High-Risk Vascular Remodeling in Takayasu Arteritis: Descending Aortic Multilobulated Saccular Aneurysms and Aortic Coarctation.

BACKGROUND: Takayasu arteritis (TAK) is a rare, chronic, idiopathic large-vessel vasculitis. Early stages are often underdiagnosed. It can lead to arterial wall thickening, stenotic or occlusive lesions, and aneurysms, resulting in stroke, blindness, refractory hypertension, or heart failure. CASE SUMMARY: A 53-year-old woman presented with dyspnea, upper limb claudication, discrepant arm blood pressures, and murmur in the interscapular region. Computed tomography scan revealed multiple calcified saccular aneurysms and postductal aortic coarctation. The heart team favored medical management, deferring invasive intervention. At follow-up, she remained stable, with mild residual claudication. DISCUSSION: The case illustrates the complexity of TAK presenting with aneurysmal dilation and thoracic coarctation. Guidelines emphasize classification scores and imaging for diagnosis, therapeutic strategies include immunosuppressors, reserving vascular intervention for high-risk lesions. TAKE-HOME MESSAGES: TAK should be considered in patients with murmurs, discrepant blood pressures, or limb claudication. Multimodality imaging is essential for diagnosis. The optimal management requires tailored immunosuppressive therapy.