Vascular surgery: the main risk factor for mortality in 146 Takayasu arteritis patients

Abstract

Takayasu arteritis (TA) is an idiopathic chronic inflammatory disease that affects the aorta and its main branches. According to disease involvement, patients may require surgical treatment mainly due ischemic lesions in association with medical therapy. We evaluated the impact of vascular interventions in a cohort of TA patients. Medical records from 146 TA patients were reviewed. Clinical features, medical, and surgical treatment were revised and disease activity was determined by clinical, laboratorial, and imaging parameters. Clinical parameters associated with mortality alongside vascular procedures were evaluated and their impact on mortality in our cohort was estimated. Ninety-four vascular interventions were performed in 61 patients (41.8%). A third of them were of endovascular procedures. The overall mortality was 4.1%, all due to early postoperative complications, which resulted in a rate of surgery-related mortality of 9.8%. All deaths occurred in patients with active disease. Clinical parameters known to be associated with mortality (aneurysm, secondary hypertension, aortic insufficiency, and cerebrovascular accident) were not found related with death. Patients whose disease began before age 20 years had an OR 3.54 of undergoing a vascular surgical intervention. The observed impact of vascular procedures on mortality in patients with Takayasu arteritis, especially during disease activity, supports the notion that such interventions should be performed with caution and preferably during periods of remission.

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

“…Undertaking surgical interventions in patients with active disease is associated with an increased risk of complications and lower patency rates 129–132. Procedures should preferably be performed only during stable control of inflammation, except for emergency indications such as critical ischaemia, neurological complications such as stroke or aneurysm dissection.…”

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

“…Evidence from other retrospective cohorts (LoE 4) combining surgery for stenotic and/or aneurysmal complications in TAK supports the need to control inflammation and disease activity before and after the surgical intervention to prevent complications and ensure a good long-term outcome. Recurrent late aneurysmal dilatation is frequently reported in aortic surgery 111 113–126…”

S2k-Leitlinie: Management der Großgefäßvaskulitiden

“…Es wurde gezeigt, dass bei chirurgischen oder endovaskulären Interventionen bei TAK die Rate an Komplikationen (z. B. Restenose, Notwendigkeit einer Reintervention, Thrombose, Ausbildung neuer stenotischer Läsionen an anderer Stelle, Tod) erhöht ist, wenn diese bei aktiv entzündlicher Erkrankung durchgeführt werden [79,95,143,222,223]. Durch die Kombination mit einer immunsuppressiven Therapie lässtsichdie langfristige Durchgängigkeit der behandelten Gefäße verbessern [29,69,134,148,158,177].…”