Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience.
BACKGROUND
With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascular complications after surgery or endovascular treatment is still to be determined.


RESULTS
This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25-50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2-11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication-free survival rates were 78% (IQR, 69%-88%), 67% (IQR, 57%-78%), 56% (IQR, 46%-70%), and 45% (IQR, 34%-60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42-39.39; P=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (P<0.001) and C-reactive protein (P<0.001) and fibrinogen (P<0.005) serum levels compared with those without complications.


CONCLUSIONS
The overall 5-year arterial complication rate was 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with Takayasu arteritis.
Service de Médecine Interne 2, Hôpital Pitié-Salpétrière, 83 Boulevard de l'hôpital, Paris, France. david.saadoun@psl.aphp.fr
David
D
Saadoun
Marc
M
Lambert
Tristan
T
Mirault
Mathieu
M
Resche-Rigon
Fabien
F
Koskas
Philippe
P
Cluzel
Cécile
C
Mignot
Yoland
Y
Schoindre
Laurent
L
Chiche
Pierre-Yves
PY
Hatron
Joseph
J
Emmerich
Patrice
P
Cacoub
D000328:Adult; D017130:Angioplasty / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000627:therapeutic use; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003131:Combined Modality Therapy; D015897:Comorbidity; D018572:Disease-Free Survival; D057510:Endovascular Procedures; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000401:mortality; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents / Q000706:statistics & numerical data; D013625:Takayasu Arteritis / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D058017:Vascular Grafting / Q000379:methods / Q000706:statistics & numerical data*
D000925:Anticoagulants; D007166:Immunosuppressive Agents; D005340:Fibrinogen; D002097:C-Reactive Protein