What is included in the long-term monitoring of Takayasu arteritis?

Updated: Nov 14, 2018
  • Author: Jefferson R Roberts, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Bypass surgery has been performed on patients with critical thoracic aortic arch arterial stenosis, upper and lower extremity ischemia, cerebrovascular accidents, and renal artery stenosis. The procedures are generally case specific. Certain issues, such as the timing of surgery in relation to disease activity or the advisability of surgery in symptom-free patients, have not been resolved. Anastomotic stenoses or graft occlusion is a potential complication of surgery.

Grafts have been used to bypass regions of severe stenosis or occlusion. Usually, the graft is a saphenous vein graft. Examples of grafts performed include bypass of renal artery stenosis for renal salvage; bypass of innominate or carotid artery; and bypass between subclavian-axillary and common carotid arteries. Extraintracranial bypass operations generally are performed for stenosis of the internal carotid or middle cerebral arteries.

Follow-up should be with a rheumatologist who can follow disease activity and treat the patient medically as needed.

A follow-up examination of critical or near-critical stenosis and disease activity with angiography (or MRI or CT angiography) and possibly FDG-PET scanning may be necessary. Recognizing that Takayasu arteritis may progress in the absence of clinical findings is important. Periodic imaging may reveal an active disease that requires treatment with immunosuppressive agents.


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