Disease Activity in Takayasu’s Arteritis Affects Long Term Graft Related Outcomes
Anthony H. Chau, M.D., Victor J. Davila, M.D., William W. Sheaffer, M.D., William M. Stone, M.D., Richard J. Fowl, M.D., Thomas C. Bower, M.D., Samuel R. Money, M.D..
Mayo Clinic Arizona, Phoenix, AZ, USA.
OBJECTIVES: Takayasu’s arteritis (TA) is a rare inflammatory large vessel vasculitis of unknown etiology which occasionally requires surgical intervention. There is a paucity of published data on the long term outcomes of surgical intervention in these patients, with or without active disease.
METHODS: A retrospective review was conducted of patients with TA who underwent open, non-cardiac vascular surgery at our institution in three geographic locations between 1994 and 2017. Basic demographics, diagnostic workup, treatment and outcomes were reviewed. Active disease was defined by National Institute of Heath and Mayo Clinic criteria.
RESULTS: Between 1994 and 2017, 51 patients with TA underwent open, non-cardiac vascular surgery. Forty four patients (86%) were female with a mean age of 38 years (range, 10-72 years). At the time of surgery, 36 patients (77%) were on steroids, with 23 patients (49%) taking an additional immunosuppressant. Twenty patients (42%) had required prior vascular surgical intervention. Six patients (13%) had an additional autoimmune disorder diagnosis. The most common location for disease was the aorta (86%), with the subclavian (80%), carotid (69%), innominate (41%), and renal (33%) arterial lesions also seen. Vascular reconstruction was performed on 82 arterial lesions. The most common location for reconstruction was the carotid artery (28%), followed by the subclavian (22%), aorta (15%), and renal artery (11%). Mean follow up was 74 months (range, 1-265 months). Early complications (< 30 days) occurred in 14 patients (31%). Late complications (> 30 days) occurred in 22 patients (49%). There were 2 perioperative mortalities (4%). Eighteen patients (40%) required endovascular and/or surgical re-intervention. The primary and primary assisted graft patency rates were 72% and 89% respectively. Seventeen patients (35%) had active disease at the time of surgery and 3 (18%) of these patients developed graft occlusion and underwent revision. Six patients (35%) with active disease required 8 additional graft related re-interventions. Thirty-one patients (65%) had quiescent disease with 3 (10%) patients occluding their reconstruction in follow-up. Four patients (13%) with quiescent disease required 4 additional graft related re-interventions. Incidence of graft related re-interventions was higher in patients with active disease (p=0.0497).
The outcome of the intervention appears be related to the presence of active disease. Patients with active disease had worse graft related outcomes compared to patients with quiescent disease.
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