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Interventions Related to Takayasu Arteritis, their Clinical and Angiographic Associations, and Prognostic Relevance -
Sandeep Balakrishnan1, Upendra Rathore1, Mishra Prabhaker2
1Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
Insights
About one-sixth of patients with Takayasu arteritis (TAK) underwent interventions, primarily endovascular procedures. Multiple interventions were needed for one-fourth of these patients, yet survival rates remained similar between those who received interventions and those who did not.
Area of Science:
- Vascular Surgery
- Cardiology
- Rheumatology
Background:
- Takayasu arteritis (TAK) is a large vessel vasculitis affecting the aorta and its branches.
- Interventions are sometimes necessary for managing complications of TAK, but their associations and impact on prognosis are not fully understood.
Purpose of the Study:
- To analyze interventions in a large cohort of patients with Takayasu arteritis.
- To investigate pre-treatment clinical and angiographic factors associated with interventions.
- To assess the prognostic relevance of interventions in TAK.
Main Methods:
- Analysis of a large ambispective, monocentric cohort of 238 patients with TAK.
- Retrieved data on endovascular or open surgical interventions.
- Compared demographic, clinical, and angiographic features using multivariable-adjusted odds ratios (OR) and assessed mortality using hazard ratios (HR).
Main Results:
- 17.23% (41/238) of patients underwent 69 interventions, predominantly endovascular (64 procedures).
- Renal arteries, subclavian arteries, and descending thoracic aorta were most commonly intervened upon.
- Patients requiring interventions more frequently presented with abdominal angina and less often with constitutional symptoms; survival was similar between intervened and non-intervened groups (HR 0.91, 95%CI 0.23-3.55).
Conclusions:
- Endovascular interventions are common in Takayasu arteritis management, with a significant proportion requiring multiple procedures.
- Clinical presentation, particularly abdominal angina, is associated with the need for interventions.
- Interventions in TAK do not appear to significantly impact long-term survival.
Objectives:
We analysed interventions related to TAK, their pre-treatment clinical and angiographic associations, and prognostic relevance from a large ambispective, monocentric cohort of TAK from India.
Methods:
Information regarding endovascular or open surgical interventions (aortoplasty, nephrectomy for refractory hypertension) was retrieved from a cohort of patients with TAK. Demographic characteristics, clinical features, and angiographic involvement were compared between patients with TAK who had undergone interventions with the rest of the cohort using multivariable-adjusted odds ratios (OR, with 95% CI). Hazard ratios were used to compare the mortality rate among TAK who had undergone interventions.
Results:
Among 238 patients with TAK in the cohort, 41(17.23%) had undergone 69 interventions related to TAK (64 endovascular procedures, one open surgical aortoplasty, 4 nephrectomies) across 55 sittings (a single intervention sitting in 31, two in seven, three in two, and four in one). The most common arterial territories undergoing intervention were the renal arteries (n=21), subclavian arteries (n=8), and descending thoracic aorta (n=6). Six patients with TAK required repeated interventions in the same arterial territories. Patients with TAK who underwent interventions more frequently had abdominal angina (OR 5.12, 95%CI 1.36-19.26), and less often had constitutional features (OR 0.39, 0.18-0.84) at presentation without significant differences in angiography. Survival was similar in TAK who had undergone interventions to those without (hazard ratio for mortality 0.91, 95%CI 0.23-3.55).
Conclusion:
About one-sixth of our cohort of TAK had undergone interventions, most often endovascular interventions. One-fourth required multiple interventions. Survival was similar in TAK with or without interventions.
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