Takayasu's arteritis : pulseless disease
Takayasu’s arteritis (TA), also known as aortoarteritis and
pulseless disease, is a rare condition. It is a form of
idiopathic, chronic granulomatous arteritis, which affects large- and medium-
sized arteries, primarily the aorta and its large branches as
well as proximal portions of pulmonary, coronary, and renal
arteries. Initially, there are mononuclear cell infiltrations in
the adventitia and granulomas with Langerhans cells in the
media, followed by disruption of the elastin layer and
subsequent massive medial and intimal fibrosis. These
lesions result in segmental stenosis, occlusion, dilatation,
and aneurysmal formation in the affected vessels.
Diminished or absent pulses are present in 84-96% of
patients, associated with limb claudication and blood
pressure discrepancies between the two arms.
symptoms are secondary to the involved artery, and it may
evolve into a life-threatening condition.Involvement of
the carotid artery results in ophthalmic artery hypoperfusion
and causes ocular ischemic syndrome.
Case study in short :-
This report describes a 57-year-old man who presented with
gradual visual loss, syncopal attack and arm claudication.
His ocular findings suggested bilateral ocular ischemic
syndrome. He was later diagnosed as having Takayasu’s
A 57-year-old man had a gradual decline in visual acuity
over the past 3 months in both eyes. The medical history
was positive for generalized fatigue, numbness and pain in
the upper extremities particularly on the left arm that
worsened on exertion resembled ischemic pain.
Brachial and radial arterial pulses of left side were absent
on palpation. Right sided pulses were normal. His blood
pressure was measured 150/90 in right arm but blood
pressure was non recordable on left arm.
On ophthalmic examination, visual acuity was 6/36 in the
right eye and counting fingers at 2 meter in the left eye.
Retinal examination showed microaneurysms, dot and blot
hemorrhages, extensive ischemic area of retina in both eyes
and new vessels at optic disc in left eye. Fundus fluorescein
angiogram showed a delay in the arm-to-retina time (18 seconds), increased arterio-venous transit time and
extensive area of capillary non-perfusion in both eyes and
leakage from disc neovacularization in left eye. On the basis
of all these findings an ophthalmologist made the diagnosis
of bilateral ocular ischemic syndrome.
Laboratory findings showed an elevated erythrocyte sedimentation rate (ESR) of 46 mm/h (normal value <20
mm/1 h) &
serum C-reactive protein level of 1.13 mg/dl
(normal value <0.5 mg/dl). Results of different laboratory
tests were normal except mild rise of total serum lipid.
Carotid Duplex Ultrasound and Angiogram showed total
occlusion of left common carotid and left subclavian artery,
partial obstruction of the right common carotid artery and
normal aorta, brachiocephlic trunk and right subclavian
artery. Coronary and renal angiogram was normal. On the
basis of clinical manifestations and angiographic findings,
the diagnosis of TA was made.
Course of treatment :-
The patient was given oral steroids on a tapered basis. The
patient underwent panretinal photocoagulation in both eyes.
We consulted with vascular surgeons who have planned to
do carotid endarterectomy on this patient.