DEFINITION OF TAKAYASU ARTERITIS
Takayasu arteritis is an inflammatory and stenotic disease of medium- and large-sized arteries characterized by a strong predilection for the aortic arch and its branches.
INCIDENCE AND PREVALENCE OF TAKAYASU ARTERITIS
Takayasu arteritis is an uncommon disease with an estimated annual incidence rate of 1.2–2.6 cases per million. It is most prevalent in adolescent girls and young women. Although it is more common in Asia, it is neither racially nor geographically restricted.
PATHOLOGY AND PATHOGENESIS OF TAKAYASU ARTERITIS
The disease involves medium- and large-sized arteries, with a strong predilection for the aortic arch and its branches; the pulmonary artery may also be involved. The most commonly affected arteries seen by arteriography are listed in Table 356-7. The involvement of the major branches of the aorta is much more marked at their origin than distally. The disease is a panarteritis with inflammatory mononuclear cell infiltrates and occasionally giant cells. There are marked intimal proliferation and fibrosis, scarring and vascularization of the media, and disruption and degeneration of the elastic lamina. Narrowing of the lumen occurs with or without thrombosis. The vasa vasorum are frequently involved. Pathologic changes in various organs reflect the compromise of blood flow through the involved vessels.
TABLE 356-7Frequency of Arteriographic Abnormalities and Potential Clinical Manifestations of Arterial Involvement in Takayasu Arteritis |Favorite Table|Download (.pdf) TABLE 356-7 Frequency of Arteriographic Abnormalities and Potential Clinical Manifestations of Arterial Involvement in Takayasu Arteritis
|Artery ||Percentage of Arteriographic Abnormalities ||Potential Clinical Manifestations |
|Subclavian ||93 ||Arm claudication, Raynaud’s phenomenon |
|Common carotid ||58 ||Visual changes, syncope, transient ischemic attacks, stroke |
|Abdominal aortaa ||47 ||Abdominal pain, nausea, vomiting |
|Renal ||38 ||Hypertension, renal failure |
|Aortic arch or root ||35 ||Aortic insufficiency, congestive heart failure |
|Vertebral ||35 ||Visual changes, dizziness |
|Coeliac axisa ||18 ||Abdominal pain, nausea, vomiting |
|Superior mesenterica ||18 ||Abdominal pain, nausea, vomiting |
|Iliac ||17 ||Leg claudication |
|Pulmonary ||10–40 ||Atypical chest pain, dyspnea |
|Coronary ||<10 ||Chest pain, myocardial infarction |
Immunopathogenic mechanisms, the precise nature of which is uncertain, are suspected in this disease. As with several of the vasculitis syndromes, circulating immune complexes have been demonstrated, but their pathogenic significance is unclear.
CLINICAL AND LABORATORY MANIFESATIONS OF TAKAYASU ARTERITIS
Takayasu arteritis is a systemic disease with generalized as well as vascular symptoms. The generalized symptoms include malaise, fever, night sweats, arthralgias, anorexia, and weight loss, which may occur months before vessel involvement is apparent. These symptoms may merge into those related to vascular compromise and organ ischemia. Pulses are commonly absent in the involved vessels, particularly the subclavian artery. The frequency of arteriographic abnormalities and ...