Waqas Ahmed, Zeeshan Ahmad.
Takayasu`s Arteritis: A case report with global arterial involvement.
Rawal Med J Jan ;30(1):43-5.

A 55 year old male presented with left arm pain of several months duration. His past medical history was significant for type II diabetes mellitus and hypertension. Six years earlier, he had developed progressive pain and weakness of his entire right arm. The findings of diminished pulses lead to an angiogram which revealed aneurysmal dilatation and critical stenosis of right subclavian artery. He underwent surgical revascularization with an end-to-end gortex graft. However, one month latter, the graft occluded with moderate residual dysfunction of his right arm. Biopsy of the arterial segment, at the time of the surgery, showed non-specific inflammation and thrombosis. On examination, a moderate size, pulsating mass was obvious in the left clavicular region. Distal pulses in the left arm were 2 + with warm skin. No peripheral pulses were palpable in the right arm. A duplex ultrasound scan revealed a very tortuous and aneurysmal left subclavian artery. He underwent aortography, left subclavian and coronary angiography. Arch aortography revealed dilated aortic arch with complete occlusion of the right subclavian artery. There were multiple areas of severe stenosis interposed between the aneurysmal segments. Coronary angiography showed aneurysmal dilatation of the left main and proximal left anterior descending artery (LAD) with moderate (50%) mid LAD narrowing. Patient was placed on high dose prednisone (40 mg twice daily) for two weeks which was tapered to 10 mg daily over the ensuing two weeks. There was substantial improvement of his claudication.

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