Patterns of aortic involvement in Takayasu arteritis and its clinical implications: Evaluation with spiral computed tomography angiography Jin Wook Chung,

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Patterns of aortic involvement in Takayasu arteritis and its clinical implications: Evaluation with spiral computed tomography angiography Jin Wook Chung, MD, Hyo-Cheol Kim, MD, Young Ho Choi, MD, Sang Joon Kim, MD, Whal Lee, MD, Jae Hyung Park, MD Journal of Vascular Surgery Volume 45, Issue 5, Pages 906-914 (May 2007) DOI: 10.1016/j.jvs.2007.01.016 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 Takayasu arteritis showing active and inactive lesions in a 25-year-old woman. A, Multiplanar reformation image shows wall thickening of aortic arch and abdominal aorta (arrowheads). Mural calcification and stenosis of descending thoracic aorta (arrow) is noted. B, CT scan shows diffuse wall thickening of ascending and descending thoracic aorta (arrowheads) suggesting active lesion. C, CT scan shows mural calcification and stenosis of descending thoracic aorta (arrowhead) suggesting inactive lesion. D, CT scan shows wall thickening, inner low-attenuated ring, and aneurismal dilation of abdominal aorta (arrowheads) suggesting active lesion. Journal of Vascular Surgery 2007 45, 906-914DOI: (10.1016/j.jvs.2007.01.016) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 The spectrum of aortic involvement in patients with Takayasu arteritis. The extent of aortic involvement is presented in 81 patients with aortic involvement. A, line without interruptions indicates contiguous involvement. Interrupted lines in 11 patients indicate the presence of skipped area between the diseased aortas. Four patients without aortic involvement are not presented on the diagram. Root, aortic root; AA, ascending thoracic aorta; Arch, aortic arch; p-DTA, proximal descending thoracic aorta; m-DTA, middle descending thoracic aorta; d-DTA, distal descending thoracic aorta; SR-AA, suprarenal abdominal aorta; IR-AA, infrarenal abdominal aorta; IIMA-AA, infra-inferior mesenteric artery abdominal aorta. Journal of Vascular Surgery 2007 45, 906-914DOI: (10.1016/j.jvs.2007.01.016) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 Takayasu arteritis involving aorta with skipped segment in a 50-year-old woman. A, Multiplanar reformation image shows wall thickening (arrowheads) of ascending thoracic aorta, aortic arch, proximal descending thoracic aorta, and abdominal aorta. No wall thickening of distal descending thoracic aorta is noted. Motion artifact (pulsation artifact) was not observed in the thickened segment such as aortic arch and abdominal aorta due to stiffness of involved aorta and was observed in the distal descending thoracic aorta (arrows) due to pulsation of the noninvolved segment. B, CT scan at the proximal descending thoracic aorta shows diffuse wall thickening and inner low attenuated ring of ascending (arrow) and descending thoracic aorta (arrowhead). C, CT scan at the distal descending thoracic aorta (arrow) shows no wall thickening of aorta. D, CT scan at the abdominal aorta shows diffuse wall thickening and inner low attenuated ring of abdominal aorta (arrow). Journal of Vascular Surgery 2007 45, 906-914DOI: (10.1016/j.jvs.2007.01.016) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 Takayasu arteritis involving abdominal aorta and both renal artery in a 20-year-old woman. A, Maximum-intensity-projection image shows severe stenoses of both proximal renal artery (arrows) and luminal irregularity of abdominal aorta (arrowheads). Normal-looking far distal abdominal aorta (yellow line) is noted. B, CT scan at the far distal abdominal aorta shows diffuse wall thickening of abdominal aorta (arrows) suggesting active inflammation of aorta wall despite of no abnormality at maximum-intensity-projection image. C, Volume rendering image after auto-transplantation of both kidneys shows the graft between the left iliac artery and left renal artery, and the right kidney directly anastomosed with right iliac artery. Journal of Vascular Surgery 2007 45, 906-914DOI: (10.1016/j.jvs.2007.01.016) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 5 Takayasu arteritis causing complete occlusion of both carotid and subclavian arteries in a 57-year-old woman. A and B, Conventional aortography shows complete occlusion of both common carotid and subclavian arteries. Dilated left vertebral artery (arrow) in noted. Reconstructed left internal carotid artery (arrowhead) is faintly observed. C, Volume rendering image clearly shows reconstituted left internal and external carotid arteries (arrow). Journal of Vascular Surgery 2007 45, 906-914DOI: (10.1016/j.jvs.2007.01.016) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 6 Takayasu arteritis involving only aortic branch vessels in a 19-year-old woman A, Multiplanar reformation image shows wall thickening of left common carotid (arrowheads) and superior mesenteric arteries (arrows). B, Arterial phase CT scan at the common carotid artery level shows diffusion wall thickening of left common carotid artery (arrows). C, Delayed phase CT scan at the common carotid artery level shows enhancing thickened wall and inner low-attenuated ring of left common carotid artery (arrows). D and E, CT scan at the descending thoracic aorta level shows no definite wall thickening of aorta (arrow). F, Arterial phase CT scan at the abdominal aorta level shows no wall thickening of abdominal aorta (arrowhead) and wall thickening of superior mesenteric artery (arrows). G, Delayed phase CT scan at the abdominal aorta level shows wall enhancement of superior mesenteric artery (arrows). Journal of Vascular Surgery 2007 45, 906-914DOI: (10.1016/j.jvs.2007.01.016) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions