Introduction: Takayasu’s arteritis is a rare chronic granulomatous large vessel vasculitis of unknown etiology affecting aorta and its main branches, and pulmonary arteries. Involvement of renal arteries leads to renal artery stenosis, ischaemic nephropathy, renovascular hypertension and may progress to renal failure. We discuss the anaesthetic management of Takaysu’s arteritis presenting for renal transplantation.

Case history: A 22yr old lady with Takaysu’s arteritis, hypertension and chronic renal failure was schedule to undergo related renal transplantation. She was on dialysis for the past 9months for renal failure due to involvement of renal arteries. At the time of presenting for transplantation she was on CAPD catheter as accessing her central veins was found to be difficult. She was on clonidine, prazosin, amlodipine and torsemide for control of hypertension. Her radial and ulnar artery pulsations were absent in left upper limb and were palpable only in the right upper limb. For intraoperative monitoring of haemodynamics her left subcalvian vein and right radial artery had to be cannulated under USG guidance. She had an uneventful intraoperative course with the transplanted kidney producing good urine. She was on tacrolimus based immunosuppression postoperatively. About a week after her transplant surgery she developed fever with increased total count and blood culture grew candida, for which amphotericin B was started. Her condition progressively deteriorated and she succumbed to fungal sepsis.

Discussion: Patients with Takaysu’s arteritis presenting for surgery pose a challenge to anaesthesiologists due to absence of peripheral pulses, severe uncontrolled hypertension leading to end-organ dysfunction and stenosis of major vessels affecting regional circulation.