Takayasu arteritis is a rare large-vessel arteritis characterized by arterial fibrosis, granulomas, and stenoses. It displays a predilection for Asian women and primarily involves the aorta and related branches.
Takayasu arteritis is a type of arteritis that causes inflammation of the large and medium-sized arteries, which further leads to aneurysms, stenoses, and fibrosis of the affected artery. The symptomatology elicited is dependent on the precise vessel affected, and in the majority of the cases, focal symptoms are experienced indicating an abnormally low perfusion of the affected organ or extremity. The disease exhibits a clear predilection for female patients  .
The aorta is the vessel most commonly affected by Takayasu arteritis; the most prominent symptoms resulting from the stenoses located in the descending thoracic aortic wall include hypertension, pain, and weakness of the arms, absent or asymmetric pulse in the extremities, leg claudication, and headaches. Renovascular hypertension may be induced in the case in which the abdominal aorta or renal arteries are involved in the inflammatory process.
If the carotid arteries are also affected by the disorder, symptoms related to cerebral hypoperfusion occur. These include strokes, visual impairment, temporary loss of consciousness, orthostatic hypotension, dizziness and headaches  . On the other hand, stenoses in the subclavian arteries in the regions proximal to a patent vertebral artery can lead to the so-called subclavian steal syndrome; The backflow of blood from the vertebral to the subclavian artery, when the corresponding arm is set in motion, leads to a diminished flow of blood in the subclavian artery. Therefore, syncope or ischemic symptoms are elicited.
Finally, the involvement of the pulmonary arteries causes pulmonary hypertension and infarcts . The former is associated with fatigue, cyanosis, leg edema, dyspnea, and syncope, as it progresses, and the latter may present with tachypnea, dyspnea, hemoptysis, pleuritic chest pain and cough . If coronary arteries also partake in the inflammatory process, the clinical picture is further complicated by angina pectoris or symptoms related to a myocardial infarction and heart failure.
The fist step towards diagnosing Takayasu arteritis is a meticulous physical examination. Any symptom that indicates hypoperfusion of organs supplied with blood flow from the aorta or its branches raises suspicion about the condition. The absence of a pulse in the extremities, especially in patients who are unlikely candidates for other cardiovascular diseases, is also an indicator of Takayasu arteritis. Additionally, the physical examination may reveal arterial bruits and a difference in the blood pressure measured in the two arms or legs.
Imaging modalities that help to establish a definitive diagnosis include a magnetic resonance angiography (MRA) or a computerized tomography angiography (CTA), which can illustrate Takayasu arteritis-related vascular pathologies, such as stenoses with post-stenotic dilatation, obstruction of blood flow, collateral circulation or aneurysms . Laboratory tests are also usually carried out but contribute little to the differential diagnosis, due to their extremely low specificity. In fact, patients affected by Takayasu arteritis exhibit an elevated erythrocyte sedimentation rate (ESR), mild or no leucocytosis and normochromic anemia during periods of exacerbation  . Other laboratory findings include anti-endothelial antibodies, which also do not assist in the final diagnosis, given the fact that they are detected in multiple other autoimmune diseases, such as connective tissue diseases. In recent years, it has been proposed that soluble vascular cell adhesion molecule-1 (VCAM-1) levels are considerably elevated in the serum of patients affected by Takayasu arteritis.
Blood pressure measurement has to be measured meticulously in such patients. In cases where both the subclavian arteries display abnormalities associated with Takayasu arteritis, blood pressure can accurately be measured solely in the lower extremities. Should the iliac or femoral arteries be affected as well, only a central arterial pressure measurement provides accurate results. The latter needs to be evaluated because the inability to measure peripheral pressure could mask hypertension.