title: Endovascular Repair and Adjunctive Immunosuppressive Therapy of Aortic Involvement in Behçet's Disease.
abstract: OBJECTIVE
  Aortic aneurysm is a serious problem in Behçet's disease, but open surgical therapy carries the risk of recurrent pseudoaneurysm. Here the outcomes of endovascular repair and adjunctive immunosuppressive therapy for aortic disease in Behçet's disease are presented.
  
  
  METHODS
  This was a retrospective study. Between 2002 and 2012, nine patients with Behçet's disease (8 male, median age 41 years, range 33-60 years) were treated by endovascular stent grafting for abdominal or thoraco-abdominal aortic pseudoaneurysm.
  
  
  METHODS
  Computed tomography angiography revealed infrarenal pseudoaneurysm in six (66.6%) patients and suprarenal pseudoaneurysm in three (33.3%). Patients received immunosuppressive therapy with oral prednisolone (60 mg/day) and cyclophosphamide (200 mg/day) for 2 weeks or more before the procedure, and intravenous hydrocortisone (200 mg/day) combined with cyclophosphamide (200 mg/day) for 3 days after the procedure. Thereafter, oral immunosuppressive therapy was continued for 2 years.
  
  
  RESULTS
  A straight tube graft was implanted in seven patients and a bifurcated graft in two patients. Two stage procedures (debranching before endovascular therapy) were performed in three patients for thoraco-abdominal aortic pseudoaneurysms. Stent grafting was successful in all patients, without any peri-operative complications. However, two patients needed abdominal exploration later: one for seroma around the graft and the other for a fistula between the duodenum and the graft. No recurrence of aneurysm was observed during a mean follow up of 40 ± 16 months. One patient died in the 15th month from a non-vascular cause.
  
  
  CONCLUSIONS
  Endovascular stent graft implantation and adjunctive immunosuppressive therapy seems to be safe and effective in the treatment of aortic involvement in Behçet's disease, but this approach needs further evaluation.
authors: Department of Cardiovascular Surgery, Near East University, North Cyprus, Cyprus.
authors: O
authors: O
authors: Balcioglu
authors: Department of Cardiovascular Surgery, Ege University Medical Faculty Hospital, Izmir, Turkey. Electronic address: serkanertugay80@gmail.com.
authors: S
authors: S
authors: Ertugay
authors: Department of Radiology, Ege University Medical Faculty Hospital, Izmir, Turkey.
authors: H
authors: H
authors: Bozkaya
authors: Department of Radiology, Ege University Medical Faculty Hospital, Izmir, Turkey.
authors: M
authors: M
authors: Parildar
authors: Department of Cardiovascular Surgery, Ege University Medical Faculty Hospital, Izmir, Turkey.
authors: H
authors: H
authors: Posacioglu
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D001528:Behcet Syndrome / Q000150:complications; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents
keywords: Behçet's disease; Behçet's syndrome; Endovascular techniques; False aneurysm; Immunosuppressive agents; Pseudoaneurysm