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Published on: February 8, 2019
Major arterial involvement and review of Behcet's disease
Ufuk Alpagut1, Murat Ugurlucan, Enver Dayioglu
1Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey. ufukalpagut@yahoo.com
Insights
Vascular involvement in Behcet's disease, particularly arterial complications, presents significant surgical challenges and predicts mortality. Optimal management involves systemic therapy and careful consideration of surgical timing.
Area of Science:
- Vascular Surgery
- Rheumatology
- Internal Medicine
Background:
- Behcet's disease is a multisystemic disorder characterized by orogenital ulcers, vascular, ocular, and cutaneous lesions.
- Vascular involvement, both venous and arterial, is a critical aspect of Behcet's disease, with arterial manifestations posing unique surgical challenges.
- The disease predominantly affects individuals in their third and fourth decades and is prevalent in Mediterranean and East Asian populations.
Purpose of the Study:
- To review the literature on Behcet's disease with a focus on vascular involvement.
- To analyze the prognosis of surgical treatment for vascular complications in Behcet's disease.
- To discuss the challenges and management strategies for arterial complications in Behcet's disease.
Main Methods:
- Retrospective review of 31 consecutive patients with vasculo-Behcet's disease.
- Analysis of clinical, pathological, and postoperative data from patients treated at the Medical Faculty of Istanbul.
- Literature review on Behcet's disease and its vascular manifestations.
Main Results:
- Vascular pathologies were observed in all 31 patients, with 15 involving the venous system and the remainder the arterial tree.
- Ten patients underwent surgery for aneurysms/pseudoaneurysms, and six for occlusive lesions.
- Recurrent pseudoaneurysms were noted in six patients, highlighting the complexity of arterial interventions.
Conclusions:
- Vascular manifestations are significant predictors of mortality and morbidity in Behcet's disease.
- Arterial complications in Behcet's disease present difficult surgical problems, with invasive procedures potentially leading to pseudoaneurysms.
- Surgical intervention should be deferred during the acute phase, and systemic therapies (colchicine, aspirin, corticosteroids) are recommended.
Abstract:
Behcet's disease was first defined by Hulusi Behcetin 1937 as a multisystemic disorder with characteristic pathologic findings including recurrent orogenitalulcers, vascular disorders, and ocular and cutaneous lesions. The disease is mostly encountered at the third and fourth decades of life and especially prevalent in Mediterranean and Far East Asia.Behcet's disease may have both venous and arterial manifestations. The arterial form is rare but it is bore with its manner and to consider recurrent surgical treatments. In this retrospective study, we reviewed the literature related to Behcet's disease and discussed in respect to vascular involvement and the prognosis of surgical treatment.Thirty-one consecutive patients with vasculo-Behcet's disease visiting the departments of cardiovascular surgery, dermatology, and internal medicine in Medical Faculty of Istanbul have been reviewed retrospectively. All available clinical,pathologic, and postoperative data were reviewed and analyzed. Venous system pathologies were present in 15 patients. The pathologies in the remaining patients were related to the arterial tree. Ten patients with aneurysms and/or pseudoaneurysms and six patients with occlusive lesions have undergone surgical treatment. Pseudoaneurysms occurred in six patients at least twice or more. Vascular manifestations are the main predictors of mortality and morbidity in Behcet's disease. Arterial complications may lead to difficult surgical problems.Any invasive methods to arterial system may cause pseudoaneurysms. Repairs by using autogenous veins or synthetic grafts may lead to anastomotic false aneurysms. Surgical treatment should not to be applied in the acute phase of the disease and systemic therapy including colchicine, aspirin,and corticosteroids should be considered for all patients.
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