title: Surgical bypass vs endovascular treatment for patients with supra-aortic arterial occlusive disease due to Takayasu arteritis.
abstract: OBJECTIVE
  This study compared treatment outcomes of patients with supra-aortic arterial (SAA) occlusive disease due to Takayasu arteritis (TA) treated with bypass surgery or endovascular treatment.
  
  
  METHODS
  All patients diagnosed with TA from September 1994 to November 2010 were identified using the hospital database. This retrospective study included 21 TA patients who underwent endovascular or surgical intervention due to SAA lesions and four patients who were referred from other hospitals after endovascular treatment of SAA lesions. Fifteen arterial lesions in 10 patients were treated with an endovascular technique, and 24 arteries in 15 patients were reconstructed using bypass surgery. We performed endovascular intervention for short (<5 cm) stenotic lesions and bypass surgery for longer occlusive lesions. After surgical or endovascular intervention, anti-inflammatory medication (steroids, methotrexate, or azathioprine, or both) was given to 12 patients (48%) with evidence of disease activity for a mean of 4.4 ± 4.5 months (median, 2.6; range, 1-15 months). We reviewed and compared demographic and clinical features, lesion characteristics, indications for treatment, and treatment results between the bypass surgery and endovascular treatment groups. To evaluate the treatment results, we assessed the patency of reconstructed arteries, recurrent symptoms, and complications associated with treatment.
  
  
  RESULTS
  During the 194-month study period, 9.6% of TA patients with SAA lesions required bypass surgery or endovascular treatment. The typical indication for treatment was brain ischemic symptoms. Two patients were neurologically asymptomatic but had cervical artery occlusion in conjunction with an aortic arch aneurysm or symptomatic aortic regurgitation. During a mean follow-up of 39.4 ± 44.4 months (median, 23.2; range, 0.5-178 months), restenosis (>50%) or occlusion of the reconstructed arteries was observed in eight of 15 arteries (53.3%) in the endovascular treatment group vs three of 24 (12.5%) in the bypass surgery group (P = .01; Fisher exact test). More serious complications, such as intracerebral hemorrhage (n = 2) due to cerebral hyperperfusion syndrome or cardiac tamponade developed in the surgical bypass group. No operative deaths occurred in either group.
  
  
  CONCLUSIONS
  Surgical or endovascular interventions were required in one of 10 TA patients with SAA occlusive lesions. Arteries reconstructed after surgical bypass had superior patency to those reconstructed by endovascular treatment. However, bypass surgery was more likely than endovascular treatment to be accompanied by serious early postoperative complications.
authors: Division of Vascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ywkim@skku.edu
authors: Young-Wook
authors: YW
authors: Kim
authors: Dong-Ik
authors: DI
authors: Kim
authors: Yang Jin
authors: YJ
authors: Park
authors: Shin-Seok
authors: SS
authors: Yang
authors: Ga-Yeon
authors: GY
authors: Lee
authors: Duk-Kyung
authors: DK
authors: Kim
authors: Keonha
authors: K
authors: Kim
authors: Kiick
authors: K
authors: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D056910:Republic of Korea; D012189:Retrospective Studies; D013625:Takayasu Arteritis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents