Long-Term Survival After Surgical Treatment of Patients With Takayasu’s Arteritis

Abstract

Background— Surgical interventions have been performed to ameliorate the complications of Takayasu’s arteritis. However, the efficacy of surgery to increase long-term survival has not been established. Methods and Results— A retrospective review was performed on the survival of 106 consecutive patients with Takayasu’s arteritis who underwent surgical treatment during the past 40 years. Their ages ranged from 5 to 69 years (mean±SEM, 31.7±1.3 years). Survival was compared with the reported results of medically treated patients according to Ishikawa’s prognostic classification. There were 12 hospital deaths, and the remaining 94 patients were followed up from 8 months to 41.8 years (mean, 19.8 years). A serious long-term complication was anastomotic aneurysm, with a cumulative incidence at 20 years of 13.8%. Thirty-one late deaths were observed, and the major cause was congestive heart failure. The overall cumulative survival rate at 20 years was 73.5%. The prognostic classification by Ishikawa had little influence on the survival of surgically treated patients. For stage 3 patients, surgery seemed to increase survival; however, surgery-related complications conversely decreased the survival of stage 1 patients. Conclusions— Surgery seems to increase the long-term survival of patients with stage 3 Takayasu’s arteritis, whereas conservative treatment is recommended for those with stage 1 or 2 disease. An anastomotic aneurysm may occur at any time after surgery, and regular follow-up using imaging modalities such as multi-detector CT, MRI, or ultrasonography at least once every several years for the rest of the patient’s life is mandatory for the early detection of anastomotic aneurysm.

Tratamento de estenose de tronco de coronária esquerda na arterite de Takayasu

“…Entretanto, lesões em subclávias, inflamação ativa ou severa calcificação da aorta tornam o procedimento difícil (10,11) . Estenoses ou oclusões nas artérias subclávias limitam a utilização da artéria torácica interna como enxerto coronário.…”

“…Além disso, a inflamação crônica e as calcificações na aorta ascendente requerem artifícios técnicos para anastomoses proximais que devem ser realizados amplamente e apoiados em enxertos de veia ou pericárdio bovino. Aneurisma no local das anastomoses proximais é comum e devem ser acompanhados anualmente, por meio de métodos de imagem (11,12) .…”

“…Deve-se realizar o seguimento pós-operatório tardio da RM nos pacientes com arterite de Takayasu com o objetivo de identificar sinais sugestivos de nova estenose e acompanhar a evolução desses pacientes no longo prazo (11) . As descrições cirúrgicas disponíveis na literatura incluem poucos casos em acompanhamento, já que a taxa de sobrevida da doença de Takayasu é variável, dependente do grau de acometimento arterial e atividade inflamatória da doença (5,11) .…”

“…As descrições cirúrgicas disponíveis na literatura incluem poucos casos em acompanhamento, já que a taxa de sobrevida da doença de Takayasu é variável, dependente do grau de acometimento arterial e atividade inflamatória da doença (5,11) . A abordagem percutânea pode ser indicada como opção terapêutica inicial ou como ponte para a cirurgia.…”

Takayasu Arteritis: Consideration of Pulmonary Involvement

“…In particular, the former group has accomplished fruitful results in regard to the surgical treatment of this interesting lesion. [8][9][10] It is well known that adolescent girls and middle-aged women in the second to fourth decades of life are highly affected by this disease. The basic pathology involves medium and large elastic arteries in a pan-arterial inflammatory process that causes marked thickening of the arterial wall of the diseased segment.…”