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(Circulation. 2008;118:2738-2747.)
© 2008 American Heart Association, Inc.

Heart Disease in Asia

Overview of Late Outcome of Medical and Surgical Treatment for Takayasu Arteritis

Hitoshi Ogino, MD, PhD; Hitoshi Matsuda, MD, PhD; Kenji Minatoya, MD, PhD; Hiroaki Sasaki, MD, PhD; Hiroshi Tanaka, MD, PhD; Yu Matsumura, MD; Hatsue Ishibashi-Ueda, MD, PhD; Junjiro Kobayashi, MD, PhD; Toshikatsu Yagihara, MD, PhD; Soichiro Kitamura, MD, PhD

From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan.

Correspondence to Hitoshi Ogino, MD, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan. E-mail hogino@hsp.ncvc.go.jp

Key Words: endovascular treatment • late outcome • medical treatment • surgical treatment • Takayasu arteritis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Takayasu arteritis (TA), which is a nonspecific inflammatory disease of unknown origin, causes various types of aortoarterial stenosis/occlusion or dilatation (Figure). Historically, Mikito Takayasu, a Japanese ophthalmologist, described a peculiar wreathlike arteriovenous anastomosis around the papillae of the retina (Takayasu disease) in 1908.¹ In the first necropsy case reported in 1940, this ophthalmologic finding was related to cervical vessel occlusion.^2,3 Subsequently, this nonspecific panarteritis that affects the intima and the adventitia of the aorta and its main branches was called Takayasu arteritis. Its clinical manifestations are varied and related to the vessel that presents the stenotic or occlusive lesions, such as the aortic arch (pulseless disease),⁴ descending thoracic or abdominal aorta (atypical coarctation),⁵ renal arteries,⁶ coronary arteries,⁷ and pulmonary arteries. Aortic aneurysm⁸ and aortic valve regurgitation with ascending aortic dilatation⁹ may also develop in some instances. Pharmacological treatment with corticosteroids is usually the initial treatment. Some patients require surgical treatment such as bypass grafting and graft replacement or endovascular repair including percutaneous transluminal angioplasty (PTA) and stent grafting, even in the active phase or in the inactive chronic phase with adequate control of the inflammation. Since the 1960s, acceptable early and midterm outcomes of medical and/or surgical treatment have been published. However, the long-term outcome, including that of recently developed endovascular treatment, has not been discussed. In this article, we describe an overview, particularly focusing on the late outcome of treatment for TA.

View larger version (120K):   Figure. Three-dimensional computed tomographic findings of an active phase of Takayasu arteritis (21 years, . . . [Full Text of this Article]