title: Long-term survival after surgical treatment of patients with Takayasu's arteritis.
abstract: BACKGROUND
  Surgical interventions have been performed to ameliorate the complications of Takayasu's arteritis. However, the efficacy of surgery to increase long-term survival has not been established.
  
  
  RESULTS
  A retrospective review was performed on the survival of 106 consecutive patients with Takayasu's arteritis who underwent surgical treatment during the past 40 years. Their ages ranged from 5 to 69 years (mean+/-SEM, 31.7+/-1.3 years). Survival was compared with the reported results of medically treated patients according to Ishikawa's prognostic classification. There were 12 hospital deaths, and the remaining 94 patients were followed up from 8 months to 41.8 years (mean, 19.8 years). A serious long-term complication was anastomotic aneurysm, with a cumulative incidence at 20 years of 13.8%. Thirty-one late deaths were observed, and the major cause was congestive heart failure. The overall cumulative survival rate at 20 years was 73.5%. The prognostic classification by Ishikawa had little influence on the survival of surgically treated patients. For stage 3 patients, surgery seemed to increase survival; however, surgery-related complications conversely decreased the survival of stage 1 patients.
  
  
  CONCLUSIONS
  Surgery seems to increase the long-term survival of patients with stage 3 Takayasu's arteritis, whereas conservative treatment is recommended for those with stage 1 or 2 disease. An anastomotic aneurysm may occur at any time after surgery, and regular follow-up using imaging modalities such as multi-detector CT, MRI, or ultrasonography at least once every several years for the rest of the patient's life is mandatory for the early detection of anastomotic aneurysm.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. miyata-2su@h.u-tokyo.ac.jp
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyata
authors.forename: Osamu
authors.initials: O
authors.lastname: Sato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shigematsu
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tada
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000783:Aneurysm / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013625:Takayasu Arteritis / Q000145:classification / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*