The patient is a 19- year- old Iranian boy from the south provinces and Arab race , known case of Takayasu disease from 1998 .

It all started 2 years ago when his severe headache and lightheadedness together with some visual disturbances( blurred vision ) brought him into the physicians attention when his abnormally high blood pressures (right hand 260 /120 and left hand 180 /100 ) were detected .

Routine lab data disclosed no specific finding except his WBC profile which revealed 45 & 55% for Neut. & Lymph. respectively .

His ESR was 10 and RF was negative . Urine creatinine level was 1.2 gr/24 hrs. (1510 total urine vol. ) . CXR revealed no rib notching .Echo . only showed mild MR and captopril DTPA , renal scans , & VMA of 24 hrs.

Urine were normal . However angiography of great vessels disclosed.

1. Bilateral proximal renal artery stenosis ( 60% in the right & 70 % in the left ) .

2. complete occlusion of left subclavian artery ,passing the branching of thyrocervical , vertebral & int. mammary .

The patient underwent medical therapy with prednisolone but hypersensitivity reaction cut it off and later since the acute phase had stopped no immunosuppressive drugs were suggested for the patient . His high blood pressure didn’t respond well to SL nifidipine, furosemide , prazosin , captopril and atenolol. So vascular surgery was performed to correct the stenosis in March 2000 .

After bilateral aorto renal bypass his BP again raised and even once reached 260/110 . U/A showed 65 mg/dl & 10 mg/dl proteinuria nearly 6 & 9 month offer surgery respectively. and WBC profile returned to normal. Now still high BPs ( Right : SBP =230, Left : SBP=195 ) are his problem and latest renal sonography showed normal corticomedullary thickness in both kidneys , the size of right kidney was 120 mm and the size of left kidney was 102 mm. He is now candidate for other vascular surgical repair for his BP.

Iran Embassy needs a letter sent to determine the following:

1)An acceptance and appointment date (It is better for me to be from 28th Feb to 10th March).

2)period of treatment

3)Estimation of total costs and more details if possible.

4)Kind of treatment and services the hospital will give.

CT Scans