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Outcomes of Vascular Interventions in Takayasu Arteritis and the Role of Biologic Therapy: A Multicenter
Aysegul Avcu1, Sema Kaymaz-Tahra2, Rıza Can Kardas3
1Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Türkiye.
Insights
Vascular interventions for Takayasu arteritis (TAK) have acceptable complication rates. Biologic therapy may reduce restenosis in crude analyses, but this benefit requires further study for confirmation.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Vascular Surgery
Background:
- Takayasu arteritis (TAK) can cause arterial stenosis, occlusion, and aneurysms, often necessitating vascular interventions.
- Evaluating the outcomes of these interventions is crucial for managing TAK patients.
Purpose of the Study:
- To assess outcomes, restenosis rates, and complications following vascular interventions in patients with Takayasu arteritis.
- To identify factors associated with restenosis after these procedures.
Main Methods:
- Retrospective analysis of 119 Takayasu arteritis patients undergoing vascular interventions across eight centers (1995-2024).
- Data collected included indications, disease activity, procedural details, outcomes, complications, and restenosis (>70% stenosis on follow-up imaging ≥3 months post-procedure).
- Restenosis analysis focused on steno-occlusive lesions.
Main Results:
- 168 steno-occlusive lesions were analyzed for restenosis, occurring in 48.8% (82/168) with a median time of 19.5 months.
- 1-, 3-, and 5-year restenosis-free patency rates were 76.8%, 63.6%, and 56.5%, respectively.
- Biologic therapy was associated with lower crude restenosis rates (30.8% vs. 53.1%) in post-diagnosis procedures, but this association was not significant in time-to-event analyses. Major complication rates were 3.9% for endovascular and 12.5% for surgical procedures.
Conclusions:
- Vascular interventions in selected Takayasu arteritis patients demonstrate acceptable major complication rates.
- While biologic therapy showed a crude association with reduced restenosis post-intervention, this requires cautious interpretation and further validation.
- Prospective studies with standardized imaging are needed to confirm the role of biologic therapy in improving long-term vascular outcomes in TAK.
Objectives:
Takayasu arteritis (TAK) may lead to arterial stenosis/occlusion and aneurysms, occasionally requiring vascular interventions. We evaluated outcomes, restenosis, and complications after vascular interventions in TAK and explored factors associated with restenosis.
Methods:
We retrospectively included TAK patients who underwent extracardiac endovascular or surgical vascular interventions before or after TAK diagnosis across eight tertiary centers (1995-2024). Indications, disease activity status at the time of intervention, procedural characteristics, early/late outcomes, major complications, and restenosis were recorded. Restenosis was defined as > 70% stenosis on follow-up imaging performed ≥ 3 months after the procedure. Restenosis analyses were restricted to steno-occlusive lesions.
Results:
We included 119 patients with 201 treated lesions (185 steno-occlusive lesions; 16 aneurysms/dissections). Of all procedures, 61.2% (n = 123) were performed after TAK diagnosis under immunosuppressive therapy. Follow-up imaging was available for 170/185 steno-occlusive procedures, and restenosis status was evaluable in 168 procedures; restenosis occurred in 82/168 (48.8%) with a median time to restenosis of 19.5 months. In exploratory Kaplan-Meier analysis, 1-, 3-, and 5-year restenosis-free patency rates were 76.8%, 63.6%, and 56.5%, respectively. In analyses restricted to post-diagnosis steno-occlusive procedures, crude restenosis was significantly less frequent under biologic therapy than without biologic therapy (30.8% vs. 53.1%; Fisher's exact p = 0.040); however, biologic therapy was not associated with time to restenosis in Cox regression (HR 1.01, 95% CI 0.51-1.99; p = 0.97) or patient-clustered Cox analysis (HR 1.01, 95% CI 0.47-2.18; p = 0.98). Major complication rates were 3.9% for endovascular procedures and 12.5% for surgical procedures. Overall mortality was 11.8%, with two deaths attributed to procedure-related complications.
Conclusions:
Vascular interventions in selected patients with Takayasu arteritis were associated with acceptable major complication rates. Among post-diagnosis steno-occlusive procedures, biologic therapy was associated with lower restenosis rates in crude analyses; however, this association was not sustained after accounting for restenosis timing. Therefore, the potential role of biologic therapy in improving post-interventional vascular outcomes should be interpreted cautiously and requires confirmation in prospective studies with standardized imaging surveillance.
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