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Current surgical approaches in Takayasu's arteritis: a single-centre experience
Caner Arslan1, Cigdem Tel2, Berk Arapi2
1Department of Cardiovascular Surgery, Cerrahpasa Medical School, University of Istanbul-Cerrahpasa, Istanbul, Turkey. canerkvc@yahoo.com.
Insights
Cardiovascular surgery in Takayasu
Area of Science:
- Vascular Surgery
- Cardiology
- Immunology
Background:
- Takayasu's arteritis (TAK) is a large-vessel vasculitis affecting the aorta and its branches.
- Cardiovascular manifestations of TAK often require surgical intervention.
- Optimal surgical strategies and outcomes in TAK patients remain under investigation.
Purpose of the Study:
- To evaluate cardiovascular surgical interventions in patients with Takayasu's arteritis.
- To assess the midterm outcomes, including graft patency and complications, of these interventions.
Main Methods:
- Retrospective study of 20 patients with TAK undergoing cardiovascular surgery between 2008 and 2016.
- Surgical procedures included coronary artery bypass grafting, aortic aneurysm repair, and revascularization of various arteries (aorta-iliac, femoral, renal, celiac, mesenteric).
- Follow-up data on graft patency, complications, and mortality were analyzed.
Main Results:
- A total of 32 grafts were placed; 12.5% occluded during a mean follow-up of 39.2 months.
- No operative mortality or anastomotic aneurysms were observed.
- Complications included graft infection (1 death), stroke (2 patients), and need for secondary interventions in 2 patients.
Conclusions:
- Cardiovascular surgery in TAK patients demonstrated relatively good midterm graft patency.
- No anastomotic pseudoaneurysms were observed, but complications like graft infection and stroke can occur.
- Endarterectomy may be considered for limited stenosis; multidisciplinary management is key for favorable outcomes.
Objectives:
We investigated cardiovascular surgical interventions in a group of patients with Takayasu's arteritis (TAK) diagnosed and followed by a single centre.
Methods:
. Twenty patients with TAK (5 males, 15 females, mean current age: 38.1±10.7) who were operated for a broad spectrum of cardiovascular diseases ranging from coronary heart disease to coeliac stenosis or aneurysm between July 2008 and April 2016 were studied. One patient underwent operation related to aneurysm of ascending aorta and aortic insufficiency, 2 patients had operations for both coronary arteries originating from aortic arch, 6 patients for only arteries originating from aortic arch, 1 patient for both carotid and infra-inguinal artery, 5 patients for aorta-iliac or femoral revascularisation, 5 patients for renal artery and/or coeliac or superior mesenteric artery revascularisations. Three of these interventions were endarterectomy and patch plasty.
Results:
The mean time between diagnosis and surgical intervention was 6.1±3.1 years (range: 3 months-12 years). A total of 4/32 (12.5%) grafts were occluded during the follow up period of mean 39.2±24.6 months. Secondary interventions like cross-femoral, or graft to superficial femoral artery bypasses were needed in 2 patients who underwent aorta-bifemoral bypasses to keep patency. There was no operative mortality. We did not observe any anastomotic aneurysm. One patient died due to graft infection 3 months after the operation. Stroke occurred in 2 patients who underwent re-vascularisations of the arteries originating from aortic arch.
Conclusions:
In our series, we have a relatively good midterm patency rates in patients with TAK and did not observe any anastomotic pseudoaneurysm. Stroke developed in 2 patients and mortality occurred in one patient due to the graft infection 3 months after the operation. In patients with limited carotid or aorta-iliac stenosis, chance for endarterectomy should be evaluated. Well-controlled disease activity with intensive medical treatment and multi-disciplinary approach could be associated with a favourable long-term outcome.
