Percutaneous Management of Occlusive Arterial Disease Associated with Vasculitis: A Single Center Experience

Abstract

The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients (10 women, 1 man; ages 35-82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis (n = 8) and Takayasu arteritis (n = 3). Thirty-three occlusive lesions (including brachiocephalic and renal arteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound. Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses (n = 8) and re-restenoses (n = 1) occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low.

Stent-supported recanalization of supra-aortic vessels in takayasu arteritis—A case report

“…One more important clinical aspect must be taken into account in the endovascular treatment of TA compared with classical atherosclerotic involvment: We are dealing with a chronic and progressive inflammatory disease, with different phases of activity. In previous reports endovascular treatment was deferred until systemic indexes of activity normalized [4] and it was accompanied by administration of prednisone or by changes in corticosteroid dosing according to the clinical status of the patient [3]. The influence of active inflammation of the vessel wall on the incidence of subacute thrombosis of the stent, on the restenosis rate, on the incidence of aneurysm at its edges, and on the long-term patency of the endovascular prosthesis is not extensively known and must be thoroughly considered in the regular followup of the patient.…”

“…One of these, Takayasu arteritis, is easily recognizable because of the involvement of vascular areas that are clinically or noninvasively easy to evaluate, such as the carotid and upper-limb arteries. Nevertheless, reports of interventional treatment of this disease are still quite scarce and treatment is performed almost exclusively in Oriental countries except for a small series of 11 patients managed successfully in Germany [4]. While the rate of immediate success, acute complications, and long-term efficacy of percutaneous transluminal dilatation in classic atherosclerotic lesions are well known in both the coronary and the peripheral circulations, the data on transluminal dilatation of stenosis due to inflammatory vascular disease are less clear.…”

Cutaneous migration of the StarClose® device

“…However, vasculitis is not a declared contraindication for application of the StarClose 1 vascular closing system. Only few report of percutaneous management of occlusive arterial disease in patients with vasculitis exist, and a tendency to vascular rupture or dissection after PTA has been described [8].…”

Bildgebende Verfahren in der Rheumatologie: Bildgebung bei Vaskulitiden

“…Sowohl die Aorta als auch sehr kleine Gefäße können abgebildet werden. Die Angiographie bietet einen guten Überblick und ermöglicht zeitgleich aortale Druckmessung sowie therapeutische Interventionen [8,9] [58]. CT und CTA haben ähnliche Eigenschaften wie MRT und MRA.…”