Anesthetic management of a high-risk cesarean delivery in a patient with multivessel Takayasu arteritis

Takayasu arteritis (TA) is a rare chronic inflammatory disease affecting large vessels that can result in stenosis, occlusion, and aneurysm formation. Although not a contraindication, TA poses significant anesthetic challenges in pregnancy. We describe the successful anesthetic management of a patient with TA complicated by aortic root dilation, abdominal aortic aneurysm, bilateral subclavian artery, and bilateral carotid artery stenosis undergoing elective cesarean delivery at 37 weeks. To minimize hemodynamic fluctuations, we used a slowly titrated dural puncture epidural technique along with standard American Society of Anesthesiologists monitors and invasive monitoring with a dorsalis pedis arterial line. The procedure was completed without perioperative maternal complications, resulting in the delivery of a healthy neonate. This case emphasizes the anesthetic challenges of managing the complex pathophysiology of Takayasu arteritis and the associated cardiovascular hemodynamics in the peripartum period.