경동맥 협착을 동반한 Takayasu 혈관염에서 경피적 스텐트 삽입술 : 단기 및 추적관찰 결과 Early and Long-Term Follow-up Results

편육범,윤영섭,박경진,김소영,심원흠 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.5

Anaortic Off-pump Coronary Artery Bypass Grafting in Patients with Takayasu’s Arteritis

나권중,이경학,오세진,황호영,김기봉 대한흉부외과학회 2013 Journal of Chest Surgery (J Chest Surg) Vol.46 No.4

Background: Coronary involvement in Takayasu’s arteritis is a rare but fatal disease. The aim of this study was to evaluate the early and mid-term results of Takayasu’s arteritis patients who underwent coronary artery bypass grafting (CABG). Materials and Methods: Of 2,280 patients who underwent isolated CABG from January 1998 to June 2012, Takayasu’s arteritis was identified in 5 patients. There were 3 female patients, and the mean age was 58±9 years. Takayasu’s arteritis was diagnosed during preoperative evaluation for coronary artery disease in 4 patients, and the initial manifestation was angina pectoris in 4 patients. All of the patients underwent anaortic off-pump CABG (OPCAB) using the in situ left or right internal thoracic arteries (ITA); 3 patients had severe stenosis of the proximal left subclavian artery and the in situ right ITA was used instead. Medical treatment for inflammatory arteritis during the perioperative and follow-up period was performed if indicated. Early, 1-year, and 5-year angiographic results and clinical outcomes were analyzed. Results: There was no surgical mortality, and all of the patients were discharged without complications on postoperative 8±2 days. Early postoperative (postoperative 2±1 days) angiography demonstrated a graft patency of 100% (12 of 12 distal anastomoses). One-year (13±3 months) angiography was performed in 4 patients, and all of the grafts were patent (100%, 9 of 9 distal anastomoses). Conclusion: By performing anaortic OPCAB in patients with Takayasu’s arteritis, we were able to avoid complications associated with manipulating an atherosclerotic and severely calcified ascending aorta. The early and mid-term graft patency of OPCAB in Takayasu’s arteritis was maintained when concomitant with medical treatment.

Takayasu씨 동맥염과 동반된 관상동맥 및 신동맥 협착

황재준,김학제,류세민,조원민,손영상,최영호 대한흉부외과학회 2002 Journal of Chest Surgery (J Chest Surg) Vol.35 No.9

=Takayasu's Arteritis Associated with Coronary and Renal Arteries Stenosis Takayasu씨 동맥염은 원인이 잘 모르는 만성 염증성 질환의 일종이다. 이 질병은 주로 대동맥궁과 대동맥의 주분지를 잘 침범하는 것으로 알려져 있으며, 관상동맥과 신동맥을 동시에 침범하는 경우는 극히 드물다. 최근 고려대학교 흉부외과학교실에서는 관상동맥과 신동맥을 동시에 침범한 Takayasu씨 동맥염 환자를 성공적으로 치료하였기에 보고하는 바이다. 환자는 23세 여자로, 운동시의 흉통을 주소로 내원하였다. 혈관조영술상 좌주관상동맥, 양측의 신동맥, 좌쇄골하동맥의 협착 소견을 보였다. 치료로는 양측의 신동맥에 스텐트를 삽입하는 혈관성형술을 시행하였고, 1주일 뒤 대복재정맥을 이용한 관상동맥우회술과 인조혈관(PTFE)을 이용한 대동맥-쇄골하동맥간 우회술을 동시에 시행하였다. 환자는 수술 후 13일째 특별한 합병증 없이 퇴원하였다.2.Arora P, Kher V, Singhal MK, et al. Renal artery stenosis in aortoarteritis: Spectrum of disease in children and adults. Kidney Blood Press Res 1997;20(5):285-9.3.Teoh MK. Takayasu's arteritis with renovascular hypertension: Results of surgical treatment. Cardiovasc Surg 1999;7(6):626-32.4.Khalilullah M, Tyagi S. Percutaneous transluminal angioplasty in Takayasu arteritis. Heart Vessels Suppl 1992;7:146-53.5.Lupi-Herrera E, Sanchez-Torres G, Marcushamer J, Mispireta Horwitz S, Espino Vela J. Takayasu arteritis: Clinical study of 107 cases. Am Heart J 1977;93:94-103. 6.Amano J, Suzuki A. Coronary artery involvement in Takayasu's arteritis. Collective review and guideline for surgical treatment. J Thorac Cardiovasc Surg 1991;102: 554-60.7.Ohara K, Kasegawa T, Ando T, et al. Surgical treatment for coronary artery disease associated with aortitis syndrome. Kyobu Geka 1986;39:423-8.

