Background Takayasu's arteritis (TAK) is a large-vessel vasculitis of unknown etiology affecting primarily the aorta and its branches. Despite treatment with immunosuppressive agents patients with TAK often develop arterial damage requiring vascular procedures. (1)
Objectives To compare the outcomes between vascular surgery and endovascular procedures in a cohort of patients with TAK.
Methods A retrospective medical record review was performed to identify all patients with TAK who underwent vascular procedures at a tertiary referral center between 01/01/1984 and 12/31/2009. The ACR criteria for TAK were used for inclusion (modified to include patients diagnosed between age 41 and 50 years). Disease activity was assessed according to the Kerr criteria. Data are reported using descriptive statistics, and Kaplan Meier methods for complication rate.
Results The cohort included 66 patients with TAK (Mean age 33.3±11.0, 58 women [88%], white [70%]) who underwent 119 vascular procedures (surgery 93[78%]; endovascular repair 26 [22%]). The most frequent indications for vascular surgery were arm claudication (40[43%]) and leg claudication (18[19%]) while arm claudication (8[31%]) and malignant hypertension (6[23%]) were the most frequent indications for endovascular repair. In 55 of 93 (59%) vascular surgical procedures and in 10 of 26 (38%) endovascular procedures, the disease was active within 1 month of intervention. The most frequent arterial lesions requiring intervention were the aorta (26[28%]), carotid (21[23%]) and subclavian (20[22%]) arteries in the vascular surgery group compared to the subclavian (9[35%]), renal arteries (5[19%]) and aorta (5[19%]) in the endovascular repair group. Corticosteroids were the most common pharmacological treatment (43[46%] in the surgery group and 12[46%] in the endovascular repair group) followed by immunosuppressants (26[28%] in the surgery group and 10[38%] in the endovascular repair group). The levels of ESR and CRP one month before surgery did not differ between the groups, but these data were available for <50% of the procedures. Early complications [<30 days] occurred after 15 (16%) surgeries and 4 (15%) endovascular repair procedures (p=0.93). Early complications included restenosis 1[1%], bleeding 2[2%], stroke 3[3%] and others 11[12%]) following surgery and restenosis 1[4%] and others 3[12%] following endovascular repair. Late complications occurred after 34 surgical procedures and 10 endovascular repair procedures (44% vs. 66% complication rate at 10 years of follow-up; p=0.33). The majority of complications in both groups were restenosis (26 after surgery and 9 after endovascular repair; 37% vs 62% restenosis rate at 10 years of follow-up; p=0.19). Other late complications included thrombosis 2[4%], stroke 1[2%] and others 8[11%]) after surgery and development of new pseudoaneurysm 1[10%]) after endovascular repair.
Conclusions In this cohort of patients with TAK undergoing vascular intervention, revascularization procedures are associated with high failure rates and frequent operative complications. We observed a trend towards higher rate of restenosis in patients who underwent endovascular procedures, compared to vascular surgery.
Schmidt J, et al. Mayo Clin Proc. 2013 Aug;88(8):822–30.
Disclosure of Interest None declared
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