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Introduction <p>Takayasu arteritis is a chronic idiopathic vasculitis that primarily affects the aorta and its major branches. Lower-extremity arterial involvement is uncommon and may mimic atherosclerotic peripheral arterial disease, potentially leading to delayed diagnosis, particularly in young patients without conventional cardiovascular risk factors.</p> Case Presentation <p>A 36-year-old woman presented with uncontrolled hypertension, intermittent bilateral lower-limb claudication, and a single episode of syncope. Laboratory evaluation showed elevated inflammatory markers and impaired renal function. Renal Doppler ultrasonography suggested significant renovascular compromise, prompting further assessment with contrast-enhanced CT angiography. Imaging revealed diffuse circumferential mural thickening, calcification, and multisegmental stenoses involving the aortic arch, thoracoabdominal aorta, subclavian arteries, and bilateral renal arteries. Extensive iliofemoral involvement was also noted, affecting the common iliac, external iliac, and common femoral arteries. Additional findings included aneurysmal dilation of the abdominal aorta and severe bilateral renal artery stenosis. The constellation of findings was consistent with Takayasu arteritis with rare iliofemoral arterial involvement. The patient was managed conservatively with antihypertensive therapy, cilostazol, and immunomodulatory treatment.</p> Conclusions <p>This case underscores the importance of considering large-vessel vasculitis in young patients presenting with claudication or atypical peripheral arterial disease. Failure to recognize such presentations may lead to misdiagnosis and suboptimal management. Comprehensive imaging, particularly CT angiography, plays a crucial role in identifying multiterritorial vascular involvement, assessing disease extent, and guiding treatment strategies. Reporting unusual patterns of vascular involvement contributes to a better understanding of disease heterogeneity and emphasizes the value of multimodality imaging in suspected large-vessel vasculitis.</p>

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Beyond Classic Territories: Atypical Iliofemoral Vascular Involvement in a Suspected Takayasu Arteritis Presenting as Peripheral Arterial Disease Mimic in Young Age

  • 期刊论文

  • 发表日期：

    2026年5月12日

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  • Gokulsamy Arumugam,
  • Resham Singh,
  • Chirag Jain,
  • Gulshan Sharma

摘要

Introduction

Takayasu arteritis is a chronic idiopathic vasculitis that primarily affects the aorta and its major branches. Lower-extremity arterial involvement is uncommon and may mimic atherosclerotic peripheral arterial disease, potentially leading to delayed diagnosis, particularly in young patients without conventional cardiovascular risk factors.

Case Presentation

A 36-year-old woman presented with uncontrolled hypertension, intermittent bilateral lower-limb claudication, and a single episode of syncope. Laboratory evaluation showed elevated inflammatory markers and impaired renal function. Renal Doppler ultrasonography suggested significant renovascular compromise, prompting further assessment with contrast-enhanced CT angiography. Imaging revealed diffuse circumferential mural thickening, calcification, and multisegmental stenoses involving the aortic arch, thoracoabdominal aorta, subclavian arteries, and bilateral renal arteries. Extensive iliofemoral involvement was also noted, affecting the common iliac, external iliac, and common femoral arteries. Additional findings included aneurysmal dilation of the abdominal aorta and severe bilateral renal artery stenosis. The constellation of findings was consistent with Takayasu arteritis with rare iliofemoral arterial involvement. The patient was managed conservatively with antihypertensive therapy, cilostazol, and immunomodulatory treatment.

Conclusions

This case underscores the importance of considering large-vessel vasculitis in young patients presenting with claudication or atypical peripheral arterial disease. Failure to recognize such presentations may lead to misdiagnosis and suboptimal management. Comprehensive imaging, particularly CT angiography, plays a crucial role in identifying multiterritorial vascular involvement, assessing disease extent, and guiding treatment strategies. Reporting unusual patterns of vascular involvement contributes to a better understanding of disease heterogeneity and emphasizes the value of multimodality imaging in suspected large-vessel vasculitis.