Surgical aspects of systemic necrotizing vasculitis

Thirty patients with systemic necrotizing vasculitis (SNV) of the polyarteritis nodosa type were reviewed. Eleven patients (36%) had only gastrointestinal manifestations of the disease. Four patients (13%) had only pulmonary involvement. Seven patients (23%) had both gastrointestinal and pulmonary manifestations of SNV. With use of an approved protocol from the National Institute of Allergy and Infectious Diseases of cyclophosphamide and prednisone, remission was attained in 29 of 30 patients (96%). However, 18 patients (60%) underwent major surgical procedures for either diagnosis or complications of the disease. Six patients underwent eight thoracotomies; six operations were required for diagnosis and two for drainage of right-sided empyemas. Ten patients underwent 14 exploratory laparotomies. Six abdominal explorations were performed for diagnostic purposes, and eight were required for treatment of complications. Two patients required digital amputations because of ischemic necrosis. Two patients (11%) developed five postoperative complications, one of whom subsequently died. Arteriographic studies were performed in 16 patients (53%). Vascular abnormalities consistent with those described for SNV were demonstrated in six cases (38%). There was no correlation of clinical manifestations, subsequent therapy, and arteriographic findings with regard to the development of intra-abdominal complications. Pulmonary complications occurred only in patients who had pulmonary infiltrates secondary to SNV.