What happens to the aorta and its branches
Immune inflammation begins in the outer layers of the wall of a large artery and gradually spreads inward. At the site of inflammation, connective tissue grows, the wall becomes dense and thick, and the lumen narrows until it closes completely. If the wall frame is destroyed, the section of the vessel is stretched and an aneurysm is formed. The subclavian and carotid arteries, aortic arch, renal and mesenteric arteries are most often affected. The body partially compensates for the narrowing by bypassing the blood flow, so complaints do not appear immediately.
- Inflammation involves the entire thickness of the vessel wall
- Narrowing of the lumen and formation of aneurysms
- Favorite zones are the aortic arch and its branches
- Damage to the renal arteries causes persistent hypertension
- Collaterals compensate for the lack of blood flow for a long time
Causes and risk factors
The reason remains unknown. The disease is considered autoimmune: immune cells react to the structures of the vascular wall in a person with a certain hereditary predisposition. A connection with previous tuberculosis has been discussed, but there is no convincing evidence, although tuberculosis must be excluded before starting immunosuppressive therapy. The main group is women aged 15 to 40 years. The disease is not contagious and is not directly inherited.
- Autoimmune inflammation of large vessels
- Female gender
- Age up to 40 years
- Genetic predisposition
- Tuberculosis is excluded before treatment, but it is not the cause
Symptoms: two stages
In the inflammatory stage, weakness, sweating, low fever, night sweats, pain in muscles and joints, and weight loss are a concern. Such complaints can easily be attributed to overwork or infection, and the diagnosis is delayed for months. In the vascular stage, the consequences of narrowing of the arteries come to the fore: dizziness and darkening in the eyes when turning the head, fatigue and pain in the arm when working, different pressures in the arms, noise when listening to the vessel, abdominal pain after eating and persistent arterial hypertension with damage to the renal arteries.
- Weakness, low-grade fever, weight loss
- Weakening or disappearance of the pulse in one arm
- Systolic pressure difference between arms
- Dizziness, blackouts, fainting
- Rapid fatigue and pain in the arm during exercise
- Vascular murmur over the carotid or subclavian artery
- Persistently elevated blood pressure in a young man
Diagnostics
The examination begins with a simple procedure: the doctor measures the pressure in both arms and legs, compares the pulse and listens to the blood vessels. Pressure differences and vascular noise are good reasons for further search. Inflammatory markers may be elevated, but normal values do not exclude the disease. The structure of the vessels is assessed by ultrasound with Doppler sonography, and a complete picture of the aorta and its branches is provided by CT or MR angiography. The same studies are used for observation over time. Before starting treatment, tuberculosis and foci of infection must be excluded.
- Measurement of blood pressure and pulse on all extremities
- ESR and C-reactive protein
- Duplex scanning of the carotid and subclavian arteries
- CT or MR angiography of the aorta and its branches
- 24-hour blood pressure monitoring
- Screening for tuberculosis before immunosuppression
Treatment and observation
The basis of treatment is suppression of inflammation with glucocorticoids with a gradual reduction in dose. To shorten the duration of hormonal therapy, an immunosuppressant is usually added, and if the course persists, a genetically engineered biological drug is added. At the same time, the consequences are treated: blood pressure is monitored, medications are selected taking into account damage to the renal arteries, and in case of high cardiovascular risk, antiplatelet agents and statins are prescribed. In case of critical narrowing of the vessel, stenting or bypass surgery is discussed, but planned interventions are performed during the period of subsidence of inflammation.
- Glucocorticoids with slow dose reduction
- Immunosuppressants and genetically engineered drugs
- Blood pressure control
- Antiplatelet agents and statins according to indications
- Stenting or bypass surgery for critical stenosis
- Smoking cessation and lipid control
- Repeated visualization of vessels in dynamics