Long-Term Patency Of Aorto-Biiliac Endoprosthesis For Critical Lower Limb Ischemia In Takayasu Arteritis After Complicated Angioplasty With Drug-Coated Balloon: Effect Of Dual Antiplatelet Therapy Combined With Tocilizumab.

Takayasu arteritis is a chronic granulomatous vasculitis of unknown etiology affecting the aorta and its major branches. Critical limb ischemia may occur and eventually require surgical intervention. Surgical outcomes are influenced by disease activity, age and comorbidities. We report a 43-year-old woman with Takayasu arteritis and stenosis of the left common iliac artery and occlusion of the left external iliac artery with limiting vascular claudication, who underwent angioplasty of the iliac artery with drug-eluting stent while being treated with infliximab. The artery ruptured a week later but was contained by the iliopsoas muscle. She required subsequent stent placement to correct the lesion. Treatment comprised aspirin, clopidogrel and the biological was switched to monthly intravenous tocilizumab. During an 8-year follow-up, serial imaging exams showed a patent aorto-biiliac endoprosthesis, without evidence of thrombosis or restenosis. Clinically, the patient denies vascular claudication and pulses remain palpable in the left lower limb. This case highlights the risks inherent to these procedures in patients with large artery vasculitis and reinforces that the effectiveness of endovascular intervention can be increased by detailed preoperative evaluation, associated with a drug strategy including immunomodulatory and antiplatelet therapy as directed by the multispecialty team. Periodic imaging examinations are required because of the reported high rate of restenosis.