Takayasu’s Arteritis  An interesting case for anesthetic management of laproscopic nepherectomy

Dr Kulkarni Vinaya; Dr. Jyoti Kole; Dr .Tayade Prajakta; Dr .Kelkar Kalpana

Volume : VI, Issue : VIII, August - 2017

Takayasu’s Arteritis An interesting case for anesthetic management of laproscopic nepherectomy

Dr Kulkarni Vinaya, Dr. Jyoti Kole, Dr . Tayade Prajakta, Dr . Kelkar Kalpana

Abstract :

Introduction:–Takayasu�s arteritis is a rare chronic progressive pan endarteritis involving the aorta and its main anches. Anesthesia in patients with this disease can be complicated by severe uncontrolled hypertension,end organ dysfunction and stenosis of major blood vessels. This case presents peri–operative anesthetic challenges and management during Laparoscopic Nepherectomy. Case Details:– A 40 years old female patient came to surgery OPD with chief complaints of pain in abdomen and vomiting since 3 months. Her CT scan showed left atrophic kidney and DTPA Scan suggestive of spilt function of left kidney 15.7% and GFR 14 ml/min signs suggestive of negligible function of left kidney. Hence patient was posted for Laparoscopic Nepherectomy. During her preanesthetic check–up she was found to have uncontrolled hypertension and absent pulsations in left radial artery,left achial artery with weak pulsations in left femoral,left popliteal and left dorsalis pedis. She was investigated for the same and her arterial doppler report showed left external iliac artery with narrowed lumen and left subclavian artery with lumen obstruction and significant hemodynamic compromise. Her CT aortography revealed complete filling defect involving proximal left subclavian artery and the left renal artery showed concentric atherosclerotic valves thickening with narrow caliber. After which she was diagnosed as of Takayasu�s arteritis with renovascular hypertension. The patient was started on anti–hypertensives after which her blood pressure was controlled.

Conclusion:– In the anesthetic management of patients with Takayasu�s arteritis it ts important that adequate t issue perfusion be maintained without haemodynamic changes.