Volume 50, Issue 2 Summer 2026 JVU 502-116 | Early vs Late Arterial Wall Changes in Takayasu Arteritis Assessed by Duplex Ultrasound-Early vs Late Arterial

Early vs Late Arterial

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This technical note describes an 8-year duplex ultrasound (DUS) follow-up in a woman with Takayasu arteritis (TA), a large-vessel granulomatous vasculitis that commonly affects young women and requires imaging for diagnosis and monitoring because reliable biomarkers are lacking.<br /><br />At initial presentation in 2015, the patient had headaches, tachycardia, diminished pulses, cervical bruits, and left arm paresthesia. Ultrasound and CTA showed diffuse circumferential arterial wall thickening and stenoses involving the carotid, subclavian, brachiocephalic, and abdominal vessels. The right common carotid artery (CCA) was completely occluded, the left carotid system was severely narrowed, and diagnosis was made using ACR/EULAR criteria.<br /><br />She was treated medically with glucocorticoids and immunosuppressive therapy, eventually transitioning to tocilizumab after inadequate response to methotrexate and rituximab. Over time, symptoms improved when treatment was maintained but recurred during interruptions, even though ESR and CRP often remained normal, illustrating that inflammatory markers may be unreliable during IL-6 blockade. Because she had preserved cerebral perfusion and no critical ischemia, revascularization was deferred.<br /><br />Comparison of 2016 and 2024 DUS studies showed mixed vascular evolution. The previously occluded right CCA developed central color flow, suggesting recanalization, while retrograde flow through the right external carotid artery persisted. In contrast, the left common carotid, external carotid, and proximal subclavian arteries showed progression of stenosis, and the vertebral artery waveform indicated early subclavian steal physiology. New heterogeneous plaque in the left ICA likely reflected chronic remodeling and secondary atherosclerotic change.<br /><br />The authors conclude that DUS is valuable for long-term TA surveillance because it can track wall thickening, stenosis, flow direction, collateralization, and hemodynamic adaptation over time.

Keywords

Takayasu arteritis

duplex ultrasound

large-vessel vasculitis

carotid stenosis

arterial wall thickening

tocilizumab

recanalization

subclavian steal

imaging follow-up

vascular surveillance