Takayasu 동맥염의 임상적 고찰

최기준(Kee Joon Choi),조주희(Joo Hee Zo),한경일(Kyung Il Han),김영권(Young Kwon Kim),조명찬(Myeong Chan Cho),손대원(Dae Won Sohn),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shik Choi),서정돈(Jung Don Seo),이영우(Young 대한내과학회 1990 대한내과학회지 Vol.39 No.5

N/A To observe the clinical features of Takayasu's arteritis and evaluate the incidence and sites of coronary arterial involvement in Takayasu's arteritis, clinical observations were made in 99 patients who were diagnosed as Takayasu's arteritis by clinical features and aortographic findings in Seoul National University Hospital from August 1971 to July 1989 Coronary arteriographies were performed prospectively in 30 patients with Takayasu's arteritis since March 1987. The results were as follows: 1) In 99 cases of Takayasu's arteritis, 15 were male and 84 were female. The male to female ratio was 1:5.7, the mean age was 29.5, and 63% of those studied were under the age of 30. 2) The following were the presenting clinical symptoms and signs in decreasing order of frequency: headache(69%), weak or nonpalpable pulse(68%), carotid or abdominal bruit(55%), Dyspnea on exertion(51%), hypertention(48%), and dizziness(43%). 3) Aorta or arterial involvement in decreasing order of frequency: left subclavian artery(62%), abdominal aorta(58%), right subclavian artery(38%), descending thoracic aorta(37%) and left renal artery(35%). 4) Using Ueno's classification, 29(29%) were Type I, 22(22g) were Type II, and 48(48%) were Type III. Type IV or pulmonary arterial involvements were seen in 11(33%) out of 33 patients. 5) In a prospective study using coronary arteriography, 8(27%) out of 30 patients of Takayasu's ateritis showed coronary involvement. Among the 13 lesions of coronary arterial narrowings in 8 patients with coronary involvements, there were 3 ostial lesions, 5 proximal and 5 middle or distal lesions. 6) Frequently there were no cardiac symptom in patients with Takayasu's arteritis who had coronary arterial lesions, and a myocadial infarction or congestive heart failure may be the first sign of the coronary arterial narrowing.

타카야수 동맥염과 동반된 망막분지동맥폐쇄

임재완(Jae Wan Lim),이승욱(Seung Uk Lee),이상준(Sang Joon Lee),남기엽(Ki Yup Nam) 대한안과학회 2016 대한안과학회지 Vol.57 No.8

목적: 타카야수 동맥염은 주로 대동맥과 그 주 분지를 침범하는 질환으로서 여러 가지 안소견이 동반될 수 있으나 망막분지동맥폐쇄가 발생하는 경우는 매우 드물다. 저자들은 이러한 증례를 경험하였기에 보고하고자 한다. 증례요약: 53세 여자 환자가 내원 2시간 전 우안의 하측 시야가 좁아지는 증상을 느껴 본원 응급실로 내원하였다. 시력은 양안 모두 1.0으로 측정되었다. 전안부 및 동공반사에서는 특이 소견을 보이지 않았고 안저 검사에서 우안 상측 망막이 창백하게 관찰되었다. 빛간섭단층촬영 및 형광안저혈관조영술 등 보조적 검사를 통해 우안 망막분지동맥폐쇄로 진단한 후 보존적 치료를 시행하였다. 과거력상 20년 전 타카야수 동맥염을 진단 받고 내과적으로 경과 관찰하던 환자로 내원 시 38.7℃의 발열과 전신 쇠약감이 동반되어 있었고 혈액검사에서 erythrocyte sedimentation rate, C-reactive protein 등의 염증 관련 수치가 증가하여 동맥염의 재발로 판단하고 내과적인 치료를 시행하였다. 발병 3개월째 우안 망막의 창백은 소실되었으나 시야는 초진 시와 유사하게 유지되었다. 결론: 타카야수 동맥염에서 분지망막동맥폐쇄가 동반된 증례를 경험하여 이를 보고하고자 하며 드물지만 두 질환의 연관 가능성에 대해서 인지할 필요가 있을 것으로 사료된다. Purpose: Takayasu’s arteritis generally involves the aorta and its main branch. Various ocular manifestations associated with Takayasu’s arteritis have been reported, but branch retinal artery occlusion (BRAO) is very rare. We report a case of BRAO associated with Takayasu’s arteritis. Case summary: A 53-year-old female patient visited out emergency room for an inferior visual field defect of the right eye that had presented 2 hours earlier. Visual acuity was 1.0 in both eyes. There were no abnormalities of the anterior segment or pupil reflex. On fundus examination, superior retinal whitening was observed in her right eye. Through ancillary study including optical coherence tomography and fluorescein angiography, she was diagnosed with BRAO and underwent conservative treatments. She had received previous treatment and had been followed-up for Takayasu’s arteritis for 20 years. She complained of general weakness, and body temperature was 38.7°C. On blood analysis, erythrocyte sedimentation rate and C-reactive protein were increased compared to previous levels. She was medically treated on the assumption of relapse of Takayasu’s arteritis. After 3 months, the retinal whitening in her right eye was resolved, but the visual field defect remained similar to that at the initial visit. Conclusions: We report this rare case of BRAO associated with Takayasu’s arteritis, indicating the need to consider an association between the two diseases.

