the long-term results of percutaneous transluminal renal angioplasty (PTRA) in the management of renovascular hypertension caused by nonspecific aortoarteritis (Takayasu disease).

Materials and Methods

The results of 96 stenoses in 66 patients were retrospectively studied. The indications for PTRA included hypertension uncontrolled by single-drug therapy, evidence of greater than 70% diameter stenosis in the renal artery with a peak systolic gradient of greater than 20 mm Hg, and clinically inactive disease.

Results

Technical success was obtained in 91 (95%) stenoses in 62 patients. Clinical success was seen in 59 (89%) and included “cure” in 14 and “improvement” in 45 patients. The stenosis decreased from 88% ± 6% (range, 70%–100%) to 11% ± 12% (range, 0%–40%), systolic pressure gradient decreased from 95 mm Hg ± 22 (range, 30–140 mm Hg) to 9 mm Hg ± 8 (range, 0–30 mm Hg), blood pressure improved from 181 ± 16 (range, 150–220)/115 ± 10 (range, 90–146) to 136 ± 25 (range, 130–210)/86 ± 16 (range, 80–130) mm Hg, and the drug requirement decreased from 3.9 ± .6 (range, 2–5) to 1.1 ± .9 (range, 0–3) (P value for all < .001). Complications included transient intrarenal arterial spasm in three patients, groin hematoma in two patients, and ipsilateral renal vein injury in one patient. At 22 months ± 17 (range, 4–84 months) follow-up, the restenosis rate, as determined by recurrence of hypertension and angiographic demonstration of restenosis, was 16%.

Conclusion

Despite some technical problems, PTRA is safe and effective in treating renovascular hypertension caused by nonspecific aortoarteritis. The complication rate is low.

References (24)

Y.Q. Liu
Radiology of aorto-arteritis
Radiol Clin North Am
(1985)
S. Sharma et al.
The incidence and patterns of pulmonary artery involvement in Takayasu's arteritis
Clin Radiol
(1990)
C. Tack et al.
Radiologic diagnosis of renovascular hypertension and percutaneous transluminal renal angioplasty
Semin Nucl Med
(1989)
P.G. Cook et al.
Case report: renovascular hypertension in Takayasu's disease treated by percutaneous transluminal angioplasty
Clin Radiol
(1986)
S. Tyagi et al.
Balloon angioplasty for renovascular hypertension in Takayasu's arteritis
Am Heart J
(1993)
K. Ishikawa
Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu's arteriopathy
J Am Coll Cardiol
(1988)
S. Sharma et al.
Angiographic morphology in nonspecific aortoarteritis (Takayasu's arteritis): a study of 126 patients from North India
Cardiovasc Intervent Radiol
(1992)
M. Yamato et al.
Takayasu's arteritis: radiographic and angiographic findings in 59 patients
Radiology
(1986)
S. Sharma et al.
Renovascular hypertension resulting from nonspecific aortoarteritis in children: mid-term results of percutaneous transluminal renal angioplasty and predictors of restenosis
AJR
(1996)
J. Klinge et al.
Percutaneous transluminal renal angioplasty:: initial and long-term results
Radiology
(1989)

G.N. Hodgkins et al.

Subclavian and carotid angioplasties for Takayasu's arteritis

Can Assoc Radiol J

(1982)

S. Saddekni et al.

Percutaneous transluminal angioplasty in nonatherosclerotic lesions

AJR

(1980)

Cited by (90)

