Early vs Late Arterial Wall Changes in Takayasu Arteritis Assessed by Duplex Ultrasound

Takayasu arteritis (TA) is a rare granulomatous vasculitis affecting large arteries, predominantly in young women. Vascular ultrasound is of immense value in disease assessment and longitudinal monitoring. We present a 2-time-point duplex ultrasound (DUS) comparison in a 39-year-old woman with TA, evaluated at diagnosis and after 8 years of medical immunosuppressive therapy without the need for surgical or endovascular revascularization. At baseline, carotid ultrasound demonstrated complete occlusion of the right common carotid artery (CCA), retrograde flow in the external carotid artery (ECA) supplying the internal carotid artery (ICA), and diffuse arterial wall thickening. At the 8-year follow-up, DUS revealed central color flow within the right CCA consistent with recanalization, persistent retrograde flow in the ECA, heterogeneous plaque formation within the ICA, progressive stenosis of the left common and external carotid arteries, restenosis of the proximal subclavian artery, and predominantly antegrade vertebral artery flow with early subclavian steal physiology. Tomographic imaging correlated well with the DUS findings. This case highlights the value of DUS in characterizing chronic vascular remodeling and hemodynamic adaptation in TA over time. Follow-up with DUS demonstrates both progression and partial improvement of arterial lesions under medical therapy, underscoring the importance of ongoing ultrasound surveillance in long-term disease management.