Clinical features of aortic dissection associated with Takayasu's arteritis

Takayasu’s arteritis (TA) is a chronic and nonspecific inflammatory vessel disease that involves the aorta and its major branches. TA results in stenosis, occlusion or aneurysmal degeneration of large arteries pathologically. Although TA is an unusual disease, it is more commonly observed to occur in Asian females compared to the general population worldwide. Aortic dissection is a very rare complication of TA, and only a limited number of TA cases presenting with aortic dissection have been published so far. This study presents the clinical characteristics, treatment, and prognosis of patients with aortic dissection associated with TA based on a case series and intends to serve as a reference.  Seven cases were recorded to have aortic dissection associated with TA in our hospital from 2000 to 2016, of which six patients were female. The clinical characteristics, medical examination findings, and follow-up details of these patients are shown in Table 1. All patients had the history of hypertension. A clear history of tearing chest pain and tightness, which is characteristic of aortic dissection, was recorded only in two patients; the remaining five patients revealed no history of chest or back pain but complained of fatigue or breathless, recurrent chest discomfort, or pulselessness, and hypertension. Angiography demonstrated a linear, low-density intimal flap dividing the aorta into a true and false lumen (Figure 1A) in patient #1. The diameter of the false lumen was greater than that of the true lumen, with the former almost completely occluding the latter (Figure 1B). Bare-metal stents were implanted. Antihypertensive drugs (angiotensin converting enzyme inhibitors, calcium channel blockers, beta blockers, and diuretics) and prednisone were continued after the invasive intervention. Follow-up examinations were conducted; her blood pressure was noted to have returned to normal levels at one month, and the left ventricular ejection fraction was improved from 45% to 55% at six month.