Arterial dissection in childhood Takayasu Arteritis: Not as rare as thought

Background: Arterial vessel wall dissection is a rare, life-threatening and rarely described complication in childhood Takayasu Arteritis (cTA). Prevalence and risk factors for arterial dissection in cTA are unknown. We sought to study the prevalence and analyse risk factors for arterial dissection in cTA. Findings: A single center retrospective review of all children with cTA was performed. Patients with arterial dissection at cTA diagnosis were reported in detail and compared to the remaining single center retrospective cohort of children without dissection. Disease activity was assessed by the Pediatric Vasculitis Disease Activity Score (PVAS). A total of 27 cTA patients (74% girls) were included. Three children (11%) presented with dissection at diagnosis of cTA. They had higher PVAS (median 21 versus 10, p=0.26), increased neutrophils (p<0.0001) and lower albumin levels (p=0.05). Arterial hypertension was common in both groups: in 67% of children with dissection and 54% of those without. Conclusions: Arterial dissection was more frequent in our cTA cohort than previously reported. Careful vascular imaging assessment is crucial to document this complication. High disease activity and markers of inflammation especially in combination with arterial hypertension, may be associated with the risk for vessel wall dissection in children with cTA.