300. RENAL BALLOON ANGIOPLASTY IN TAKAYASU ARTERITIS (TA)

Abstract

Background: TA is a granulomatous large-vessel vasculitis that provokes symptomatic or significant vascular lesions in the aorta, subclavian, carotid and renal arteries. Treatment with steroids, immunosuppressants and biological agents improves the outcome, but symptomatic or significant vascular lesions need interventions. Superiority between balloon angioplasty and stenting has been unresolved; however, stenting in the renal arteries presented a significantly higher incidence of restenosis than balloon angioplasty. Methods: Review of the clinical history and bibliography. Results: 29 year old male, with personal history of smoking (10 cigarettes/day) cannabis and Skip to lMeadi nk eCtoamteine, came to emergency room for hypertensive crisis (217/143). He suffered dyspnea and pain on his 3th to 5th fingers in both feet. He had lost of weight of 10 kg and referred myalgias at night. At exploration, he presented vascular ulcers on the fourth toe of his right foot and on the third toe of his left foot with presented pulses and livedo reticularis in his legs. Chest X-ray showed lung congestion. Renal insufficiency was detected in laboratory test. Intravenous prostraglandins were incited. Echocardiography showed hypertensive miocardiopathy. CT angiography showed thickening of the aorta at the level above and juxta-renal, generalized estasia of splecnica vascularization with occlusion of celiac trunk, stenosis of superior mesenteric artery and both renal arteries. In the following days the pain is controlled and analytically the renal function of the patient begins to gradually improve. Blood pressure is still very difficult to control, being necessary six antihypertensive drugs. Treatment with intravenous corticosteroids and intravenous cyclophosphamide was initiated. Jointly with the Vascular Surgery Unit, it was decided to perform an angioplasty balloon in the right renal artery. The procedure was performed with good results and without immediate complications. Blood pressure began to improve as necessary to reduce the antihypertensive treatment. In subsequent revisions, the patient remained asymptomatic. Conclusion: Balloon angioplasty of renal artery is an effective treatment of renovascular hypertension in TA.