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      Percutaneous transluminal angioplasty of complex aortoiliac occlusive disease secondary to Takayasu's aortoarteritis in a young female

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          Abstract

          As the initial treatment of patients with the iliac occlusive disease, percutaneous transluminal angioplasty (PTA) became common. Though not supported by the latest TransAtlantic Inter-Society Consensus (TASC) II guidelines, percutaneous treatment of complex aortoiliac lesions is possible and provides comparable angiographic and clinical outcomes compared to open surgery at both short- and long-term follow-up, also in complex lesion settings. TASC C and D lesions with the latest instruments, procedures, and modalities may also be managed endovascularly. It provides new opportunities for a population of highly comorbid patients. We assume that the outcomes of endovascular therapy for aortoiliac lesions in the setting of Takayasu's arteritis will be further enhanced through continuous technological progress and new advances in materials. In light of the current progression towards minimally invasive procedures, a growing number of skilled centres should be able to treat by endovascular intervention the great majority of all arterial pathologies.

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          Most cited references10

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          Surgical bypass vs endovascular treatment for patients with supra-aortic arterial occlusive disease due to Takayasu arteritis.

          This study compared treatment outcomes of patients with supra-aortic arterial (SAA) occlusive disease due to Takayasu arteritis (TA) treated with bypass surgery or endovascular treatment. All patients diagnosed with TA from September 1994 to November 2010 were identified using the hospital database. This retrospective study included 21 TA patients who underwent endovascular or surgical intervention due to SAA lesions and four patients who were referred from other hospitals after endovascular treatment of SAA lesions. Fifteen arterial lesions in 10 patients were treated with an endovascular technique, and 24 arteries in 15 patients were reconstructed using bypass surgery. We performed endovascular intervention for short ( 50%) or occlusion of the reconstructed arteries was observed in eight of 15 arteries (53.3%) in the endovascular treatment group vs three of 24 (12.5%) in the bypass surgery group (P = .01; Fisher exact test). More serious complications, such as intracerebral hemorrhage (n = 2) due to cerebral hyperperfusion syndrome or cardiac tamponade developed in the surgical bypass group. No operative deaths occurred in either group. Surgical or endovascular interventions were required in one of 10 TA patients with SAA occlusive lesions. Arteries reconstructed after surgical bypass had superior patency to those reconstructed by endovascular treatment. However, bypass surgery was more likely than endovascular treatment to be accompanied by serious early postoperative complications. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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            Surgery and Endovascular Management in Patients with Takayasu’s Arteritis: A Ten-year Retrospective Study

            Takayasu's arteritis (TA) is an uncommon chronic vasculitis, and there is a lack of long-term large cohort studies regarding the optimal revascularization outcomes of patients with TA.
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              Takayasu Arteritis: Criteria for Surgical Intervention Should Not Be Ignored

              Takayasu aortoarteritis is a rare, chronic granulomatous panarteritis with significant morbidity amongst young patients. Current challenges include a lack of awareness about the condition, delays in diagnosis due to its varied presentation, and suboptimal methods for assessing disease activity. The development of noninvasive imaging including magnetic resonance angiography and positron emission tomography is aiding earlier diagnosis. Early initiation of immunosuppressive treatment is crucial to control active inflammation and minimize arterial injury. Recent studies investigating biological agents such as tumour necrosis factor- α antagonists are encouraging. Surgical revascularization should only be undertaken following careful consideration, as restenosis is common. The indications for considering intervention include uncontrolled hypertension due to renal artery stenosis, severe symptomatic coronary artery or cerebrovascular disease, severe aortic regurgitation, stenotic or occlusive lesions resulting in critical limb ischemia, and aneurysms at risk of rupture. In these cases, the risk benefit ratio for intervention is good. Open surgery, at present, has better outcomes compared to endovascular techniques. However, technological advances in endovascular treatment are continually improving. Controlling disease activity prior to and following revascularization is key to preventing complications. A multidisciplinary approach to the diagnosis and management of Takayasu arteritis is essential to achieve satisfactory patient outcomes.
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                Author and article information

                Journal
                Indian J Radiol Imaging
                Indian J Radiol Imaging
                IJRI
                The Indian Journal of Radiology & Imaging
                Wolters Kluwer - Medknow (India )
                0971-3026
                1998-3808
                Jul-Sep 2020
                15 October 2020
                : 30
                : 3
                : 405-408
                Affiliations
                [1]Department of Cardiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
                [1 ]Department of Rheumatology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
                [2 ]Interventional Radiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
                [3 ]Department of Radiodiagnosis, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, India
                Author notes
                Correspondence: Dr. Pankaj Jariwala, Department of Cardiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, - 500 082, Telangana, India. E-mail: Pankaj_jariwala@ 123456hotmail.com
                Article
                IJRI-30-405
                10.4103/ijri.IJRI_225_20
                7694727
                e75e812f-e4bb-46c6-8aea-944a71979375
                Copyright: © 2020 Indian Journal of Radiology and Imaging

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 10 April 2020
                : 28 May 2020
                : 18 June 2020
                Categories
                Case Report

                Radiology & Imaging
                aortoiliac occlusive disease,percutaneous trans-luminal angioplasty,self-expanding stents,takayasu arteritis

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