Claudication and Hypertension From Aortic Occlusion in Takayasu Arteritis: Revascularization With Excimer Laser and Drug-Eluting Stent

Abstract

Objective

To evaluate the efficacy of a multimodal endovascular approach integrating excimer laser atherectomy (ELA), percutaneous transluminal angioplasty (PTA), and drug-eluting stent (DES) implantation for managing complex aortic occlusion in Takayasu arteritis (TA).

Methods

A 24-year-old female with TA presented with progressively debilitating clinical manifestations, including severe hypertension (217/126 mmHg) and bilateral lower limb claudication that significantly impaired daily function despite medical management. Imaging confirmed a chronic infra-renal aortic occlusion. Given the lesion complexity and the patient’s young age, a multidisciplinary team decision prioritized a minimally invasive approach to avoid the higher risks of open surgery. The selected strategy sequentially integrated ELA for controlled debulking of the fibrotic occlusion and DES implantation to mitigate long-term restenosis risk.

Results

At 6-month follow-up, ankle-brachial indices improved bilaterally, with normalized systolic blood pressure and absence of claudication. Postoperative contrast-enhanced computed tomography angiography (CTA) confirmed sustained aortic artery patency without restenosis or collateral formation.

Conclusion

This case demonstrates the feasibility of ELA and DES integration as a minimally invasive strategy for TA-related aortic lesions, achieving durable hemodynamic and clinical outcomes.