Souza Magalhães Ricardo Filipe, Dos Santos Campelo Priscilla Ribeiro, da Costa Matos Juliana, Dos Santos Souza José Emerson, Alves Ramos Diniz Paulo Inácio, Rios Rodriguez Juan Eduardo, Velludo Bernardes Marcos, Pessoa Cavalcante Leonardo
Federal University of Amazonas, Getulio Vargas University Hospital, Vascular Surgery Division, Manaus, AM, Brazil.
Fundacao Hospital do Coração Francisca Mendes, Vascular and Endovascular Surgery Division, Manaus, AM, Brazil.
Ann Med Surg (Lond). 2022 Jul 31;81:104247. doi: 10.1016/j.amsu.2022.104247. eCollection 2022 Sep.
Takayasu arteritis (TA) is a chronic inflammatory arteriopathy of unknown etiology that affects the aorta and its branches. Inflammation leads to arterial stenosis, thrombosis, and aneurysm formation. Management strategies for TA include medical therapy and revascularization procedures after inflammation is controlled.
We report the case of a 12-year-old female patient, who presented with dyspnea and growth retardation. Initial clinical and radiological evaluations revealed hypertension and congestive heart failure. After controlling the inflammatory phase of the disease and blood pressure partially (with three antihypertensive agents), the patient underwent percutaneous balloon angioplasty of both renal arteries, with angiographic and clinical success. At the 2-year follow-up, she presented with re-stenosis of the right renal artery and progression of the supra-renal aortic stenosis. She was subjected to a second balloon angioplasty of the right renal artery and aortic balloon angioplasty.
After controlling the inflammatory phase of the disease, stenotic and/or aneurysmal lesions can be addressed. Percutaneous revascularization of renal arteries is reasonable for patients with hemodynamically significant renal artery stenosis.
TA with renal involvement must be considered as an etiologic factor for secondary hypertension in young patients, even if there is no blood pressure difference between the upper extremities. In this case, renal and aortic stenosis were performed with low perioperative morbidity.
大动脉炎（TA）是一种病因不明的慢性炎症性动脉病，累及主动脉及其分支。炎症会导致动脉狭窄、血栓形成和动脉瘤形成。TA的治疗策略包括药物治疗以及在炎症得到控制后进行血运重建手术。
我们报告一例12岁女性患者，表现为呼吸困难和生长发育迟缓。初始临床和影像学评估显示高血压和充血性心力衰竭。在部分控制疾病的炎症期和血压（使用三种抗高血压药物）后，患者接受了双侧肾动脉经皮球囊血管成形术，血管造影和临床均获成功。在2年随访时，她出现右肾动脉再狭窄和肾上腺上方主动脉狭窄进展。她接受了右肾动脉第二次球囊血管成形术和主动脉球囊血管成形术。
在控制疾病的炎症期后，可处理狭窄和/或动脉瘤性病变。对于有血流动力学意义的肾动脉狭窄患者，经皮肾动脉血运重建是合理的。
即使上肢血压无差异，TA合并肾脏受累也必须被视为年轻患者继发性高血压的病因。在本病例中，肾动脉和主动脉狭窄手术的围手术期发病率较低。
