Arterial hypertension at widespread vasculitis – only tip of the iceberg

• S.V. Gar’kina
• E.A Surkova
• Medvedeva E.A.
• S.A Gudkova
• N.A. Cherepanova
• A.I. Gracheva
• O.V. Efimova
• Khokhlunov S.M.
• Duplyakov Dmitriy V.

Abstract

The article provides a brief literature review of diagnosis and treatment problems of Takayasu's arteritis (TA) with coronary artery involvement. The pathogenesis complexity, lack of clear etiological factors, variety of clinical forms, possible complications and associated conditions allow discussion about several reasons of the disease appearance and progression.TA belongs to the group of systemic vasculitis. TA affects the wall of large arterial vessels (especially aorta and its branches), granulomatous inflammation with the formation of hemodynamically important stenoses and occlusions, along with the processes of arterial dilation and aneurysmal dilatation. It is not infrequent that the first manifestation of AT may be resistant arterial hypertension, which greatly complicates diagnostics. Pectanginous symptoms in patients with TA are always attended by a poor prognosis, as evidenced in the formation of large epicardial coronary vessel luminal sub-occlusion or occlusion (most often – main trunk of the left coronary artery). However, consider inflammatory process activity and necessity for such a therapeutic measure as combined immunosuppressive therapy, revascularization is associated with high risk of complications.

This article discusses current approaches to the management of coronary artery stenosis lesions in patients with AT. In this article different surgical tactics with the use of intravascular interventional approaches and open reconstructive operations (based on literature data) are compared. The experience of patient monitoring with AT that involve the ascending, thoracic and abdominal aorta, brachiocephalic and renal arteries on both sides and a critical involvement of major coronary arteries was described.

The complexity of systemic vasculitis diagnosis, consider the long-standing hypertension and ischemic heart disease manifestations is demonstrated. Successful surgical revascularization tactic combined with reconstructive operations on the aorta on a background of adequate immunosuppressive therapy is described.

Keywords:hypertension, Takayasu arteritis, acute coronary syndrome, surgical myocardial revascularization, reconstructive operations

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