Disease progression after initial surgical intervention for Takayasu arteritis

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Rheumatology

Background:

• Takayasu arteritis (TA) is a large-vessel vasculitis.
• TA can lead to end-organ ischemia requiring revascularization.
• Long-term outcomes after revascularization for TA are not well-defined.

Purpose of the Study:

• To determine the incidence of disease progression in patients with TA.
• To assess the need for subsequent revascularization procedures in TA patients.
• To evaluate long-term outcomes and survival after revascularization for TA.

Main Methods:

• Retrospective review of patients with TA undergoing initial revascularization from 1980-2009.
• Analysis of incidence of revascularization in new vascular beds or revision of initial procedures.
• Assessment of postoperative morbidity, mortality, and actuarial survival.

Main Results:

• Forty patients underwent initial revascularization for indications including hypertension, renal dysfunction, extremity ischemia, and stroke.
• Disease progression or revascularization failure occurred in 40% of patients during a mean 6.4-year follow-up.
• Subsequent procedures were required for renal, cerebrovascular, and extremity ischemia, among others. Postoperative morbidity was 14% with one operative death.

Conclusions:

• Disease progression is common in Takayasu arteritis patients requiring revascularization.
• Lifelong global vascular surveillance is essential for TA patients post-intervention.
• The impact of immunosuppressive therapy on reoperation rates warrants further investigation.