Multidisciplinary Management of Type IIa Takayasu Arteritis with Mechanical Aortic Valve and Subclavian Artery Occlusion: A Complex Case Report
Naeem Hamza* and Muhammad Mudassir Wajahat
ABSTRACT
Takayasu arteritis (TA) is a rare, chronic large-vessel vasculitis characterized by granulomatous inflammation of the aorta and its major branches. Diagnosis and management are challenging due to its insidious presentation, variable vascular involvement, and frequent relapsing course. We report the case of a 52-year-old European woman with Type IIa TA complicated by bilateral subclavian artery disease, prior Dacron graft repair for an ascending aortic aneurysm, and mechanical aortic valve replacement for severe regurgitation. The patient presented with metrorrhagia requiring gynecological intervention, raising significant perioperative concerns due to her chronic anticoagulation and high cardiovascular risk profile. On admission, she demonstrated absent left upper limb pulses, anemia secondary to ongoing bleeding, and an elevated INR.
Anticoagulation was carefully bridged with low molecular weight heparin, in accordance with international guidelines for mechanical prosthetic valves, allowing safe biopsy and polypectomy with concurrent endocarditis prophylaxis. During hospitalization, she experienced hypotensive episodes and brief atrial fibrillation, necessitating optimization of antihypertensive therapy and rhythm monitoring. Ongoing rheumatologic follow-up was arranged, with continued low-dose methotrexate and corticosteroid therapy for disease control. This case highlights the intricate balance required in managing TA patients with complex cardiovascular comorbidities, emphasizing the interplay between autoimmune inflammation, vascular complications, anticoagulation strategies, and procedural safety. Effective outcomes relied on a multidisciplinary approach involving cardiology, rheumatology, gynecology, and hematology. Our report underscores the importance of individualized treatment strategies in TA, especially when complicated by prosthetic heart valves, grafts, and severe large-vessel disease
