Takayasu's Aortoarteritis: Clinical Manifestations and Arteriographic Features in 7 Cases

高安氏動脈炎：七病例之臨床經驗與動脈攝影研究

吳定國(Ding-Kwo Wu) ； 何耀輝(Yau-Hui Ho)

《中華放射線醫學雜誌》 13卷3期 (1988/09) Pp. 253-265

摘要

高安氏動脈炎是一種罕見的非特異性動脈炎，常侵犯主動脈和其大分枝偶而侵犯肺動脈，引起管腔狹窄、擴張、閉塞和動脈瘤。本病好發於40歲以下之年輕人，七例發病年齡從8至40歲，平均21歲，男性5例，女性2例。此病臨床表現多樣性，主要以高血壓、大腦、腎臟、視網膜及四肢之缺血性病變較常見。六例已進入慢性期，一例在急性期被診斷。
動脈攝影之發現，72%之病例屬廣泛型，一例侵犯主動脈弓分枝，另一例只侵犯兩側腎動脈，主動脈極小。七例中一例侵犯兩側冠狀動脈，引起心肌梗塞。主動脈分枝中以左側頭頸部動脈，腎動脈和上腸系動脈較常受侵犯。兩例出現動脈瘤，一例在右肱動脈，另一例在腹主動脈。
追踪期間從六個月至四年，一例發生猝死，其餘六例存活。三例接受繞道手術以改善腎動脈阻塞或狹窄，其中兩例早期術後情況良好，一例失敗。另一例接受經皮穿腔左腎動脈擴張，效果不現想，血壓下降持續短暫，其餘三例行保守療法。病人呈現嚴重高血壓和侵犯冠狀動脈，則預後不良。

並列摘要

The clinical manifestations and arteriographic features of 7 patients with Takayasu's aortoarteritis are presented in this communication. There are 5 males and 2 females with age of onset ranging between 8 to 40 years old, mean 21 years old. Major clinical presentations are hypertension with or without encephalopathy, ischemia of brain, kidney, retina, and extremities, and vascular bruit. Coronary artery involvement resulting in myocardial infarction is found in one particular case. Only one patient was identified in the active stage. Correlative clinical syndromes are aortic arch syndrome, aortic coarctation syndrome, renovascular hypertension, and Leriche's syndrome.
Total aortography is mandatory in the diagnosis and evaluation of aortoartiretis. Varying degree of luminal stenosis, dilatation, occlusion, and aneurysm in the affected arteries are observed on arteriography. Extensive involvement of the aorta and its major branches is found in 72% of our series, with left-sided brachiocephalic arteries, visceral arteries, and renal artery commonly affected. Graft surgery and percutaneous transluminal renal angioplasty are the major interventions for renal artery stenosis. Hypertension with congestive heart failure and coronary artery involvement with myocardial infarction are the two complicutions that influence the prognosis in these patients.

並列關鍵字

Takayasu's aortoarteritis ； aortography ； selective arteriography ； percutaneous transluminal renal angioplasty