Takayasu′s 동맥염에 의한 쇄골하 동맥류(1예)

조남수,조수형,박광철 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Takayasu's arteritis is a non-specific inflammatory process that involves the aorta and its main branches, the etiology of which remains unknown. This arteritis occurs predominantly in young Asian women, although there have been many documented cases in males and non-Asians. Criteria for the diagnosis of Takayasu's arteritis were developed by The Subcommittee on Classification of Vasculitis of the American College of Rheumatology in 1990, of which a modified version is shown in Table 1. The presence of three or more of the six criteria shown demonstrated a diagnostic sensitivity of 90.5% and a specificity of 97.8%. Takayasu's arteritis is known as 'pulseless disease,' and this non-specific inflammatory arteriopathy typically produces segmental arterial narrowing and occlusion with resultant end-organ ischemic consequences, including upper extremity digital necrosis, stroke, visceral ischemia and renal failure. Previously reported sites of aneurysm formation include the thoracic and abdominal aorta, as well as the innominate, the carotid and the superior mesenteric arteries, but rarely the subclavian artery. A 26-year-old man presented with a progressively enlarging and tender pulsatile mass at the base of the left neck, intermittent Claudication of the upper limbs in association with a decreased brachial artery pulse and a bruit over the subclavian artery. Computed tomography and aortography demonstrated a 4 cm × 5 cm aneurysm of the left subclavian artery. There was no evidence of occlusive disease. An aneurysmectomy with 8 mm hemashield graft interposis was performed. Pathology revealed a chronic, active inflammatory process. Aneurysm formation is an unusual complication of Takayasu's arteritis. Emergency department physicians must carefully observed patiens with symptomatic upper extremity pain and paresthesia and must consider whether those symptoms might be due to the formation of a subclavian artery aneurysm due to Takayasu's arthritis

Coexistence of ulcerative colitis and Sjogren`s syndrome in a patient with Takayasu`s arteritis and Hashimoto`s thyroiditis

( Hyun Woo Park ),( Hyun Seok Lee ),( Sejin Hwang ),( Han Sol Lee ),( Han-ik Bae ),( Ghilsuk Yoon ) 대한장연구학회 2017 Intestinal Research Vol.15 No.2

A 31-year-old woman with a 15-year history of Takayasu`s arteritis (TA) and a 13-year history of Hashimoto`s thyroiditis presented with hematochezia. She received a diagnosis of Sjogren`s syndrome at 1 month before her visit to Kyungpook National University Medical Center. Her colonoscopic findings were compatible with a diagnosis of ulcerative colitis (UC). She was treated with oral mesalazine, and her hematochezia symptoms subsequently disappeared. The coexistence of UC and TA has been reported; however, reports on the coexistence of UC and Sjogren`s syndrome, or of UC and Hashimoto`s thyroiditis are rare. Although the precise etiologies of these diseases are unknown, their presence together suggests that they may have a common pathophysiologic background. Furthermore, in patients with autoimmune or vascular diseases, including TA, systemic manifestations should be assessed with consideration of inflammatory bowel diseases including UC in the presence of gastrointestinal symptoms such as diarrhea and hematochezia. (Intest Res 2017;15:255-259)

Takayasu 동맥염 후에 병발된 류마티스 관절염 1예

정낙영,정일화,신표진,김재우,서정인,송창호,리원연,용석중,신계철 연세대학교 원주의과대학 1999 원주의대논문집 Vol.12 No.1

Takayasu 동맥염이 동반된 임신의 양상과 예후

임준희(June Hee Lim),김성민(Sung Min Kim),김미하(Mi Ha Kim),오수영(Soo Young Oh),문정빈(Jeong Bin Moon),박중신(Joong Shin Park),전종관(Jong Kwan Jun),윤보현(Bo Hyun Yoon),신희철(Hee Chul Syn) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

