Clinical Scenario and Long‐Term Outcome of Childhood Takayasu Arteritis Undergoing 121 Endovascular Interventions: A Large Cohort Over a Fifteen‐Year Period

Abstract

Objective Evidence‐based studies on endovascular approaches for childhood Takayasu arteritis (TAK) are limited. Our objective was to present the largest current real‐world scenario for patients with childhood TAK undergoing interventions and their postinterventional outcomes. Methods Data were collected for patients with childhood TAK admitted from 2002 to 2017. Complication/reintervention‐free survival was projected by Kaplan‐Meier methods. Associated factors for intervention and predictors for postinterventional complications/reinterventions were assessed via regression models. Results Among 101 patients enrolled, 69 (68.3%) underwent 121 interventions (angioplasty 95, stenting 26) during a 3.1‐year follow‐up. Compared with the nonintervention group, the intervention group independently associated with a male population (odds ratio [OR] 0.27, P = 0.035) and type IV disease (OR 17.92, P = 0.001). Male sex also marginally indicated a risk for reintervention (hazard ratio [HR] 3.22, P = 0.05). Baseline retinopathy, delay in diagnosis, and descending thoracic aorta involvement were associated with stent insertion (P < 0.05). Hypertension secondary to renal artery stenosis (RAS; 59.4%) or mid‐aorta stenosis (MAS; 14.5%), heart failure (21.7%), and claudication (21.7%) were leading clinical hints for interventions. The technical success rate was 96.7%. During a median 2.88‐year of follow‐up after intervention, 36 lesions occurred with complications in 28 patients, and 22 lesions in 17 patients, particularly on the renal artery or mid‐aorta. The 5‐year complication‐free and reintervention‐free survivals were 50.7% and 65.8%, respectively. Peri‐interventional dual antiplatelet therapy (DAPT; HR 0.31), concurrent surgery (HR 26.5), and technical failure (HR 3.65) were independent predictors for complications (P < 0.05). Male sex (HR 2.52), retinopathy secondary to hypertension (HR 3.41), and pulmonary artery hypertension (PAH; HR 3.64) were baseline indicators for complications (P < 0.05). Conclusion Over two‐thirds of patients with childhood TAK require interventions, and the 5‐year complication‐free survival is 50.7%. Male sex, retinopathy, and PAH at baseline indicate the possibility of unfavorable outcomes. Interventions on MAS or RAS in childhood TAK raise specific concerns. DAPT peri‐intervention appears to protect patients with childhood TAK from postinterventional complications.

Percutaneous transluminal pulmonary angioplasty for Takayasu arteritis‐associated pulmonary hypertension: A single‐arm meta‐analysis

“…The full-text of six potentially eligible papers was reviewed. One study 20 was eliminated because of the unavailability of study data; ultimately, five observational studies 10,11,15,21,22 that fulfilled the predefined inclusion criteria were analyzed. The flowchart of the study selection process is shown in Figure 1.…”

The effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis patients

“…В последнее десятилетие ХХ века в Российской Федерации диагноз АТ ставился в среднем через 5 лет после появления первых симптомов -как правило, уже на этапе необратимых изменений артерий, ассоциированных с высоким риском развития сосудистых осложнений и ухудшением прогноза [25,26]. Ретинопатия, задержка постановки диагноза и поражение нисходящей грудной аорты были ассоциированы с более частой имплантацией стентов (p<0,05) у пациентов с АТ [27]. Задержка в постановке диагноза более 12 месяцев ассоциировалась с более частым проведением различных хирургических вмешательств, включая ангиопластику [28].…”

Operative experience on descending aorta with Takayasu Arteritis: a review

“…It has been established that graft-related complications, including restenosis and anastomotic aneurysms, are the most common complications after surgery ( 88 ). Other study also proposed that peri-interventional dual antiplatelet therapy, concurrent surgery, and technical failure were predictors for complications ( P < 0.05) ( 20 ).…”

“…Consistently, our prior retrospective study, which examined 116 TA patients who received surgery or endovascular interventions (such as PTA and stent-graft repair), revealed that both surgical approaches were effective and safe. However, open surgical repair was found to be more suitable for complex lesions due to its longer durability (19). Moreover, other factors are related to restenoses, such as hypertension (P = 0.01), dyslipidemia (P = 0.01), and high-dose steroids (P = 0.012) (6).…”