Takayasu's arteritis: Diagnosis, treatment

The article was consulted with Dr. Nguyen Van Duong - Interventional Cardiologist - Cardiovascular Center - Vinmec Central Park International General Hospital.

Takayasu's arteritis is an inflammatory disease of the arteries of medium and large size that, when advanced, causes narrowing, occlusion, or aneurysm. Diagnosis of takayasu pathology is usually based on vascular imaging. Takayasu disease can be treated by medical methods or vascular interventions.

Takayasu's arteritis is a rare disease, with inflammation mainly affecting large arteries such as the aorta. Takayasu disease can lead to arterial blockage or narrowing or dilation of the arteries. Takayasu's arteritis is sometimes referred to as "vasodilator disease", because peripheral vessels are difficult to detect due to narrowing of the blood vessels.
Takayasu's pathology mainly occurs in girls and women under 40 years of age. The female to male ratio is 9: 1. Although the disease has a worldwide distribution, it is more common in Asian women. The frequency of Takayasu disease is about 2-3 patients per million people in the population per year.

Diagnosing Takayasu's arteritis can be extremely difficult. The disease usually progresses insidiously for many years, causing only nonspecific symptoms associated with the systemic phase or being asymptomatic, until complications occur. These major complications can include dilation of the aorta causing aortic regurgitation that severely reduces blood flow to the arms or legs, high blood pressure stroke, myocarditis, heart failure, myocardial infarction .
Once suspected, takayasu pathology is diagnosed by vascular imaging such as:
Doppler vascular ultrasound can provide very high resolution images of arteries, such as the carotid arteries and arteries under the blow. In addition, Doppler ultrasound can detect small changes in the arteries. Vascular Doppler ultrasound can also help differentiate between Takayasu's arteritis and atherosclerosis. X-ray angiography with contrast dye more accurately diagnose Takayasu's arteritis. This test can assess blood flow, lumen, narrowing or blockage. Contrast-enhanced computed tomography angiography allows the structure of the aorta and its branches to be examined and blood flow to be assessed. Magnetic resonance angiography (MRA) with contrast injection. This method uses pulses and magnetic fields to create detailed, slice-of-life images of organs in the body. Histopathological analysis of blood vessels under the microscope is not used to diagnose Takayasu's arteritis. Takayasu's vasculitis is pathologically indistinguishable from giant cell arteritis. In both of these cases, damage to the blood vessel wall and giant cells are present.

Takayasu's arteritis is difficult to treat. The goals of Takayasu's treatment are to control inflammation, prevent further damage to blood vessels, and limit the side effects of medications.
The majority of patients with Takayasu's arteritis respond to corticosteroids. Corticosteroids such as prednisone or methylprednisolone are first-line treatment. The usual starting dose is about 1 mg per 1 kg of body weight per day (for most people about 60 mg a day). Prednisone is usually significantly effective, taking effect within a few hours of the first dose. However, there are some patients who respond only partially. Because of the significant side effects of long-term use of high doses of prednisone, the dose is tapered over several weeks to a dose that is tolerable by the patient. Long-term side effects of corticosteroids include edema, weight gain, osteoporosis, hyperglycemia, increased risk of infection, menstrual irregularities, and delayed wound healing.
For long-term treatment of takayasu, in addition to prednisone, methotrexate, azathioprine, and even cyclophosphamide are sometimes used. These immunosuppressive agents are also used when the patient's symptoms recur or worsen despite corticosteroid therapy. The mechanism of action of the drug is to suppress the immune system, effectively reducing the inflammation of blood vessels. The most common side effect of taking the drug is an increased risk of infection.
In patients who do not respond to standard therapy, immunomodulatory drugs such as adalimumab, etanercept, infliximab and tocilizumab can be used. However, further studies on the effectiveness of this class of drugs are needed.
If the lumen is severely narrowed or blocked, surgery is indicated to restore circulation. Methods of revascularization include stenting, percutaneous angioplasty, and arterial bypass surgery.
In addition, maintaining a healthy lifestyle that includes not smoking, regular exercise and a good diet is an effective way to reduce the risk of further damage to blood vessels and organs.

Currently, Cardiovascular Center - Vinmec International General Hospital is one of the leading centers in the country for examination, diagnosis, screening and treatment of cardiovascular diseases. Vinmec not only has the convergence of a team of experienced and reputable leading experts in the field of surgical, internal medicine, interventional cardiac catheterization but also has a system of modern equipment, on par with The most prestigious hospitals in the world such as: MRI 3 Tesla (Siemens), CT 640 (Toshiba), EVIS EXERA III high end endoscopes (Japan Olympus), high anesthesia system Avace level, Hybrid operating room according to international standards... Thanks to good medical quality, the hospital has achieved a lot of achievements in the examination and treatment of many dangerous diseases.