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Takayasu arteritis

Key sources
The following summarized guidelines for the evaluation and management of takayasu arteritis are prepared by our editorial team based on guidelines from the American Heart Association (AHA/ACC 2022), the Vasculitis Foundation (VF/ACR 2021), the European League Against Rheumatism (EULAR 2020; 2018), and the Society for Cardiovascular Angiography and Interventions (SCAI/STS/SVM/AATS/SCA/AHA/ACR/ACC/ASA/SIR 2010).
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Guidelines

1.Diagnostic investigations

Diagnostic imaging: as per ACC 2022 guidelines, obtain prompt evaluation of the entire aorta and branch vessels with MRI or CT, with or without 18F-FDG-PET, in patients with large vessel vasculitis.
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  • Assessment of comorbidities

2.Medical management

General principles: as per ACR 2021 guidelines, consider initiating medical management over surgical intervention in patients with TA with renovascular hypertension and renal artery stenosis, or stenosis of a cranial/cervical vessel without clinical symptoms.
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  • Corticosteroids

  • Other immunosuppressants

  • Antithrombotics

3.Surgical interventions

Reconstructive surgery: as per ACC 2022 guidelines, consider performing elective endovascular or open surgical intervention to treat aortic and branch vessel complications in patients with TA in remission.
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4.Patient education

Patient education: ensure access for patients to education focusing on the impact of large vessel vasculitis, its key warning symptoms and treatment (including treatment-related complications).

5.Follow-up and surveillance

Indications for referral: refer all patients presenting with signs and symptoms suggestive of TA to a specialist team for multidisciplinary diagnostic work-up and management.
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  • Follow-up assessment