Endovascular repair of infrarenal aortic aneurysm and severe stenosis in Type V Takayasu arteritis: a rare case report and clinical insights

Abstract

Background: Takayasu arteritis (TA) is a rare, chronic vasculitis affecting the aorta and its major branches, leading to stenosis, aneurysm, and ischemic complications. It primarily affects young adults and may progress to critical ischemia, necessitating revascularization strategies. Endovascular aneurysm repair (EVAR) is increasingly recognized as an effective, minimally invasive intervention for managing TA-associated complications. Case description: A 28-year-old male presented with a three-month history of progressive bilateral lower limb discomfort and tingling exacerbated by activity, intermittent abdominal cramps, and fatigue. Physical examination revealed a significant blood pressure discrepancy between the upper limbs (right: 193/66 mmHg, left: 100/71 mmHg), reduced lower limb pressures (right ankle: 66/41 mmHg, left ankle: 72/42 mmHg), pulse deficits, and diminished ankle-brachial indices (right: 0.34; left: 0.37). Transthoracic echocardiography (TTE) demonstrated all-chamber dilatation, reduced systolic function (EF: 38%), severe mitral regurgitation, moderate aortic regurgitation, and a large right atrial thrombus (3.0 × 1.9 cm). Computed tomography angiography (CTA) revealed critical mid-aortic stenosis (6.9 × 11.9 mm), a post-stenotic saccular aneurysm (20.6 × 22.4 mm), and severe narrowing of the left subclavian and axillary arteries. The patient underwent endovascular aneurysm repair (EVAR), with a thoracic stent graft (24 × 80 mm) successfully deployed. Six months post-procedure, the patient experienced complete resolution of symptoms, with improved ABI values (right: 0.94; left: 0.73) and significant regression of the aneurysm (13.1 × 13.1 mm). Conclusion: EVAR may represent a feasible option for carefully selected TA patients with focal lesions and high surgical risk, although open repair remains necessary for more complex disease. Lifelong surveillance and further research are essential to optimize management strategies in this rare condition.