Long Term Outcomes of Open or Endovascular Treatment for Arterial Manifestations in Behçet Disease

Behçet disease (BD) is a rare multisystemic disorder with occasional involvement of large vessels. While many patients with BD are managed medically, arterial manifestations often necessitate surgical or endovascular intervention. This study aimed to analyse invasively treated arterial involvement in BD and identify risk factors for recurrent re-interventions.

A retrospective review from January 1990 to December 2020 included 30 patients who underwent 54 procedures for arterial BD. Initial operations were categorised as open or endovascular. Demographic data, arterial lesions, causes of operations, pre-operative medications, re-operation rates, and death were assessed. Re-operations were classified by surgery type and lesion site. Analytical methods encompassed comparisons of graft materials, laboratory findings, and the International Criteria for BD (ICBD).

Index procedures involved 21 open operations and nine endovascular interventions. The median age was 39 years, and 77% were male. Mainly involved arteries were the abdominal aorta (ten cases), peripheral arteries (14 cases), and visceral artery (one case). Arterial manifestations included intact aneurysms (20 cases), ruptured aneurysms (six cases), and thrombotic occlusions or stenoses (four cases). Abdominal aortic diseases were mainly treated by endovascular interventions; otherwise the open and endovascular groups showed similar demographics. Re-operations were performed in 40% of cases, demonstrating a statistically significant association with ICBD score (p = .004). An ICBD score of ≥ 6 points showed 4.8 times higher risk of re-intervention.

Arterial manifestations in BD often mandate surgical intervention, with a notable proportion requiring multiple re-operations. No discernible differences were found between open and endovascular approaches, but a higher ICBD score emerged as a risk factor for re-operation.