Thrombotic obliteration of the branches of the aortic arch.

PULSELESS disease, or Takayashu's disease, is an unusual syndrome characterized by the obliteration of the major branches of the arch of the aorta. The name, pulseless disease, does not appear to be adequate, for it fails to indicate the peculiar localization of the disease and the clinical variants with diminished, but present pulses. The name Takayashu's disease is subject to the criticism usually voiced against eponyms; further, Takayashu described only the ocular manifestations of this condition.1 In addition, this syndrome was adequately documented by Broadbent2 33 years prior to Takayashu's description. The most appropriate nomenclature is considered to be thrombotic obliteration or thromboangiitis obliterans of the branches of the aortic arch because of the consistent demonstration of intravascular clot formation (thrombus), of inflammation of the vessel wall (angiitis), and of the peculiar anatomic localization (aortic arch). Furthermore, this name implies an appropriate lack of knowledge of specific etiology. Although 90 cases have been reported of this condition to the present time,1' 37 only 5 reports have originated in the United States.4 517 This report presents the sixth case to be documented in this country and a comprehensive review on this subject.