An unusual endothelial reaction after angiography during Takayasuʹs arteritis: case report

Takayasuʹs arteritis (TA) is a panarteritis that affects large arteries such as aorta and its major branches. In the early stage there is granulomatous arteritis with transmural inflammation and patchy destruction of the medial elastic lamina. Several Authors demonstrated perforin-secreting cells in the inflammatory infiltrate and deposition of perforin on the vascular cells, and suggested that cytotoxic cells, particularly heat-shock protein-recognizing gamma/delta-T cells, are responsible for tissue destruction. Although cellular infiltrates in TA tend to be localized in the adventitia and outer part of the media with marked inflammation of the vasa vasorum, the vascular endothelium-however-takes part in this vasculitis, given the elevated titers of anti-endothelial cell antibody (AECA) and vonWillebrandʹs factor antigen. Horein We report the peculiar ultrasonographic changes of a 55-year-old caucasian woman who presented -at onset- with claudication of upper extremities and arthralgia, decreased brachial artery pulses, carotid and renal artery bruits. At first Doppler-echographic examination she presented thickening of the common carotid aa., segmental stenosis of subclavian aa. and thrombosis of both axillary aa., with total absence of structural changes of the common and superficial femoral aa. But at successive ultrasonographic follow-up, performed after aortic angiography, un unexpected reaction of intimal wall was demonstrated in the entrance seat of transfemoral angiographic catheter with ipoechogenic material between right common femoral a. and right superficial femoral a. that determined an haemodynamic alteration of bloody flow. We debate about pathogenesis of this phenomenon.