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A 68-year-old woman with a history of Takayasu arteritis presented with 10 months of postprandial abdominal pain associated with loss of appetite and a 3 kg weight loss in 3 months. Her medical history was notable for a 30-year history of Takayasu arteritis involving the thoracic descending aorta, abdominal aorta and renal arteries, with aortic regurgitation for which she had been treated with prednisolone. At the time of presentation, she was prescribed prednisolone 6 mg daily and amlodipine.
On physical examination, vital signs were stable with no significant difference between blood pressures measured in each arm. There was a to-and-fro murmur at the aortic valve area and an abdominal bruit on auscultation. CT revealed profound calcification from the ascending aorta to the level of the renal arteries with narrowing of the superior mesenteric artery (figure 1A). An echocardiogram showed preserved left ventricular function with moderate aortic regurgitation, which was mild 10 years before. A Fluoro Deoxy Glucose - Positron Emission Tomography (FDG-PET) did not reveal arterial inflammation. Angiography revealed a 30 mm Hg pressure difference between thoracic descending aorta and abdominal aorta, severe narrowing of superior mesenteric artery (figure 1B) and development of multiple collateral vessels.
(A) Profound calcification from the ascending aorta to the level of the renal arteries and superior mesenteric artery (arrow) were notable. (B). Angiography revealed severe narrowing of superior mesenteric artery (arrows), with development of collaterals.
Limited forward arterial flow to the gut due to advanced aortic regurgitation, and arterial narrowing between the thoracic descending aorta and the abdominal aorta may have contributed to mesenteric ischaemia. Abdominal angina was diagnosed, and her symptoms resolved after a bypass graft was placed from the left common iliac artery to the superior mesenteric artery (figure 2).
A bypass graft was placed from the left common iliac artery to the superior mesenteric artery (arrow).
Takayasu arteritis, which is prevalent in young women, often involves the aorta and its primary branches including renal, coeliac and superior mesenteric arteries.1 Patients with Takayasu arteritis have ischaemic symptoms of the affected arteries, diminished pulses and constitutional symptoms such as fever. However, abdominal angina is an uncommon presentation.2 Circumferential calcification of thoracic and abdominal aorta resulting in intraluminal stenosis is a potential complication of long-standing Takayasu arteritis.3
Learning points
Takayasu arteritis, which is prevalent in young women, often involves the aorta and its primary branches including renal, coeliac and superior mesenteric artery.
Patients with Takayasu arteritis have ischaemic symptoms of the affected artery, diminished pulses and constitutional symptoms such as fever, however, abdominal angina is an uncommon presentation.
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Acknowledgments
We thank Dr Rita McGill (Department of Nephrology, University of Chicago) for English correction of the manuscript. We also thank Drs Kohei Chida, Toru Ishimine and Naoki Taniguchi for their surgical intervention.
Footnotes
Contributors HT wrote manuscript and collected data. HY wrote manuscript and collected data. MK contributed to overall writing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.