Takayasu arteritis is also known as pulseless disease as it affects the arterial tree and the patient’s peripheral pulses become non-palpable. It is a chronic inflammatory disease of unknown aetiology affecting the aorta and its main branches. The inflammatory arteritis can affect any organ system of the body leading to occult or overt multi-organ dysfunction. Anaesthetic management of these patients presenting for emergency surgery can be quite challenging as there may not be enough time available for complete evaluation of every organ system. We hereby present the anaesthetic challenges in a case of emergency urological surgery in a patient of Takayasu’s arteritis with obstructive uropathy and fibrotic lung changes.