An autopsy study of Takayasu arteritis in India. Discussion

Autopsy findings of 10 patients with Takayasu arteritis (TA) are presented. These patients include six females and four males with a mean age of 22.6±10.2 years. Hypertension was the commonest mode of presentation. On autopsy, the vascular lesions in the aorta comprised of stenosis (eight), dilatation (six), aneurysm (two) and dissection of aorta involving its arch, thoracic and abdominal aorta (one). Abdominal aorta was the commonest site of involvement (nine patients) and renal artery was involved in six patients. Histologically, the three types of lesions were identified - active, fibrotic and combination of active and fibrotic lesions. Active inflammatory lesions in the arterial circuit were present despite a clinically chronic (silent) phase of the disease. Cardiac involvement included left ventricular hypertrophy (nine), right ventricular hypertrophy (four), biventricular hypertrophy (three), myocarditis (two) (rheumatic and Takayasu's myocarditis - one patient each) and involvement of coronary artery (one). The pulmonary artery was involved in two patients. Kidneys showed changes of malignant hypertension and benign nephrosclerosis in one patient each. Associated tuberculosis was present in four patients. The causes of mortality were congestive heart failure (four), chronic renal failure (two), intracranial bleed, aneurysmal rupture and pulmonary thromboembolism in one patient each. Thus, the major causes of morbidity and mortality in Indian patients with TA is due to severe uncontrolled hypertension and its effect on heart, kidney and brain. The disease appears to have a persistent activity for a prolonged period even when it appears to be clinically silent.