¹Mansoor C Abdulla

¹Sultan Qaboos Hospital

Introduction: Takayasu arteritis is a chronic idiopathic granulomatous large-vessel vasculitis that affects the aorta, its main branches, and pulmonary arteries. It typically affects young women and is often not diagnosed until late in the disease because of its rarity, often indolent course, nonspecific early symptoms, and lack of specific diagnostic markers1. The subclavian steal syndrome occurs due to the reversal of flow in the vertebral artery toward the subclavian artery (during periods of increased demand) because of stenosis/occlusion of the proximal subclavian artery2.

Method(s): A 40-year-old man was admitted with vertigo and intermittent pain over the left upper limb, which worsened with exertion. He denied history of fever, weight loss, drug abuse, and addictions. He had no other relevant medical illness in the past. Peripheral pulsations were feeble in the left upper limb and bilateral lower limbs (popliteal, posterior tibial & dorsalis pedis). Blood pressure was 140/80 mm of Hg in the right upper limb and 90 /60 mm of Hg in the left upper limb. The rest of the systemic examination was unremarkable.

Biochemical parameters including electrolytes, renal function tests, liver function tests, and blood counts were normal. Erythrocyte sedimentation rate was 30mm in 1 hour and c reactive protein was high(11.68mg/L). Electrocardiogram, chestx-ray and trans thoracic echocardiogram were normal. Arterial Doppler showed reversal of flow in the left vertebral artery, absent flow in the left common carotid, bilateral internal carotid, and bilateral superficial femoral artery occlusion. HIV, venereal disease research laboratory test, hepatitis B and hepatitis C serology were negative. Autoantibody profiles including antinuclear antibody, rheumatoid factor, c-antineutrophil cytoplasmic antibody, p-antineutrophil cytoplasmic antibody, and anti-phospholipid antibodies were all negative. Serum complement levels were normal.  Digital subtraction angiography showed total occlusion of the right internal carotid artery, left common carotid, and left subclavian artery. On injecting dye to the vertebral artery extensive collaterals from posterior circulation were visible and the left upper limb was receiving blood supply by subclavian steal.  The patient was diagnosed with subclavian steal syndrome secondary to Takayasu’s arteritis. He was started on steroids (which was tapered down later), and antiplatelets. He was referred for further management.

Result(s): The patient was diagnosed with subclavian steal syndrome secondary to Takayasu’s arteritis. He was started on steroids (which was tapered down later), and antiplatelets. He was referred for further management.

Conclusion(s): We present a case of takayasu arteritis which presented with subclavian steal which is extremely unusual. The case reminds the readers to be aware of such rare presentations of Takayasu’s arteritis which help them to early recognise the disease for prompt management.