Acute Type B Dissection in Remission Phase of Takayasu Arteritis

P0028 

Abstract Submission 

Yuki Ikeno (1), Francesco Brandini (1), Lucas Ribe (1), Anthony Estrera (1), Akiko Tanaka (1)

(1) McGovern Medical School at UTHealth, Houston, TX

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Francesco Brandini    -  Contact Me
McGovern Medical School at UTHealth

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

*Anthony Estrera    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
McGovern Medical School at UTHealth

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Objective:
Takayasu arteritis (TA) is an uncommon chronic inflammatory disorder, characterized by granulomatous panarteritis primarily affecting the large vessels, particularly the aorta and its branches, leading to stenosis, occlusion, and aneurysm formation. Aortic dissection, a catastrophic complication associated with TA, occasionally presents as an initial manifestation in an even more extraordinarily rare subset, occurring in less than 1% of patients with TA.

Methods:
In this report, we present a case of TA complicated by acute aortic dissection, an event that occurred during the remission phase and notably in the absence of aortic dilation and inflammation.

Results:
A 64-year-old female patient with a prolonged history of Takayasu arteritis (TA) presented with the sudden onset of back pain. She had previously been prescribed steroids for her condition; however, steroid treatment had been discontinued over the past two years due to the development of osteoporosis. Notably, her TA had been effectively managed without recurrences. During outpatient visits, her systolic blood pressure had consistently measured around 110 mmHg. Approximately one month prior to her current presentation, the patient had undergone routine TA follow-up evaluation, including computed tomography (CT) imaging. The CT scan from that evaluation had revealed no signs of inflammatory response surrounding the aorta and indicated no significant dilatation of the aortic structure (Figure 1). The diameter of the descending aorta was measured at 30 mm. However, upon her recent presentation, a follow-up CT scan revealed an acute Stanford type B aortic dissection with an exclusively thrombosed false lumen that extended from Zone 4 to Zone 9, type III anatomic classification of aortitis (Figure 2). Importantly, there were no discernible indications of organ malperfusion or aortic rupture. The patient's aortic dissection was managed conservatively, and she was discharged home without experiencing any complications. Stress-dose steroids were gradually tapered off over the course of eight weeks following the dissection event.

Conclusions:
We encountered a case of acute type B aortic dissection in a patient with TA, despite the absence of aortic dilation during remission. This underscores the critical need for proactive risk factor modification and regular aortic monitoring as indispensable components of long-term management for

Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)