Takayasu's arteritis

Abstract

The aorta and its major branches are the prime disease targets in Takayasu's arteritis (TA). Clinical symptoms of vascular inflammation and vascular insufficiency are usually accompanied or preceded by a systemic inflammatory process. TA disease tends to affect women much more often than men (female:male ratio 9:1), and has a predilection for Asian women. However, the disease has been described in individuals of all racial and ethnic backgrounds. TA is associated with granulomatous inflammation within the blood vessel wall. The histopathologic features of the disease closely resemble those of giant cell arteritis. TA leads to vascular narrowing in most of the blood vessels it affects. However, in the aorta, the disease can cause aneurysms. These often lead to aortic regurgitation of the ascending aorta. A lesion of great concern in TA is renal artery stenosis, which can lead to a rennin-mediated hypertension. If the patient has narrowings in all of the blood vessels to the four extremities, then peripheral blood pressure measurements may not be accurate assessments of the true central aortic pressures. Catheterization may be required to determine the patient's blood pressure accurately. Eye lesions in TA are of two major types: hypertensive retinopathy (particularly in the setting of renal artery stenosis) and proliferative retinopathy (caused by extreme narrowing of the blood vessels supplying the head, which leads to neovascularization of the retinal vascular supply). Anterior ischemic optic neuropathy, the most common ocular lesion of giant cell arteritis, occurs very rarely in TA. © 2010 Springer-Verlag London.