title: Vascular surgery: the main risk factor for mortality in 146 Takayasu arteritis patients.
abstract: Takayasu arteritis (TA) is an idiopathic chronic inflammatory disease that affects the aorta and its main branches. According to disease involvement, patients may require surgical treatment mainly due ischemic lesions in association with medical therapy. We evaluated the impact of vascular interventions in a cohort of TA patients. Medical records from 146 TA patients were reviewed. Clinical features, medical, and surgical treatment were revised and disease activity was determined by clinical, laboratorial, and imaging parameters. Clinical parameters associated with mortality alongside vascular procedures were evaluated and their impact on mortality in our cohort was estimated. Ninety-four vascular interventions were performed in 61 patients (41.8%). A third of them were of endovascular procedures. The overall mortality was 4.1%, all due to early postoperative complications, which resulted in a rate of surgery-related mortality of 9.8%. All deaths occurred in patients with active disease. Clinical parameters known to be associated with mortality (aneurysm, secondary hypertension, aortic insufficiency, and cerebrovascular accident) were not found related with death. Patients whose disease began before age 20 years had an OR 3.54 of undergoing a vascular surgical intervention. The observed impact of vascular procedures on mortality in patients with Takayasu arteritis, especially during disease activity, supports the notion that such interventions should be performed with caution and preferably during periods of remission.
authors.affiliation: Division of Rheumatology, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
authors.forename: Nilton Salles
authors.initials: NS
authors.lastname: Rosa Neto
authors.affiliation: Division of Rheumatology, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
authors.forename: Samuel Katsuyuki
authors.initials: SK
authors.lastname: Shinjo
authors.affiliation: Division of Rheumatology, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
authors.forename: Maurício
authors.initials: M
authors.lastname: Levy-Neto
authors.affiliation: Division of Rheumatology, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil. rosamariarp@yahoo.com.
authors.forename: Rosa Maria Rodrigues
authors.initials: RMR
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002423:Cause of Death; D057286:Electronic Health Records; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013625:Takayasu Arteritis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D055815:Young Adult
keywords: Epidemiology; Mortality; Takayasu arteritis; Vascular surgery; Vasculitis