10 year old male patient was admitted to the clinic because of weight loss and hemoptysis. Arm blood pressures of the right arm was 130/90, left arm was 90/70. Echocardiography revealed coarctation. In this region, the gradient was measured at 30 mmHg. The left pulmonary artery could not be evaluated. CT angiography, multiple strictures in the descending aorta, and coarctation, left subclavian artery and complete obstruction of the left pulmonary artery showed complete occlusion was observed. Blood tests were higher in acute phase reactants. Patient with Takayasu's arteritis was considered predetermined. Now question is, other than routine treatment, (steroids, etc.) when the patient invasive treatment of vascular perspective can be done? Thank you in advance for your recommendations.
Takayasu arteritis and other vasculopathies, or inflammatory diseases causing blood vessel inflammation, can lead to strictures and obstruction of blood vessels throughout the body. Various options for dealing with them include catheterization with balloon angioplasty (plus the addition of a stent, if it is felt to be needed), surgical bypass of the vessel, or surgical revision of the vessel. The least invasive is balloon angioplasty, which also may be as effective as any of the other interventions, depending on how severe and how long the stenoses (obstructions) are. It can be done at any time, and would be well tolerated by a larger patient, such as someone who is 10 years old (as compared to an infant). Sadly, despite what is reported as a 3-5 year period of relief of obstruction, there can be as much as a 75% recurrence rate. Overall, the sooner that it is done, the less likely that there will be downstream damage to other organs, especially to the lungs with the obstruction of the pulmonary artery.
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