Renal artery angioplasty in Takayasu disease: difficult anatomy addressed with a novel technique
2023, Medical Journal Armed Forces India
Takayasu arteritis is a well-established medical entity involving inflammatory changes in large arteries. We describe a characteristic case of Takayasu arteritis, in a young woman with significant renal artery stenosis, presenting with hypertensive urgency. Unsuccessful guide wire passage due to fibrotic septae in lumen of the left renal artery necessitated an innovative interventional approach, using an IMA-guide catheter and a UB3 coronary guidewire to cross the lesions, followed by placement of a coronary drug eluting stent, with an aim to avoid restenosis.
Takayasu's arteritis
2020, Revista Colombiana de Cardiologia
La arteritis de Takayasu es una enfermedad de etilogía un poco incierta por la diversidad de factores que pueden afectarla. Sus manifestaciones radican en la afección vascular que produce, en cuyo caso la aorta y sus grandes vasos son los más afectados. Esta vasculitis parece más prevalente en el suroeste asiático, y a pesar de llevar varios años de su descripción, en Europa y América solo se encuentran series de casos de la misma, lo que podría indicar un posible subdiagnóstico. Es importante conocer esta vasculitis ya que su manejo oportuno puede evitar el avance de la enfermedad y la presentación de complicaciones vasculares. El tratamiento de un paciente con arteritis de Takayasu seguirá siendo un desafío para los clínicos ya que no se cuenta con un estándar de manejo; por consiguiente, las decisiones generalmente se basan en recomendación de expertos, por lo cual cada caso deberá individualizarse con el objetivo de ofrecer el manejo más adecuado a los pacientes y disminuir la aparición de complicaciones.
Takayasu's arteritis is a disease of uncertain origin due to the diversity of factors that can be involved. Its manifestions stem from the vascular involvement that occurs, with the aorta and its large vessels being the most affected. This vasculitis seems more prevalent in south-west Asia, and due to the fact that it has been described for years, and only one series of cases of this disease are found in Europe and America, this could indicate a possible under-diagnosis. It is important to know this vasculitis since its timely management may avoid advancement of the disease, and the presentation of vascular complications. The treatment of a patient with Takayasu's arteritis will follow, being a challenge for clinicians since there is no standard management. For this reason, decisions are generally based on the recommendations by experts, therefore each case will be individualised with the aim of providing the patients with the most suitable management and reducing the appearance of complications.
Surgery and Endovascular Management in Patients With Takayasu's Arteritis: A Ten-Year Retrospective Study
2020, Annals of Vascular Surgery
Takayasu's arteritis (TA) is an uncommon chronic vasculitis, and there is a lack of long-term large cohort studies regarding the optimal revascularization outcomes of patients with TA.
One hundred and sixteen patients with TA who underwent surgery or endovascular repair over a 10-year period were studied retrospectively. One hundred and fifty-four vascular procedures were performed consisting of 69 open and 85 endovascular repairs.
After a mean follow-up period of 48.5 ± 38.5 months, three cases each of cerebrovascular accident (CVA) and death occurred in the open repair group while two cases of CVA and 4 deaths were observed in the endovascular repair group. At 1, 3, 5, and 10 years of follow-up, the primary patency rates were 97.3%, 86.2%, 70.5%, and 48.8% in the open repair group and 93.3%, 73.1%, 57.5%, and 31.8% in the endovascular repair group, respectively. The primary assisted patency rates were 98.2%, 90.3%, 73.2%, and 47.2% in the open repair group and 95%, 81%, 64.4%, and 35% in the endovascular repair group, respectively. The secondary patency rates were 98.2%, 96.1%, 83.5%, and 56.2% in the open repair group and 98.7%, 86%, 71.2%, and 44.9% in the endovascular repair group, respectively. The cumulative survival rates were 96.9%, 96.9%, 96.9%, and 90% in the open repair group and 97.4%, 97.4%, 88%, and 79.2% in the endovascular repair group, respectively.
Both surgical repair and endovascular management are safe and efficient modes of treatment of TA. Surgical repair showed long-term durability, and it is suitable for complex lesions and failed cases of endovascular management.
Takayasu arteritis therapy: The role of imaging in the exploration of the disease and its interventional results
2020, Bulletin de l'Academie Nationale de Medecine
La maladie de Takayasu est une vascularite inflammatoire chronique d’origine inconnue qui affecte les vaisseaux de gros calibre, principalement l’aorte et ses branches principales. L’inflammation de la paroi artérielle conduit à l’épaississement de la paroi, sa fibrose et à une sténose. Souvent asymptomatiques à la phase initiale, les lésions artérielles peuvent se manifester par le retentissement de ces sténoses : claudication de membre, accident cérébral ischémique transitoire, accident cérébral ischémique constitué, hypertension artérielle rénovasculaire. Ces symptômes étant peu spécifiques, quelle place a l’imagerie dans le diagnostic de la maladie, et au-delà de son concours au diagnostic, quelle place prend-elle dans le suivi et la caractérisation de l’activité de cette artérite ? Une façon d’évaluer la place de l’imagerie dans l’exploration de l’artérite de Takayasu est de se poser la question de faire sans. Enfin, qu’elle est la place des interventions basées sur l’évaluation de l’artérite de Takayasu ?
Takayasu arteritis is a chronic inflammatory vasculitis of unknown origin that affects large vessels, mainly the aorta and its main branches. Inflammation of the arterial wall leads to thickening of the wall, fibrosis and stenosis. Often asymptomatic in the initial phase, arterial lesions can manifest themselves by the consequences of these stenoses: limb claudication, transient ischemic stroke, constituted ischemic stroke, renovascular hypertension. These symptoms are not very specific, questionning the place of imaging in the diagnosis of the disease, and beyond its contribution to the diagnosis, what place it has in the monitoring and characterization of the activity of this arteritis. One way to evaluate the contribution of imaging in the exploration of Takayasu arteritis is to ask the question of doing without. Finally, what is the place of interventions based on the evaluation of Takayasu arteritis?
Diagnosis and Treatment of Renovascular Disease in Children
2019, Seminars in Roentgenology
CSI position statement on management of heart failure in India
2018, Indian Heart Journal

View all citing articles on Scopus

^☆: From the Departments of Cardiovascular Radiology (S.S., H.G., K.T., M.R.), Cardiology (A.S., S.S.K.), and Surgery (S.G.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029.

View full text

Vasular StentsResults of Renal Angioplasty in Nonspecific Aortoarteritis (Takayasu Disease)☆

Purpose

Materials and Methods

Results

Conclusion

Radiol Clin North Am

Clin Radiol

Semin Nucl Med

Clin Radiol

Am Heart J

J Am Coll Cardiol

Angiographic morphology in nonspecific aortoarteritis (Takayasu's arteritis): a study of 126 patients from North India

Cardiovasc Intervent Radiol

Takayasu's arteritis: radiographic and angiographic findings in 59 patients

Radiology

Renovascular hypertension resulting from nonspecific aortoarteritis in children: mid-term results of percutaneous transluminal renal angioplasty and predictors of restenosis

AJR

Percutaneous transluminal renal angioplasty:: initial and long-term results

Radiology

Subclavian and carotid angioplasties for Takayasu's arteritis

Can Assoc Radiol J

Percutaneous transluminal angioplasty in nonatherosclerotic lesions

AJR

Vasular Stents
Results of Renal Angioplasty in Nonspecific Aortoarteritis (Takayasu Disease)☆