Arterial lesions in Behçet's disease. A study in 25 patients.
OBJECTIVE
To identify the prognostic indicators of patients with Behçet's disease complicated with arterial lesions.


METHODS
Retrospective chart analysis of 25 consecutive patients with Behçet's disease and angiographically proven arterial lesions.


RESULTS
Occlusive lesions were present in 7 patients, aneurysms in 3, and both occlusive and aneurysmal lesions in 15. High dose corticosteroids were not effective in isolated occlusive lesions and probably contributed to one fatal infection. Death was related to aneurysms in 5 patients. Twenty-seven vascular surgical procedures were performed in 15 patients. Arterial lesions recurred in all patients who did not received postoperative corticosteroids. Within a 2 yr period after operation, the rate of therapy failure was lower in the group of patients treated with a postoperative combination of corticosteroids and immunosuppressive drugs, compared to the group treated with corticosteroids alone. In patients treated for lower limb arterial lesions, the rate of relapse was similar whether venous autologous or prosthetic grafts were used. Graft thrombosis occurred in 3/7 patients given anticoagulants and in 3/4 patients with no antiaggregant or anticoagulant therapy.


CONCLUSIONS
Aneurysms have a worse prognosis than occlusive lesions. High dose corticosteroids should not be systematically prescribed for isolated occlusive lesions. Surgery, when feasible, is indicated for aneurysms because they entail a high risk of rupture. Postoperative corticosteroids are necessary to prevent arterial relapse. A combination of corticosteroids and immunosuppressive therapy is more effective than corticosteroids alone. After bypass for lower limb arterial lesions, anticoagulation is warranted to prevent graft thrombosis.
Lê Thi Huong
D
D
Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Wechsler
B
B
Papo
T
T
Piette
J C
JC
Bletry
O
O
Vitoux
J M
JM
Kieffer
E
E
Godeau
P
P
D000005:Abdomen / Q000098:blood supply; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000783:Aneurysm / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D001528:Behcet Syndrome / Q000150:complications*; D001807:Blood Vessel Prosthesis; D002648:Child; D003327:Coronary Disease / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011651:Pulmonary Artery; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors