Outcomes of surgery for patients with Behcet's disease causing aortic pseudoaneurysm: a shift from open surgery to endovascular repair

Abstract

OBJECTIVES:Behcet’s disease is a form of systematic vasculitis that affects vessels of various sizes. Aortic pseudoaneurysm is one of the most important causes of death among patients with Behcet’s disease due to its high risk of rupture and associated mortality. Our study aimed to investigate the outcomes of Behcet’s disease patients with aortic pseudoaneurysms undergoing open surgery and endovascular aortic repair.METHODS:From January 2003 to September 2014, ten consecutive patients undergoing surgery for aortic pseudoaneurysm met the diagnostic criteria for Behcet’s disease. Endovascular repair was the preferred modality and open surgery was performed as an alternative. Systemic immunosuppressive medication was administered after Behcet’s disease was definitively diagnosed.RESULTS:Eight patients initially underwent endovascular repair and two patients initially underwent open surgery. The overall success rate was 90% and the only failed case involved the use of the chimney technique to reach a suprarenal location. The median follow-up duration was 23 months. There were 7 recurrences in 5 patients. The median interval between operation and recurrence was 13 months. No significant risk factors for recurrence were identified, but a difference in recurrence between treatment and non-treatment with preoperative immunosuppressive medication preoperatively was notable. Four aneurysm-related deaths occurred within the follow-up period. The overall 1-year, 3-year and 5-year survival rates were 80%, 64% and 48%, respectively.CONCLUSIONS:Both open surgery and endovascular repair are safe and effective for treating aortic pseudoaneurysm in Behcet’s disease patients. The results from our retrospective study indicated that immunosuppressive medication was essential to defer the occurrence and development of recurrent aneurysms.

Ruptured Suprarenal Abdominal Aortic Pseudoaneurysm with Superior Mesenteric and Celiac Arteries Occlusion, Revealing Behçet's Disease: A Case Report

“…Its advantages are lesser operating time and blood loss, shorter hospital stay, and avoidance of late complications such as recurrence and anastomotic disruption. The literature reports that the success rate of endovascular treatment ranges from 80% to 90%, although there is no clinical evidence suggesting that the endovascular option results in better prognosis for patients with BD with pseudoaneurysms [16,17]. Nevertheless, the endovascular approach was not the best choice in this case because the ruptured false aneurysm involved the visceral segment of the abdominal aorta.…”

Multiple Recurrent Pseudoaneurysms after Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Behçet’s Disease

“…We found six previously reported cases of a recurrent pseudoaneurysm at the proximal margin of an infrarenal stent graft in BD patients. Among them, two patients underwent open surgical repair, 6,7) one patient received careful follow-up observation without additional intervention, 8) and three patients died due to rupture of the pseudoaneurysm. 5,8,9) Although the technique was an off-label use of existing devices, we achieved good results with endovascular repair using the chimney technique in the present patient.…”

Incomplete intestinal obstruction as the possible main complaint in Behcet’s disease after surgery for recurrent abdominal aortic pseudoaneurysms: a case report and literature review

“…Surgical repair is the standard treatment for aneurysms with dilatation, stenosis, or obstruction, while alternative treatments involve minimally invasive endovascular therapy for aneurysm repair [22, 24, 25]. Shen et al reported that both open surgery and endovascular repair were safe and effective for treating aortic pseudoaneurysm in BD [26]. Furthermore, Naganuma et al reported that ulcer lesions in the ileum and colon, which could lead to intestinal obstruction, were found in surgical patients with intestinal BD [27].…”