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Oct23
TAKAYASU ARTERITIS IS A RELATIVELY COMMON ENTITY TO COME ACROSS IN OUR DAILY CLINICAL PRACTICE MORE SO IN ASIAN POPULATION.THESE PATIENTS ARE EITHER ASYMPTOMATIC OR ELSE PRESENT WITH VASCULAR SYMPTOMS.ITS NOT UNSUAL TO FIND A YOUNG WOMAN WITH NO SYMPTOMS INSPITE OF ABSENT PULSES ON THE FOREARM.BUT NOT ALL PATIENTS ARE THAT LUCKY.PATIENTS COME TO YOU WITH SYMPTOMS RANGING FROM MILD PAIN IN THE FOREARMS ON EXERSION TO SEVERE PAIN ABDOMEN ON TAKING SMALL MEALS.CLINICAL REASONING,THOROUGH EXAMINATION AND AWARENESS OF THIS ENTITY IS MANDATORY TO PROCEED FURTHER IN SUCH CASES.TREATMENT OPTIONS IN SYMPTOMATIC POPULATION ARE NOT MANY WITH THE GENERAL VASCULAR TREND FAVOURING SURGERY IN SUCH CASES.THOUGH VASCULAR SURGEONS TEND TO WAIT TILL THE DISEASE PROCESS COMES UNDER CONTROL BEFORE THEY EMBARK ON DOING SURGERIES IN THIS SMALL BUT SYMPTOMATIC POPULATION,THERE ARE SITUATIONS WHERE ‘WAIT AND WATCH’ THEORY DOES NOT HELP.WE REPORT TO YOU A SIMILAR CASE OF TAKAYASU ARTERITIS.

THIS GIRL 17 YEARS OLD CAME TO US WITH UNCONTROLLED RENAL HYPERTENSION INSPITE SHE BEING ON 3 ANTIHYPERTENSIVES,PAIN ABDOMEN ON TAKING SMALL MEALS AND SIGNIFICANT BILATERAL LOWER LIMB CLAUDICATION.A CT ANGIO DONE ON HER WAS SUGGESTIVE OF MULTIPLE LARGE SACCCULAR ANEURYSMS IN THE AORTA(POST LEFT SUBCLAVIAN) INVOLVING THE ORIGIN OF THE LEFT SUBCLAVIAN ARTERY,DESCENDING AORTA,SUPRACELIAC AORTA,ONE IN THE SUPRARENAL REGION AND IN ADDITION AORTO-ILIAC OCCLUSION.SHE THEREFORE PRESENTED WITH MULTIPLE AORTIC ANEURYSMS AND AORTO-ILIAC DISEASE AT THE SAME TIME.HER LEFT KIDNEY WAS SMALL AND NON-FUNTIONAL.WE WERE IN A DILEMMA THE VERY MOMENT WE SAW THE ANGIO BUT WE REGROUPED OURSELVES AND DECIDED SURGERY WAS THE BEST OPTION IN HER EVEN IF IT MEANT OPEARATING ON HER WITH THE DISEASE PROCESS STILL ACTIVE.

WE REPLACED THE WHOLE AORTA STARTING FROM THE LEFT SUBCLAVIAN ARTERY(INCLUDING THE REIMPLANTATION OF LEFT SUBCLAVIAN ON THE DACRON GRAFT) TILL THE AORTIC BIFURCATION.AORTIC BIFURCATION WAS REPLACED WITH A STANDARD AORTO-BIFEMORAL GRAFT..IN ADDITION WE DID A LEFT SIDED NEPHRECTOMY.PATIENT IS DOING OK AND IS IN REGULAR FOLLOWUP.
TO DATE GOING BY THE LITERATURE THIS IS THE FIRST OF ITS KIND CASE DONE IN THE WORLD WHEREIN SUBTOTAL AORTIC REPLACEMENT HAS BEEN DONE IN A YOUNG PATIENT OF 17 YEARS WITH THIS KIND OF PRESENTATION.


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Nov05

HelloSir,U have done a marvelous job .Keep it up.


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