Takayasu's arteritis is an inflammatory arteriopathy that often progresses to obliteration of multiple large arteries. Variable results have been reported after medical and surgical management. Twenty female patients with Takayasu's arteritis were treated from 1973 to 1989. Eleven (55%) patients had hypertension. Upper or lower extremity ischemia was present in 12 (60%) patients and cerebrovascular insufficiency in seven (35%). Nine patients initially managed with corticosteroids had no improvement in signs or symptoms of arterial insufficiency. Eleven patients had 16 vascular procedures for the following indications: renovascular hypertension (6), extremity ischemia (5), cerebrovascular insufficiency (2), dilation ascending aorta with aortic insufficiency (1), thoracic aortic aneurysm (1), abdominal aortic aneurysm (1). Procedures included aortorenal bypass (5), carotid-subclavian, axillary, or brachial bypass (4), aorto-carotid bypass (2), aneurysm resection (2), supra-celiac aorto-femoral bypass (1), ascending aorta/aortic valve replacement (1), and nephrectomy (1). Clinical improvement occurred in all patients. There were no operative deaths. All are alive at a mean follow-up of 5.75 years (6 months to 16 years). Revision of the initial reconstruction has been required for recurrent renovascular hypertension in one patient and extremity ischemia in another. The other nine patients remain symptomatically improved. Symptomatic Takayasu's arteritis frequently requires arterial reconstruction. Symptomatic improvement and excellent long-term graft patency can be expected after arterial reconstruction.
Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery Sjöström L, Lindroos A-K, Peltonen M, and The Swedish Obese Subjects Study Scientific Group. N Engl J Med 2004;351:2683-93.
Conclusion:Bariatric surgery, when compared with conventional obesity therapy, provides better long-term weight loss, improved lifestyle, and amelioration of cardiovascular risk factors, with the exception of hypercholesterolemia.Summary: The Swedish Obese Subjects Study is a prospective investigation involving obese subjects who underwent bariatric surgery or conventional treatment for obesity. This report documents follow-up data for subjects (mean age, 48 years; mean body mass index, 41 kg/m 2 ) who were enrolled in the study for at least 2 years (4047 subjects) or 10 years (1703 subjects). The follow-up rate for laboratory examinations was 86.6% at 2 years and 74.5% at 10 years.After 2 years of follow-up, weight increased 0.1% in the control group and decreased 23.4% in the surgery group (P Ͻ .001). After 10 years, weight had increased by 1.6% in the control group and had decreased by 16.1% in the surgery group (P Ͻ .001). There were proportionally more physically active subjects in the surgery group than in the control group throughout the observation period. Two-to 10-year recovery rates from hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, diabetes, hypertension, and hyperuricemia were more favorable in the surgery than the control group. There were no differences in recovery from hypercholesterolemia in the control and surgery groups. The surgery group had lower 2-and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group. There were no differences between the groups in the incidence of hypercholesterolemia and hypertension.Comment: This was not a randomized study. The data, however, strongly implicate bariatric surgery as an effective means of improving cardiovascular risk factors in the morbidly obese. The study does not tell us whether progression of established vascular disease in the morbidly obese can be slowed by bariatric surgery. We are not currently at the point where we can recommend bariatric surgery as a treatment to slow progression of peripheral vascular disease. However, in patients with established cardiovascular risk factors who are morbidly obese, bariatric surgery can be recommended to diminish these risk factors and improve lifestyle.
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