Factors Associated With Need for Revascularisation in Non-coronary Arterial Occlusive Lesions Secondary to Takayasu's Arteritis

Hinojosa, Carlos A.; Anaya‐Ayala, Javier E.; Gómez-Arcive, Zeniff; Laparra-Escareño, Hugo; Torres-Machorro, Adriana; Lizola, Rene

doi:10.1016/j.ejvs.2017.05.020

Cited by 7 publications

(16 citation statements)

References 25 publications

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“…Evidence supporting the surgical management of arterial stenosis in TAK arises from several retrospective case series (LoE 4), with variable baseline characteristics of the patients included, different involved vascular sites and variable concomitant medical treatment 76–108. Indications for referral, when specified, mainly comprised symptomatic arterial stenosis (eg, renovascular uncontrolled hypertension, transient ischaemic attack, limb claudication, syncope, vertigo, angina).…”

Section: Resultsmentioning

confidence: 99%

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

et al. 2019

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ObjectiveTo collect available evidence on management of large vessel vasculitis to inform the 2018 update of the EULAR management recommendations.MethodsTwo independent systematic literature reviews were performed, one on diagnosis and monitoring and the other on drugs and surgical treatments. Using a predefined PICO (population, intervention, comparator and outcome) strategy, Medline, Embase and Cochrane databases were accessed. Eligible papers were reviewed and results condensed into a summary of findings table. This paper reports the main results for Takayasu arteritis (TAK).ResultsA total of 287 articles were selected. Relevant heterogeneity precluded meta-analysis. Males appear to have more complications than females. The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. Evidence for details on the best disease monitoring scheme was not found. High-quality evidence to guide the treatment of TAK was not found. Glucocorticoids are widely accepted as first-line treatment. Conventional immunosuppressive drugs and tumour necrosis factor inhibitors were beneficial in case series and uncontrolled studies. Tocilizumab failed the primary endpoint (time to relapse) in a randomised controlled clinical trial; however, results still favoured tocilizumab over placebo. Vascular procedures may be required, and outcome is better when performed during inactive disease.ConclusionsEvidence to guide monitoring and treatment of patients with TAK is predominantly derived from observational studies with low level of evidence. Therefore, higher-quality studies are needed in the future.

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Section: Resultsmentioning

confidence: 99%

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

et al. 2019

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“…Of note, rates of revision at 5 and 10 years post-procedure were zero in patients with quiescent disease not requiring steroids; 5% at 5 years and 19% at 10 years in those with quiescent disease on maintenance steroids; 43% at both 5 and 10 years in patients with evidence for active disease for which they were currently receiving steroids, and finally 67% at both 5 and 10 years in those with active disease not prescribed steroids (20). Recent data support these findings and highlight the association between cardiovascular risk factors and a current smoking history and higher restenosis rates (13,34,35). In addition to effective pre-operative treatment, our practice is to continue this during surgery and in the peri-operative period.…”

Section: Pre-surgery Assessment and Peri-operative Medical Therapymentioning

confidence: 91%

Surgical intervention and its role in Takayasu arteritis

Mason

2018

Best Practice & Research Clinical Rheumatology

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Vascular surgery remains an important option in the management of Takayasu arteritis. Its use is predominantly confined the treatment of symptomatic organ ischaemia or life-threatening aneurysm formation. In most cases this follows the failure of medical therapy to prevent arterial injury. Open surgery and endovascular approaches are used. The choice between them, at least in part, is determined by the site and nature of the lesion. Although more invasive, open surgery offers enhanced duration of arterial patency. For endovascular intervention, primary angioplasty without stenting is preferred, with stenting reserved for primary or secondary angioplasty failures. Although there is increasing interest in the role of stent grafts and tailor-made endovascular stents, long-term outcomes remain to be reported. Interventional outcomes are improved and complications reduced by therapeutic control of disease activity pre-and post-surgery. The wider use of combined immunosuppression and the introduction of biologic therapy for refractory Takayasu arteritis may reduce future requirements for surgical intervention.

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“…Rauchen scheint mit einem erhöhten Risiko für die Entwicklung von Steno-sen großer Gefäße bei RZA und TAK assoziiert zu sein [108,131].…”

Section: Versorgung Vaskulärer Komplikationenunclassified

“…Durch die Kombination mit einer immunsuppressiven Therapie lässtsichdie langfristige Durchgängigkeit der behandelten Gefäße verbessern [29,69,134,148,158,177]. Schwerwiegende akute Durchblutungsstörungen (Aortendissektion, Schlaganfall, akutes Koronarsyndrom) können jedoch Notfalleingriffe auch im floriden Stadium der GGV erforderlich machen [29,108,134,148,204].…”

Section: Versorgung Vaskulärer Komplikationenunclassified