Surgical treatment should be done only after adequately treating with immunosuppressive medications (see Table 2). Surgical indications include severe uncontrolled renovascular hypertension, coarctation of the aorta, severe cerebral ischemia, severe aortic regurgitation and progressive aneurismal enlargement or dissection. Surgical bypass procedures have good long-term survival rates, with restenosis rates being less than 30%.3,4 The surgical procedures can be done either by open procedures or through endovascular approach with the use of either autologous or synthetic grafts.
Back to the Case
Our patient had aneurysms at more than one site. There was rapid worsening of the aortic aneurysm leading to rupture. He was fortunate to have survived that and improved after an extensive emergency surgery. Although the femoral artery aneurysm was asymptomatic, because it was reasonably large and had the potential to rupture, elective surgery was done after a six-month period of escalated immunosuppression.
G.C. Yathish, MD, is a rheumatology DNB student at Hinduja Hospital in Mumbai, India.
Taral Parikh, MD, is a rheumatology DNB student at Hinduja Hospital in Mumbai, India.
Parikshit Sagdeo, MD, is a rheumatology DNB student at Hinduja Hospital in Mumbai, India.
Balakrishnan Canchi, MD, is the chief of rheumatology at Hinduja Hospital in Mumbai, India.
Gurmeet Mangat, MD, is a consultant rheumatologist at Hinduja Hospital in Mumbai, India.
Hemanth Kumar Pandharpurkar, MS, is a consultant vascular surgeon at Hinduja Hospital in Mumbai, India.
References
- Jain S, Kumari S, Ganguly NK, et al. Current status of Takayasu arteritis in India. Int J Cardiol. 1996 Aug;54 Suppl:S111–S116.
- Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis. Ann Intern Med. 1994 Jun 1;120(11):919–929.
- Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol. 2005 Jan;17(1):16–24.
- Miyata T, Sato O, Koyama H, et al. Long-term survival after surgical treatment of patients with Takayasu’s arteritis. Circulation. 2003 Sep 23;108(12):1474–1480.