**3. Takayasu's arteritis, giant cell arteritis**

entiate these from infected aneurysms when blood culture is negative or infected focus remains unclear. Another disease which we must differentiate is IgG4-related diseases

**Figure 2.** A case of medical treatment of an infected aneurysm. A 75-year-old man with familial hypercholesterolemia, cerebral infarction, and coronary bypass grafting presented with high fever and chest pain. Panel A and B showed a severely calcified ascending aorta. The repeated CE-CT on the 5th day revealed aneurysmal change with protrusion (Panel C), indicating an infected aneurysm. Due to a prohibitive risk of surgery, medical treatment was the choice of him and his family, but the infected aneurysm gradually enlarged despite the control of bacteremia with antibiotics

A detailed history and a careful physical examination are important for the diagnosis and assessment of the extent of vascular lesions. The mean age at onset of Takayasu's arteritis and giant cell arteritis was between 17 and 26 years of age and with 69 years, respectively, primarily in women (about 80 %) [16]. Systemic symptoms are common such as fatigue, weight loss, and low-grade fever are common in these disorders, along with local symp‐ toms, for example, arthralgia, skin lesion (erythema nodosum), and abdominal pains. HLA-B27–associated spondyloarthropathies accompanies with ankylosing spondylitis, reactive arthritis, or inflammatory bowel disease with negative rheumatic factors. Skin and mucosa, ocular system, GI manifestations include abdominal pain, nausea, and diarrhea with or without blood, and/or musculoskeletal and neurological system are involved in Behçet's

(13th day: Panel D, 24th day: Panel E, and 58th day; Panel F), and he died 2 months after onset.

(chronic periaortits).

408 Artery Bypass

Takayasu's arteritis, also called pulseless disease, involves the ascending aorta and aortic arch, and carotid and subclavian arteries, causing dilations and obstruction at the stage of healing and recurrences. CT angiography revealed the diseased lesion, thickened arterial wall in acute phase and aneurysmal or stenotic lesion in chronic phase [18]. The ultrasonog‐ raphy and MR angiography are also useful. In acute phase, the high signal of T2-weighted and/or STIR MR images and the increased uptake of 18Fluorodeoxy-glucose indicate the presence of active inflammation [19]. The mainstay of therapy for Takayasu's arteritis is glu‐ cocorticoids. Giant cell arteritis (GCA) is a chronic vasculitis of large and medium sized ves‐ sels. The following classification criteria were as follows: 1) Age older than 50 years at onset, 2) Localized headache de novo, 3) Tenderness or decreased pulse of the temporal artery, 4) Erythrocyte sedimentation rate (ESR) greater than 50 mm/h, 5) Biopsy-proven necrotizing arteritis with multinucleated giant cells [20].
