Vascular Interventions in Takayasu Arteritis

A significant proportion of patients with Takayasu arteritis (TAK) need vascular surgical interventions to correct enlarging aneurysms and severe stenotic or occluded arteries with tissue ischemia. This review aims to analyze critically the outcomes of TAK patients undergoing different modalities of vascular interventions and the impact of disease activity and current therapy for TAK on outcomes.

Vascular interventions are a crucial part of TAK management and comprise different modalities of open surgery graft bypass and endovascular interventions. Vascular interventions are indicated for hemodynamically significant stenosis or occlusions leading to ischemia and to repair dissecting or increasing aneurysms in TAK patients. Ideally, TAK patients should undergo vascular interventions during the remission state of the disease and still under therapy with glucocorticoids and immunosuppressive agents. Despite several complications that may occur especially restenosis, pseudoaneurysms, bleeding, or infection, vascular interventions have a positive impact on the prognosis of TAK patients presenting severe disease. Restenosis is more frequently observed in patients undergoing endovascular procedures compared to those who performed open vascular surgery.

Vascular interventions are an important part of TAK management and should be indicated whenever medical therapy fails to treat vascular lesions with significant ischemia. The rate of complications is lower in patients with stable disease and still under therapy.