목적 : Takayasu 동맥염을 동반한 임신의 임상적 양상과 본 질환이 산모 및 태아에 미치는 영향에 대해서 알아보고자 하였다. 연구방법 : 본 연구는 후향적 연구로서 1989년 6월부터 1999년 12월까지 서울대학교병원 산부인과에서 분만한 환자들중에 Takayasu 동맥염을 동반한 산모의 14례 임신에 대한 의무기록을 검토하여, 환자의 임신 전 상태와 주산기 예후에 대해 기술하였다. 결과 : 연구 기간 동안 본원에서 분만건수는 총 19,885례가 있었는데 이 중 Takayasu 동맥염이 동반된 여성에서의 분만은 12명의 환자에서 14례였다. 산모와 신생아 사망의 예는 없었으며, 진단 당시 평균 연령은 24.6세 (범위 18세-31세)였고, 임상양상 중에 맥관계 잡음(58.3%), 말초 혈관의 박동감소(50%), 고혈압(50%)순으로 빈도가 높았다. 고혈압 환자 6명중에 5명이(83.3%)이 신혈관성 고혈압이었고, 이중에 2명이 임신중 전자간증을 보였다. 진통중 현저한 혈압상승이 동반된 경우가 3례(25%)있었고, 이중 2례는 임신전 고혈압의 증거가 없었으며, 임신중에 전자간증도 동반되지 않았다. 제왕절개를 통한 분만은 5례(35.7%)에서 이루어졌고, 조기분만은 2례(14.3%)에서, 발육지연 상태의 신생아가 4례(28.6%)에서 있었다. 단지 1명의 신생아가 신생아중환자실에 입원하여 집중치료를 받았는데, 1분 아프가 점수가 5점으로 경도의 쳐짐을 나타내었다. 14례의 임신 중 3례에서 분만 후 산모의 합병증이 초래되었는데 이는 호흡곤란, 흉막삼출, 일시적 혈압감소 등의 심혈관계 합병증에서 기인한 것이었다.결론 : Takayasu 동맥염은 가임기 여성에서 빈발하여 임신 중 처음으로 발견되기도 한다. 주산기에 일어날 수 있는 다양한 심혈관계의 합병증의 가능성에도 불구하고 대부분 본 질환은 임신에 의해 영향을 받지 않고 산과적으로 커다란 문제없이 건강한 아이를 분만할 수 있다. Objective : To evaluate the clinical characteristics, course, and the outcomes of pregnancies with Takayasu's arteritis. Methods : The retrospective study was done by the review of medical records of 14 pregnancies with Takayasu's arteritis found between June, 1989 and December, 1999. Pre-pregnant status and pregnancy outcome were described.Results : Takayasu's arteritis was found in 14 cases among 19,885 women who had delivered at our unit during the study period. There were no maternal or neonatal death. The median age at diagnosis was 24.6 years. Common clinical findings were vascular bruit(58.3%), pulse deficit(50%), and hypertension(50%) at diagnosis. Among the 6 patients who had hypertension, 5(83.3%) showed renovascular hypertension and superimposed preeclampsia developed in 2(33.3%) cases. Marked elevation of systolic blood pressure during labor was associated with 3 pregnancies(25%), including 2 patients who were prepregnant normotensive and without preeclampsia. Cesarean section was performed in 35.7%(5/14) of cases. There were 2 preterm birth(14.3%), 4 growth-restricted newborns(28.6%). Only one was admitted into NICU with 5 Apgar score at 1 minute. Three fourteenths had various postpartum problems, most of which were related to cardiovascular events ; dyspnea, pleural effusion, and transient depressed blood pressure. Conclusion : Because the disorder affects women in childbearing age mainly, it may be recognized the first time during pregnancy. Despite various cardiovascular events which may occur in the perinatal period, the basic disease is usually unaffected by pregnancy and both maternal and fetal clinical outcome may be fair.

타카야수 동맥염 환자에서 발생한 허혈 대장염 1 예

박지영 ( Ji Young Park ),박영숙 ( Young Sook Park ),김세영 ( Se Young Kim ),박대림 ( Dae Rim Park ),조윤주 ( Yun Ju Jo ),김성환 ( Seong Hwan Kim ),송문희 ( Moon Hee Song ),이한효 ( Han Hyo Lee ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.2

Ischemic colitis is one of the most common intestinal ischemic injury in which more than 90% of patient are over 60 year-old. It results from impaired perfusion of blood to the bowel and is rarely caused by vasculitis such as systemic lupus erythematosus, polyarteritis nodosa, and Takayasu`s arteritis. Takayasu`s arteritis affects the aortic arch, medium-sized and large arteries but rarely involves inferior mesenteric artery. We report a case of Takayasu`s arteritis involving inferior mesenteric artery which developed ischemic colitis in a 70 year old female. To the author`s knowledge this is the first case report in Korea. A 70 year old woman who had suffered from Takayasu`s arteritis for 5 years was admitted for sudden abominal pain and hematochezia. On sigmoidoscopy, there were multiple segmental longitudinal ulcerations around splenic flexure and diffuse hemorrhagic edematous mucosa from descending colon to sigmoid colon. On abdominal CT angiography, inferior mesenteric artery was not traced. We diagnosed it as ischemic colitis combined with Takayasu`s arteritis. After the conservative treatment, abdominal pain and hematochezia disappeared. She was followed up to 2 years without recurrence of symptoms. (Korean J Gastroenterol 2007;49:110-113)